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PubMed2000

Physician/patient rapport concerns administrators.

An ED staffing survey of 588 hospital administrators revealed widespread concerns about the quality of care in the ED and identified trends in staffing and operations. 40% of respondents reported concerns regarding physicians' rapport with patients. One in 10 administrators surveyed said they would not choose to go to their hospital's ED for treatment if they were seriously injured, and 20% indicated concerns about professional competence in the ED. Respondents indicated that more than 80% of ED physicians are involved in medical leadership of the hospital.

Attitude of Health Personnel↗
PubMed2000

Career management, not transition.

Managing your career means more than just changing jobs. It's a process that you can plan and control. Find out the steps to shaping your professional future in this article.

Career Choice↗
PubMed2000

Physician/patient rapport concerns administrators.

In a recent survey of hospital emergency department (ED) administrators, 40% of respondents reported concerns regarding physicians' rapport with patients. ED administrators also indicated they were concerned about the quality of care given in the ED. More than 20% of respondents expressed concern about the professional competence, availability, and quality of care given in the ED. In fact, one in 10 administrators surveyed would choose an ED other than the one at their hospital if they were seriously hurt.

Emergency Service, Hospital↗
PubMed2001

Abortion, information & the law: what every doctor needs to know.

1. Before commencing any treatment, doctors must inform patients of all material risks of the treatment (Rogers v. Whitaker, 1992). 2. It is not up to the professional judgment of doctors to decide how much information to give to patients (Rogers v. Whitaker, 1992). 3. The same duty to inform applies to abortion ("Ellen's Case," 1998). 4. GPs and counsellors who refer for abortion also have a legal duty to inform women of risks, because everyone who gives specialized or professional advice may be sued for negligence if that advice is given without due care (Evatt's Care, 1969). 5. Doctors have been inadequately informed on the medical risks of abortion, by writers seeking to present abortion as a risk-free procedure. 6. Abortion may increase the risk of cancer. 7. Abortion carries risks of injury and illness. 8. Abortion caries risks of future reproduction. 9. Abortion may have adverse psychological and psychiatric sequelae. In some women, these sequelae are severe and intractable, and may occur irrespective of a woman's personal attitudes towards abortion (Melinda Tankard Reist, Giving Sorrow Words: Women's Stories of Grief After Abortion, Sydney, Duffy & Snellgrove, 2000). 10. Women still die in Australia from abortion. 11. It has not been proved that pregnancy and delivery are more dangerous than abortion. 12. The risks of mortality and morbidity in carrying a pregnancy to term are often exaggerated, in an effort to make abortion appear safer. 13. Doctors are not required to refer for abortion. On the other hand, doctors do have a duty to inform themselves of the professional competence of any practitioner to whom they refer any patient for any procedure. Doctors who are referring for abortion can avoid legal jeopardy by informing women fully of the risks, and by keeping very comprehensive records of the information they have given. Alternatively, doctors can avoid legal liability by declining to refer for abortion. There are compelling medical reasons for treating abortion as a social, non-therapeutic, potentially harmful procedure with which conscientious doctors would choose not to involve themselves.

Abortion, Legal↗
PubMedDate not supplied

[Evidence-based medicine: accurate review of the international literature].

The Authors emphasize the continual scientific technological advances of medical science, the appearance of new nosological extents and the increased health request by people. Physicians are called to up-to-date all the time to keep a high-level of professional competence also after the end of the university studies. Every medical staff can use EBM, setting aside all personal specialization and also with the limitations estimated in our research.

Evidence-Based Medicine↗
PubMed2001

A study of Maryland dental hygienists' perceptions regarding self-assessment.

PURPOSE: This research applied the Theory of Reasoned Action to study dental hygienists' perceptions about self-assessment (SA). This theory suggests that individuals are likely to exhibit a given behavior, i.e., self-assessment, when they view it positively and when they believe that important others think they should perform it. Using the Theory of Reasoned Action model, the study addressed the following research questions: What are dental hygienists' beliefs, attitudes, motivations, and intentions regarding SA? Respondents were asked if they actually self-assess when providing dental hygiene services and if they felt they had adequate time to do so. The study also examined correlations between socio-demographic variables (i.e., initial year of licensure, educational level, practice characteristics, and professional membership) and self-assessment intention and behavior. METHODS: A self-administered survey was mailed to 200 dental hygienists randomly selected from a list of all currently licensed dental hygienists in Maryland. Data analysis included descriptive statistics, correlations to predict intention and behavior, and analyses of differences related to socio-demographic variables. RESULTS: A total of 119 usable surveys were returned after one mailing, achieving a 59.5% response rate. The demographic data indicated that the respondents were a representative sample, with 66% holding associate degrees, 30% baccalaureate degrees, and 3% masters' degrees. Respondents' attitudes toward SA and intention to perform SA were strongly positive (X = 2.7, 2.6 respectively, on a Likert Scale ranging from -3 to +3) and, as the Theory of Reasoned Action suggests, attitude was strongly associated with intention (r = .6673). However, in contrast to the Theory, intention was weakly associated with behavior (r = .3721). Only one socio-demographic variable correlated with SA intention or self-reported behavior. Subjects who worked 20 hours per week or more were significantly more likely to self-assess when providing dental hygiene care than those who worked less than 20 hours per week (p < .01, .0089). A majority of respondents (76%) reported that they consistently perform SA and felt they had adequate time to do so. Respondents seemed to be motivated by perceived benefits of SA rather than by social pressure to perform it. CONCLUSION: Dental hygienists in this study appear to value self-assessment, use it when they provide patient care, and believe they have the time to do it. The extent and scope of their SA behaviors were not investigated. As SA is an integral component of quality assurance, application of well-developed self-assessment strategies in both educational and practice settings may benefit both dental hygienists and the public they serve.

Attitude of Health Personnel↗
PubMed2001

The views of Otago urban and rural general practitioners on mental health services.

AIM: To examine the views of Otago general practitioners (GPs) about local mental health services and their role in providing such health care. METHODS: A questionnaire was distributed to all GPs working in Otago. RESULTS: 100 replies (59%) were received. There were large differences between GPs in the estimated numbers of patients with psychiatric conditions they were seeing. 85% were keen on sharing management of patients with mental health services. Average confidence levels for diagnosis and management of depression and anxiety were good. GPs felt less confident about psychosis, somatisation, eating and personality disorders. Obstacles to GPs doing more mental health work included time, cost, access to specialist services and training. On balance, GPs viewed the present mental health services as adequate. CONCLUSIONS: GPs appeared prepared to do more mental health work if the barriers of cost and time could be overcome and they were provided with adequate education and backup from specialised services.

Attitude of Health Personnel↗
PubMed2001

The relationship of education and moral reasoning to ethical practice: a meta-analysis of quantitative studies.

This meta-analytic article of quantitative studies is aimed at summarizing knowledge gained on ethical practice for the period of 1987 to 1997 and at suggesting directions for future research. It specifically investigated the relationships of education and moral reasoning to ethical practice, with ethical practice as the dependent variable. The sample consisted of eight studies that investigated the relationship between education and ethical practice, and five studies that addressed the relationship between moral reasoning and ethical practice. A small to medium relationship between education and ethical practice was found, with an overall mean for effect sizes, d = .44, p = .000. To test the relationship between moral reasoning and ethical practice the Pearson product moment coefficient r was used as the effect size estimate, as each of the studies in this group reported correlation analyses. A small but significant relationship was found between moral reasoning and ethical practice (overall r of .2, p = .000). These results are evaluated in comparison to those of a decade earlier and overall trends are identified. As before, the majority of the studies are in the form of dissertations, and few of their authors have published their work in the general scientific literature. Similarly, clarity has not yet been achieved with regard to the conceptual and operational definitions of ethical practice. Theoretical, measurement, and policy issues are discussed in highlighting the implications of the study.

Education, Nursing↗
PubMed1999

Publish or perish: the scientific publications of women physicians in late Imperial Russia.

Women physicians in late 19th century Russia emerge just as the Russian professions begin attempting to achieve some degree of autonomy from bureaucratic interference. Women took advantage of this discourse to portray themselves as competent professionals dedicated to bettering the lives of Russian people. Quite often these attempts to justify their work in the profession also motivated them to publish their scientific findings so that they could be viewed as legitimate scholars and physicians. This article concentrates on six women physicians, Elizabeth Drentel'n, Aleksandra Ekkert, Maria Pokrovskaia, Evgeniia Serebrennikova, Anna Shabanova, and Maria Volkova.

History, 19th Century↗
PubMed1991

Is health-care delivery by partially trained professionals ever morally justified?

...teaching institutions should establish policies for all aspects of care provided by residents-in-training (not just for the acquisition of informed consent to treatment) and establish mechanisms to monitor how these policies are implemented and their effect on the quality of patient care and patient satisfaction with care. Clear policy on which treatments are provided by junior residents and which treatments and aspects of care are provided by senior residents is necessary for patients and their families to have control over what happens to them in the health-care institution.... Teaching institutions should regularly assess whether residents are being asked to take on more responsibilities in patient care than they are prepared to do. The reasons to do this are not solely related to protecting the patient from harm. Protecting the residents-in-training from overwhelming guilt, fear, and providing them with a more humane approach to medical education should be a minimal expectation for the training of those who will be expected to provide humane care to others....

Altruism↗
PubMed1993

Prolegomena to any future code of ethics for bioethics.

If bioethicists, qua bioethicists, restrict themselves to the humble but honorable task of education and delimit their authority accordingly, they will be on solid ethical ground. Moreover, by adopting and professing this role, bioethicists should ensure that they will continue to be held in high regard by those who, suspicious of partisans and advocates, will turn to them for help, not for certainties and answers, to be sure, and certainly not for moral authority, but rather for a measure of clarity and distinctness in an increasingly complex world. What the bioethicist is rightfully authorized to do or say speaking-as-a-bioethicist is valuable enough and can make a difference.

Bioethics↗
PubMed1993

Constructiveness where it counts.

CONCLUSION: I hope that this response to Scofield's paper has accomplished two goals: 1) it helps put to rest unreal discussion of a "profession" of clinical ethics and 2) it helps to focus on the most important issues raised by Scofield upon which action can be taken. It is true that "ethics is everybody's business" and ethicists must restrain their bias when it comes to the decision-making process. But special knowledge and skills are required to nurture the elements of a clinical ethics program, to unite the efforts of its multitalented members, and to relate the literature of a rapidly growing activity in healthcare to practical projects. The issues raised in the constructive parts of Scofield's paper are an excellent point of departure for debate on how best to shape the education, training, and standards of practice for clinical ethics.

Bioethics↗
PubMed1993

Scofield as Socrates.

Well, as Socrates exclaimed, "By the dog, Gorgias, there will be a great deal of discussion before we get to the truth of all this." In the course of that discussion, we will find that Mr. Scofield does ask many very pertinent questions about the nature and teaching of ethics. Each question is worth examining in itself. But somewhere along the line, he has wandered into exaggerations, rhetoricities, and illogicisms that make it difficult to "get to the truth of all this." If we were being truly Socratic, I would test each assertion and allow him to respond in turn, and he could question me. In so doing, we might elucidate the ideas behind ethics consultation and evaluate its worth. We might then learn, as Socrates would have us learn, how much we do not know. We might also learn, as Socrates desired, how to pursue the elusive answers. Unfortunately, in this essay, Scofield fails as Socrates.

Decision Making↗
PubMed1993

Ethics consultation: a dangerous, antidemocratic charlatanry?

Giles Scofield's argument indicates ethics consultants may need to better clarify what in fact they are and what they are not doing, claiming, and striving for. But we must not step back too far. We must neither engage in putting in envious professional claims for exclusive rights in the area of difficult and momentous decisions in healthcare nor get stuck in discussing normative ethics at the level of metaphysics, ontology, and dogmatics (as has happened in Germany for decades). We must not do so especially in view of the achievements of ethics consultation and the growing demand for it by all parties involved, conceded even by sceptics. Ethics consultation, according to Scofield, appears to be dangerous....Let us look more closely at the logic of the argument by discussing the presumed "antidemocratic" nature. The "new tyranny" of thoughts, and the "proper" role of bioethics consultation. Some considerations about the possibility of ethics expertise shall be left for the end.

Decision Making↗