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PubMed2004

Patient and clinician satisfaction with a store-and-forward teledermatology consult system.

The aim of this study was to assess satisfaction with and acceptance of a store and forward teledermatology consult system among patients, referring primary-care clinicians, and consultant dermatologists. As part of a randomized clinical trial that compared the clinical and economic outcomes of store and forward teledermatology to a conventional referral process, we conducted satisfaction assessments among participating patients, referring primary-care clinicians, and consultant dermatologists. Survey questions included issues related to the timeliness of each consult process, the confidence participants displayed in each consult modality, and assessments of overall satisfaction and preferences. A majority of referring clinicians (92%) and dermatologist consultants (75%) reported overall satisfaction with the teledermatology consult process. Ninety-five percent of referring clinicians reported that teledermatology resulted in more timely referrals for their patients. This finding was validated by the observation that teledermatology patients reached a point of initial intervention significantly sooner than did patients in usual care (41 days versus 127 days, p = 0.0001). Teledermatology patients reported satisfaction with the outcome of their teledermatology consultation 82% of the time. However, patients did not express a clear preference for a consult method. A total of 41.5% of patients preferred teledermatology, 36.5% preferred usual care, and 22% were neutral. Our study showed a high level of satisfaction among all users of a store-and-forward teledermatology consult system, and, in some cases, our survey results could be validated with observed clinical outcomes.

Attitude of Health Personnel↗
PubMed1996

Quality assessment of skin biopsy specimens referred to anonymous consultants.

BACKGROUND AND DESIGN: Managed care organizations may direct dermatopathologic specimens to anonymous consultants. I hypothesized that the quality of the consultation decreases when there is no incentive for an anonymous consultant to actively pursue the dermatologist/consumer. Therefore, I examined 364 consecutive specimens that had been directed to anonymous consultants. The specimens were obtained from patients who consulted a university-based dermatology clinic or the office of a collaborating practitioner. The quality of consultation was evaluated in 5 areas: factual correctness, arguable differences in degree, evidence that the history had been read by the consultant, knowledge of dermatologic disease evident in the interpretative aspects of the report, and appropriate direct interaction with the referring physician when indicated. RESULTS: There was concordance between the interpretation by anonymous consultants and the findings of my review in 66.8% of cases that involved common dermatopathologic diagnoses. There were errors in fact in 26 cases (7.1%). There were examples of failure to correlate histologic findings with clinical history, apparent lack of understanding of dermatologic disease, and failure to resolve conflicts between the histologic pattern and the clinical information. CONCLUSIONS: I found a decrease in the quality of biopsy specimen interpretation received from anonymous consultants. Dermatologists need to maintain and/or upgrade their skills in dermatopathology to supervise the quality of interpretation obtained from anonymous consultants.

Biopsy↗
PubMed1998

The origin, content, and workload of e-mail consultations.

CONTEXT: Despite the common use of e-mail, little beyond anecdote or impressions has been published on patient-clinician e-mail consultation. OBJECTIVE: To report our experiences with free-of-charge e-mail consultations. DESIGN: Retrospective review of all e-mail consultation requests received between November 1, 1995, and June 31, 1998. SETTING AND PARTICIPANTS: Consecutive e-mail consultation requests sent to the Division of Pediatric Gastroenterology at the Children's Medical Center of the University of Virginia in Charlottesville. MAIN OUTCOME MEASURES: Number of consultation requests per month, time required to respond, who initiated the request and their geographic origin, and the kind of information requested in the consultation. RESULTS: During the 33-month period studied, we received 1239 requests, an average (SD) of 37.6 (15.9) each month. A total of 1001 consultation requests (81%) were initiated by parents, relatives, or guardians, 126 (10%) by physicians, and 112 (9%) by other health care professionals. Consultation requests were received from 39 states and 37 other countries. In 855 requests (69%), there was a specific question about the cause of a particular child's symptoms, diagnostic tests, and/or therapeutic interventions. In 112 (9%), the requester sought a second opinion about diagnosis or treatment for a particular child, and 272 consultations (22%) requested general information concerning a disorder, treatment, or medication without reference to a particular child. A total of 1078 requests (87%) were answered within 48 hours of the initial request. On average, reading and responding to each e-mail took slightly less than 4 minutes. CONCLUSION: E-mail provides a means for parents, guardians, and health care professionals to obtain patient and disease-specific information from selected medical consultants in a timely manner.

Communication↗
PubMed2004

Telephone consultation and triage: effects on health care use and patient satisfaction.

BACKGROUND: Telephone consultation is the process where calls are received, assessed and managed by giving advice or by referral to a more appropriate service. In recent years there has been a growth in telephone consultation developed, in part, as a response to increased demand for General Practitioner (GP) and Accident and Emergency (A&E) department care. OBJECTIVES: To assess the effects of telephone consultation on safety, service usage and patient satisfaction and to compare telephone consultation by different health care professionals. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials, the specialised register of the Cochrane Effective Practice and Organisation of Care (EPOC) group, Pubmed, EMBASE, CINAHL, SIGLE, and the National Research Register. We checked reference lists of identified studies and review articles and contacted experts in the field. The search was not restricted by language or publication status. SELECTION CRITERIA: Randomised controlled trials (RCTs), controlled studies, controlled before/after studies (CBAs) and interrupted time series (ITSs) of telephone consultation or triage in a general health care setting. Disease specific phone lines were excluded. DATA COLLECTION AND ANALYSIS: Two reviewers independently screened studies for inclusion in the review, extracted data and assessed study quality. Data were collected on adverse events, service usage, cost and patient satisfaction. Due to heterogeneity we did not pool studies in a meta-analysis and instead present a narrative summary of the findings. MAIN RESULTS: Nine studies met our inclusion criteria, five RCTs, one CCT and three ITSs. Six studies compared telephone consultation versus normal care; four by a doctor, one by a nurse and one by a clinic clerk. Three studies compared telephone consultation by different types of health care workers; two compared nurses with doctors and one compared health assistants with doctors or nurses. Three of five studies found a decrease in visits to GP's but two found a significant increase in return consultations. In general at least 50% of calls were handled by telephone advice alone. Seven studies looked at accident and emergency department visits, six showed no difference between the groups and one, of nurse telephone consultation, found an increase in visits. Two studies reported deaths and found no difference between nurse telephone triage and normal care. REVIEWERS' CONCLUSIONS: Telephone consultation appears to reduce the number of surgery contacts and out-of-hours visits by general practitioners. However, questions remain about its affect on service use and further rigorous evaluation is needed with emphasis on service use, safety, cost and patient satisfaction.

Emergency Service, Hospital↗
PubMed2007

The role of education in biostatistical consulting.

Medical students, residents, postdoctoral fellows, and faculty commonly consult with biostatistical experts about study design and data analysis when conducting clinical research. The role of biostatistical training during these consultations is examined, and characterizations of the connections between biostatistical consultation and education are reviewed. The presence and kinds of teaching efforts during biostatistical consults at four academic research institutions over various periods of time between 1999 and 2005 (237 consultations in total) were recorded and are described. By site, 67, 70, 78, and 100 per cent of the consulting sessions included biostatistical training, with an overall 78 per cent (95 per cent CI: 73-83 per cent) of consultations including an educational component when all consultations were combined. Training covered a wide range of biostatistical topics. Seventy-five per cent of the consultations with faculty (120/161), 79 per cent with fellows and residents (31/39), and 100 per cent with medical students (10/10) included some degree of instruction in study design or statistical analysis topics. Results show that both the need and the opportunity exist for specialized biostatistical instruction during one-on-one sessions between a consulting biostatistician and physicians, medical students, and research staff. Academic researchers are ideally positioned to absorb this kind of training when they initiate a request for assistance with their own research project.

Biometry↗
PubMed2006

Child care health consultation programs: barriers and recommendations.

OBJECTIVES: While many studies describe the need for health services in early care and education (ECE) settings and the role of child care health consultants (CCHCs), little information exists about the challenges to developing health consultation programs. The goal of this paper is to provide insight for the development of current and future child care health consultation programs by describing the barriers identified by CCHCs related to program implementation in 20 California counties. METHODS: Forty-four child care health consultants participated in nine focus groups during their health consultation training at the California Training Institute. Participants were asked to discuss the barriers they encountered while establishing new county-wide child care health consultation programs. Themes were assigned to each response, and frequency and percentage of each theme were documented and trends were identified. RESULTS: The four general themes describing barriers to program implementation were: Program Management, Child Care Culture, Geography and Community Services. Twenty additional sub-themes, including Multi-agency involvement, Chaos, Travel time, and Fragmentation, were assigned to each response. The most frequent general theme was Program Management. The most frequent sub-theme was Professional Support. CONCLUSIONS: The barriers identified by the child care health consultants can be valuable for administrators and clinicians establishing or developing child care health consultation programs. Program managers should be prepared for the unique challenges of child care health consultation and provide flexibility and support for child care health consultants.

California↗
PubMed1991

Management of patient-staff and intrastaff problems in psychiatric consultations.

Four possible types of management of patient-staff and/or intrastaff (PS/IS) problems in psychiatric consultations are distinguished and operationalized. The occurrence and correlates of these types of interventions were studied in a multisite investigation of 1112 consecutive consultations in five general hospitals. PS/IS problems (possibly, probably, or certainly) played a role in 28.1% of the consultations studied. The psychiatric consultants utilized a primarily patient-oriented approach in 56.7% of these 310 consultations, whereas in 42.3% they performed (covert or overt) staff-oriented case consultations. A staff-oriented approach may be contraindicated when the PS/IS problems are not very serious or too complex. In the literature staff resistance and hospital culture are frequently mentioned as obstacles to staff-oriented interventions. The present study showed, however, that it was often the consultants' own degree of security about the PS/IS problems that determined the way they handled these problems. Staff-oriented consultations took significantly more of the psychiatric consultants' time. The clinical and economic benefits of such interventions have still to be established. But the psychiatric consultant with a true biopsychosocial approach should always be cognizant of the possible occurrence of PS/IS problems and consider applying a staff-oriented intervention.

Humans↗
PubMed2002

Nephrology consultation in acute renal failure: does timing matter?

PURPOSE: Patients who develop acute renal failure in the intensive care unit (ICU) have extremely high rates of mortality and morbidity. The goals of this study were to identify correlates of the timing of nephrology consultation in acute renal failure, and to explore the relation between timing of consultation and outcomes. METHODS: We explored associations among timing of nephrology consultation and in-hospital mortality, lengths of hospital and ICU stay, and recovery of renal function in 215 ICU patients with acute renal failure at four U.S. teaching hospitals. We used multivariable logistic regression and propensity scores to adjust for confounding and selection effects. RESULTS: Nephrology consultation was delayed (>or=48 hours) in 61 patients (28%) (median time to consultation, 4 days). Lower serum creatinine levels (P <0.0001) and higher urine output (P = 0.002) were associated with delayed consultation. Delayed consultation was associated with increased mortality among dialyzed (31/42 [74%] vs. 50/103 [49%], P = 0.006) and nondialyzed patients (10/19 [53%] vs. 11/51 [22%], P = 0.01), and increases in lengths of hospital (median, 19 days vs. 16 days, P = 0.01) and ICU stay (17 days vs. 6 days, P <0.0001). The association between delayed consultation and mortality was attenuated by covariate adjustment, and was no longer statistically significant after adjustment for propensity score (odds ratio = 2.0; 95% confidence interval: 0.8 to 5.1). CONCLUSION: In acute renal failure, delayed nephrology consultation was associated with increased mortality and morbidity, whether or not dialysis was ultimately required. Using observational data, we cannot determine whether these findings reflect residual confounding, selection bias, adverse effects of delayed recognition of acute renal failure, or the benefits of nephrology consultation.

Acute Kidney Injury↗
PubMed1995

Impact of endocrine and diabetes team consultation on hospital length of stay for patients with diabetes.

PURPOSE: To determine whether consultation by an individual endocrinologist or by a multidisciplinary diabetes team (endocrinologist, diabetes nurse educator, and registered dietitian) can impact length of hospital stay of patients with diabetes. PATIENTS AND METHODS: Hospital stays of consecutive patients with a principal diagnosis of diabetes were compared. Forty-three patients were seen by an individual endocrine consultant and 27 were managed by the internist alone. Thirty-four patients were seen in consultation by the diabetes team. All consultations were performed at the request of the primary physician. There were no statistically significant differences among groups with respect to age, duration of diabetes, admitting diagnosis, glucose levels, or concomitant acute or chronic illness. RESULTS: Average length of stay of diabetes-team patients was 3.6 +/- 1.7 days, 56% shorter than the value, 8.2 +/- 6.2 days, of patients in the no-consultation group (P < 0.0001), and 35% shorter than the value, 5.5 +/- 3.4 days, of patients who received a traditional individual endocrine consultation (P < 0.05). The length of stay correlated with time from admission to consultation (regression equation: y = 3.92 + [1.09 x time to consultation]; r = .55; P < 0.0001). The slope (1.09) indicates that each 1-day delay in consultation resulted in a 1-day increase in length of stay. CONCLUSIONS: Length of stay was lowest in patients who received diabetes-team consultation. Three million Americans are hospitalized annually with diabetes at a cost of $65 billion. A team approach to their inpatient care may reduce their hospital stays, resulting in considerable health and economic benefits.

Adult↗
PubMed1998

Response of consultants to the emergency department: a preliminary report.

STUDY OBJECTIVE: To determine the timeliness of response of consultants called to evaluate patients in the emergency department of a community hospital. METHODS: Consultation requests from an ED located in a medium-sized community hospital were studied for a 1-month period. Data collected included name and specialty of the consultant, urgency of patients' conditions, times of pages, and times of consultants' responses and arrival in the ED. RESULTS: Two hundred forty-one consultations were requested and 199 data forms relating to 21 staff physicians were analyzed. Mean number of pages required to reach a consultant was 1.5+/-.4. Mean time from the first page to telephone response was 8+/-6 minutes and from first page to ED arrival was 42+/-23 minutes. Mean time from the first page to the consultant's arrival in the ED was significantly shorter for emergency (17+/-10 minutes) than for urgent or nonurgent patients (50+/-41 and 41+/-23 minutes, respectively). There were wide variations in individual patterns of response; the 7 fastest consultants had a mean first page to arrival time of 25+/-10 minutes, and for the slowest 5 consultants the time was 56+/-24 minutes. CONCLUSION: Response times of consultants to the ED vary depending on the urgency of the patient's condition and individual behavior patterns.

Emergency Medical Service Communication Systems↗
PubMed1989

The value to the anesthesia-surgical care team of the preoperative cardiac consultation.

A retrospective analysis of 202 consultations for preoperative cardiology evaluation was conducted. The most common problems generating the consultation were: (1) abnormal electrocardiogram, 45 patients; (2) chest pain, 36 patients; (3) history of myocardial infarction, 27 patients; (4) dysrhythmia, 25 patients; and (5) hypertension, 23 patients. The most common diagnoses by the consultants were: (1) arteriosclerotic heart disease, 46 patients; (2) angina, 20 patients; and (3) hypertension, 40 patients. Mitral valve prolapse was the most common valvular disease (18 patients). Of the consultation requests, 108 asked for an evaluation; 79 asked for a "clearance"; 9 did not specifically ask for anything; and 6 asked a highly specific question. Most consultations provided a diagnosis (96%), addressed the problem (80%), and provided logical recommendations (96%). A minority of the consultations "cleared" a patient (28%), provided for follow-up care (41%), or suggested intraoperative monitoring techniques (41%). Out of the 189 patients who eventually had surgery, 137 patients had no change in their preoperative therapy, while 52 patients had a change in preoperative therapy. There was no difference in the incidence of complications between these two groups. An important finding was that 15% of the study group (31 patients) had disease processes (hypertension and angina) that were newly diagnosed by the consultant or felt to be not adequately treated before the consultation. It is concluded that few requesting anesthesiologists and surgeons ask for clarification of a specific problem, while most responses from the cardiology consultants provided necessary information. In addition, the preoperative cardiac consultation was found to identify medical conditions requiring long-term care and follow-up.

Adolescent↗
PubMed2001

The design and evaluation of a simulated-patient teaching programme to develop the consultation skills of undergraduate pharmacy students.

OBJECTIVES: This study aimed to identify the key skills and knowledge required for the delivery of an ideal patient consultation in order to develop a training programme (using simulated-patients) to teach consultation skills to undergraduate pharmacy students. METHODS: Participants included all third year undergraduate Pharmacy students (MPharm, level III) at the School of Pharmacy & Biomolecular Sciences, University of Brighton (from October 1999 to March 2000). Working in groups of 12, students participated in two 4 hour seminars. A structured questionnaire was designed to assess students' perceptions of the difficulty of conducting a consultation and their confidence in delivering a structured consultation. MAIN OUTCOME MEASURES: Questionnaires were administered before and after delivery of the teaching programme to assess changes in students' confidence and ability to consult with patients. RESULTS: Twelve volunteers satisfied the criteria set to serve as simulated patients and then received appropriate training. Six scenarios were developed which focused on the key skills and knowledge identified from the adherence and consultation skills literature. A total of 91 students participated in the programme (mean age = 23 years, SD = 4.5). Following participation in the programme students' perceived 'confidence' for conducting an effective consultation significantly increased (t = -5.9, p < 0.01) while a statistically significant decrease was seen in students' perceived level of 'difficulty' when conducting a consultation (t = 4.0, p < 0.01). CONCLUSION: This study has shown that the use of a structured teaching programme improves students' perceptions of their ability and confidence in conducting an effective consultation. Providing skills training around the consultation process, using simulated patients, provides pharmacists with a good framework around which to practice pharmaceutical care.

Adult↗
PubMed2003

Informal consultations in infectious diseases and clinical microbiology practice.

Informed consultation between physicians is an important part of medical practice. The aim of the study was to evaluate the nature and frequency of such consultations in infectious diseases and clinical microbiology practice. This study was done in five university hospitals. Twenty-one infectious diseases and clinical microbiology specialists participated in informal ('curbside') consultations. In a written questionnaire, physicians were asked to report the number and nature of the informal consultations (ICs) they were asked to provide. A total three hundred and sixty-two such consultations were carried out during a three-month period. The ICs occurred most frequently in the hospital (82.3%). Most of the ICs from outside the hospital were by telephone. Most of the ICs (54.4%) were requested by fellows of specialists. 78.7% of the ICs were requested during working hours. 58.8% of consultations took less than 5 min, 18.8% took 6-10 min, 15.2% took 11-20 min, and 7.2% took over 20 min. The four most common reasons for obtaining ICs were to: help to select an appropriate treatment plan (41.4%), help to select an appropriate prophylaxis (19.3%), interpret laboratory data (10.2%), and provide information about antibiotics (10.2%). 30.1% of ICs resulted in subsequent formal consultation and only four patients (1.1%) were transferred to the consultants' clinics. Informal consultations are a frequent occurrence in the practice of infectious diseases and clinical microbiology (ID&CM). Physicians use this sort of consultation to select an appropriate treatment plan and obtain medical information. This study confirms the importance of the ID&CM specialists as a resource for medical personnel.

Communicable Diseases↗
PubMed1998

Medical consultation for migraine: results from the American Migraine Study.

BACKGROUND: Migraine headaches are often disabling but usually responsive to treatment. Nonetheless, many people with migraine never consult a doctor for headaches. In a sample of the US population, we sought to determine the proportion of active migraineurs who ever consulted a doctor for headache and to identify the headache characteristics and sociodemographic factors associated with consulting. METHOD: A mailed questionnaire survey was sent to 15,000 US households, selected from a panel to be representative of the US population. Of 20,468 eligible respondents ranging in age from 12 to 80 years, 2479 met a case definition for migraine. We mailed a second questionnaire to all migraineurs identified on the first survey and achieved a 69.4% response rate. The second survey assessed headache characteristics, patterns of medical care use, medication use, and method of payment for health care. RESULTS: Sixty-eight percent of female and 57% of male migraineurs reported having ever consulted a doctor for headache. Consultation was more likely with increasing age and in women who ever married. In females, several headache characteristics including pain intensity, number of migraine symptoms, attack duration, and disability were associated with consultation. Of those who never consult, 61% report severe or very severe pain and 67% report severe disability or the need for bed rest with their headaches. CONCLUSION: The results of this survey indicate that a significant proportion of migraine sufferers never consult doctors for their headaches. Given that a large proportion of persons who never consult report high levels of pain and disability, these data suggest that there are opportunities to appropriately increase health care utilization for migraine. Given that 40% of migraineurs who have ever consulted do not report a physician diagnosis of migraine, there is a need to improve headache diagnosis and/or doctor-patient communication about migraine.

Adolescent↗
PubMed2005

Trends in primary care consultations for asthma in Switzerland, 1989-2002.

BACKGROUND: There is widespread debate about trends in the occurrence of asthma in industrialized countries. This study was conducted to investigate time trends in consultations for asthma in primary care in Switzerland. METHODS: Prospective observational study from 1989 to 2002 within the Swiss Sentinel Surveillance Network; a primary care surveillance system. We used time series analysis and non-parametric smoothing methods to investigate long-term and short-term trends in rates of asthma episodes per 1000 consultations. From 1994 to 2002 we compared rates of first episodes with all subsequent consultations for asthma. RESULTS: Overall consultation rates for asthma per 1000 primary care consultations increased from 1989 to 1994 then stabilized and have declined since 2000. Long-term trends showed a small decline in first consultations for asthma from an average of 0.78 (95% credibility intervals (CI) 0.74-0.81) in 1999 to 0.62 (95% CI 0.55-0.69) per 1000 consultations in 2002. Subsequent consultations for asthma have been declining since at least 1994, from an average of 1.5 (95% CI 1.40-1.61) per 1000 consultations in 1994 to 0.93 (95% CI 0.82-1.04) in 2002. In addition, the ratio of subsequent to first episodes of asthma fell in all age groups. CONCLUSIONS: In Switzerland, primary care consultations for asthma, subsequent to the initial diagnosis, have been declining since 1994. This is more likely to be owing to an increase in the use of home medication than to a shift in care to hospital settings. The incidence of diagnosed asthma might also be decreasing.

Adolescent↗
PubMed2005

Residents' access to ethics consultations: knowledge, use, and perceptions.

PURPOSE: To examine residents' levels of awareness, use, and perceptions of the ethics consultation service at Loyola University Medical Center, a large Midwestern academic teaching hospital. METHOD: In 2001-2002, the authors conducted a cross-sectional survey and semistructured interviews about knowledge and use of the ethics consultation service among all 229 internal medicine, surgery, anesthesiology, pediatrics, and medicine-pediatrics residents. Chi-square and t tests were used to compare categorical and continuous variables. RESULTS: In all, 135 (59%) of the residents responded, and of these 22 (16%) completed an interview. Most survey respondents (76%) reported awareness of the ethics consultation service, although only 28 (21%) indicated they knew how to request one. Most respondents (89%) had never personally requested an ethics consultation. Thirteen residents (10%) had wanted to call an ethics consultation, but decided not to request one. Residents reported barriers to requesting an ethics consultation were the attending physician's opposition (46%), lack of awareness of the ethics consultation service (15%), and negative perceptions of ethics consultations (15%). CONCLUSION: Several barriers hindered residents' use of ethics consultation services. Health care institutions should systematically educate employees about the availability and use of ethics consultation services. Institutions should establish mechanisms to give health care professionals in subordinate roles within the medical hierarchy a safe way to access and use the service.

Adult↗
PubMed2000

Impact of ethics consultations in the intensive care setting: a randomized, controlled trial.

OBJECTIVE: To determine the following: a) whether ethics consultations in the intensive care setting reduce nonbeneficial treatments, defined as days in the intensive care unit (ICU) and treatments delivered to those patients who ultimately fail to survive to hospital discharge; and b) whether physicians, nurses, social workers, and patients/families agree that ethics consultations in the ICU are beneficial in addressing treatment conflicts. DESIGN: Prospective, randomized, controlled trial of ethics consultations. SETTING: Medical and pediatric ICUs in a university medical center. PATIENTS: Seventy-four patients in whom value-based treatment conflicts arose during the course of treatment. INTERVENTIONS: The patients were randomly assigned to an intervention (ethics consultation offered) or nonintervention (ethics consultation not offered) arm of the trial. MEASUREMENTS: Medical data and ICU hospital days were compared between the intervention and control groups before and after the randomization. Likert scale and commentary responses were recorded to structured and open-ended interviews with the responsible physicians, nurses, social workers, and families of patients assigned to the intervention arm within 1 month after the patient's death or hospital discharge. Interviewees were asked whether ethics consultations helped with the following: a) to identify ethical issues; b) to analyze ethical issues; c) to resolve ethical issues; d) to educate about ethical issues; and e) to present personal views. MAIN RESULTS: There were no differences in overall mortality between the control patients and patients receiving ethics consultations. However, ethics consultations were associated with reductions in ICU hospital days and life-sustaining treatments in those patients who ultimately failed to survive to discharge. Also, ethics consultations were regarded favorably by most participants. CONCLUSIONS: Ethics consultations seem to be useful in resolving conflicts that may be inappropriately prolonging futile or unwanted treatments and are perceived to be beneficial.

Attitude of Health Personnel↗
PubMed1987

Social Security disability determinations. Knowledge and attitudes of consultative physicians.

Social Security spends $135 million yearly, contracting with physicians to provide consultative examinations for disability applicants. However, little is known about who these physicians are or how they view the determination of impairment. We surveyed a random sample of 153 physicians from North Carolina who performed consultative examinations for the North Carolina Disability Determinations Agency in 1983 (the consultative group), and a randomly selected group of 165 physicians of similar medical specialties (the comparison group). Response rates were 75% for the consultative group and 66% for the comparison group. Most consultative physicians (63%) performed fewer than 6 examinations per month. Characteristics of the consultative physicians were similar to the comparison group. Both groups were skeptical of the claims of disability applicants; 48% of the consultative and 55% of the comparison group thought that a majority of applicants could be employed. Of the consultative physicians, 53% indicated that they had learned little about disability programs from any source. Most consultative physicians (58%) judged it "almost impossible" to determine impairment on the basis of a single office examination. However, consultative physicians were less likely than the comparison group to view Social Security as difficult to work with (25% vs. 54%; P less than 0.01). Agencies that determine disability ask physicians to perform a task for which they feel ill prepared and have little special knowledge.

Attitude of Health Personnel↗