Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Physicians”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 109 records · Page 6Linked to original sources
PubMed2001

Views of United States physicians and members of the American Medical Association House of Delegates on physician-assisted suicide.

OBJECTIVE: To ascertain the views of physicians and physician leaders toward the legalization of physician-assisted suicide. DESIGN: Confidential mail questionnaire. PARTICIPANTS: A nationwide random sample of physicians of all ages and specialties, and all members of the American Medical Association (AMA) House of Delegates as of April 1996. MEASUREMENTS: Demographic and practice characteristics and attitude toward legalization of physician-assisted suicide. MAIN RESULTS: Usable questionnaires were returned by 658 of 930 eligible physicians in the nationwide random sample (71%) and 315 of 390 eligible physicians in the House of Delegates (81%). In the nationwide random sample, 44.5% favored legalization (16.4% definitely and 28.1% probably), 33.9% opposed legalization (20.4% definitely and 13.5% probably), and 22% were unsure. Opposition to legalization was strongly associated with self-defined politically conservative beliefs, religious affiliation, and the importance of religion to the respondent (P <.001). Among members of the AMA House of Delegates, 23.5% favored legalization (7.3% definitely and 16.2% probably), 61.6% opposed legalization (43.5% definitely and 18.1% probably), and 15% were unsure; their views differed significantly from those of the nationwide random sample (P <.001). Given the choice, a majority of both groups would prefer no law at all, with physician-assisted suicide being neither legal nor illegal. CONCLUSIONS: Members of the AMA House of Delegates strongly oppose physician-assisted suicide, but rank-and-file physicians show no consensus either for or against its legalization. Although the debate is sometimes adversarial, most physicians in the United States are uncertain or endorse moderate views on assisted suicide.

Adult↗
PubMed1999

An intervention to increase patients' trust in their physicians. Stanford Trust Study Physician Group.

PURPOSE: To investigate the effect of a one-day workshop in which physicians were taught trust-building behaviors on their patients' levels of trust and on outcomes of care. METHOD: In 1994, the study recruited 20 community-based family physicians and enrolled 412 consecutive adult patients from those physicians' practices. Ten of the physicians (the intervention group) were randomly assigned to receive a one-day training course in building and maintaining patients' trust. Outcomes were patients' trust in their physicians, patients' and physicians' satisfaction with the office visit, continuity in the patient-physician relationship, patients' adherence to their treatment plans, and the numbers of diagnostic tests and referrals. RESULTS: Physicians and patients in the intervention and control groups were similar in demographic and other data. There was no significant difference in any outcome. Although their overall ratings were not statistically significantly different, the patients of physicians in the intervention group reported more positive physician behaviors than did the patients of physicians in the control group. CONCLUSIONS: The trust-building workshop had no measurable effect on patients' trust or on outcomes hypothesized to be related to trust.

Adult↗
PubMed2002

Assessing physicians' interpersonal skills: do patients and physicians see eye-to-eye?

OBJECTIVE: To determine the level of agreement between standardized patient ratings and resident physician self-ratings of physician interpersonal skills and the level of agreement between faculty observer and standardized patient ratings of resident physicians' interpersonal skills. DESIGN: Structured clinical evaluation. A total of 25 resident physicians in physical medicine and rehabilitation conducted a 10-min interview of a standardized patient to obtain a history. A resident physician, a standardized patient, and a faculty observer rated the resident physician's interpersonal skills immediately after the interview. The main outcome measure was a modification of the patient assessment measure from the American Board of Internal Medicine, a 9-item rating scale assessing communication (score range, 9-45). RESULTS: There was a low level of agreement between standardized patient ratings and the resident physicians' self-ratings of interpersonal skills (Lin's concordance coefficient, rc = 0.11, P = 0.58). Conversely, there was a statistically significant degree of agreement between the standardized patient and faculty observer ratings of resident physician interpersonal skills (rc = 0.50, P = 0.006). CONCLUSIONS: Some resident physicians have significant difficulty accurately assessing how well they communicate with patients. Physicians in training rarely get feedback regarding their interpersonal skills and may have difficulty using social comparison. Conversely, standardized patients and faculty observers may have insight into interpersonal skills about which resident physicians are unaware.

Communication↗
PubMed1996

Physician-run health plans and antitrust. American College of Physicians.

As the health care system changes and large managed care entities gain greater control in some markets, proponents of antitrust reform have expressed concern that physicians could lose their autonomy. To respond to this concern, the American College of Physicians has consistently argued that physicians should be allowed to establish their own health plans and networks to provide high-quality and cost-effective care. Moreover, the College has advocated utilization review reform and due process protections to empower physicians in their dealings with insurers. Under current antitrust law, as interpreted by the federal enforcement agencies, physicians already have the legal authority to form their own health plans and networks, and many state medical societies are sponsoring such plans. The law also allows physicians to operate the clinical components of a health plan, regardless of who owns it. Moreover, physicians can share information about quality, utilization, and, in some circumstances, fees. An examination of federal enforcement agency actions since the mid-1970s shows that physician networks have rarely been challenged. In light of market developments, however, the College has urged the federal antitrust agencies to analyze the effect of their current enforcement policies on physician activities and adopt a more flexible approach. Further monitoring and analysis of the changing health care marketplace are necessary to ensure that physicians are being treated fairly and to determine which factors spur or inhibit the development of physician-run health plans and networks.

Antitrust Laws↗
PubMed2003

Do osteopathic physicians differ in patient interaction from allopathic physicians? An empirically derived approach.

Colleges of osteopathic medicine teach osteopathic principles, which provide a different approach to and interaction with patients than principles taught in allopathic medical schools. The authors examined whether osteopathic primary care physicians' interactions with patients reflect the principles of osteopathic medicine when compared with allopathic physicians' interactions. The principles of osteopathic medicine were adapted to elements that could be measured from an audio recording. This 26-item index was refined with two focus groups of practicing osteopathic physicians. Fifty-four patient visits to 11 osteopathic and 7 allopathic primary care physicians in Maine for screening physicals, headache, low back pain, and hypertension were recorded on audiotape and were dual-abstracted. When the 26-item index of osteopathic principles was summed, the osteopathic physicians had consistently higher scores (11 vs. 6.9; P = .01) than allopathic physicians, and visit length was similar (22 minutes vs. 20 minutes, respectively). Twenty-three of the 26 items were used more commonly by the osteopathic physicians. Osteopathic physicians were more likely than allopathic physicians to use patients' first names; explain etiologic factors to patients; and discuss social, family, and emotional impact of illnesses. In this study, osteopathic physicians were easily distinguishable from allopathic physicians by their verbal interactions with patients. Future studies should replicate this finding as well as determine whether it correlates with patient outcomes and satisfaction.

Female↗
PubMed2007

Response of rural physicians in a non-fee-for-service environment to acute increases in demand due to physician shortages.

INTRODUCTION: The Weeneebayko Health Ahtuskaywin (WHA) is an Aboriginal regional health authority serving a large remote region on the west coast of James Bay. The physicians are all paid on a non-fee-for-service basis. There are periods of acute shortage, periods of relative stability and periods when much of the care is provided by locum physicians. As a closed system, it is ideal for the investigation of physician response to periods of acute increases in demand for service. PURPOSE: This study investigated the relationships between staffing levels and service provision to describe the response of physicians to increased demand due to an acute shortage of physicians. It also looked at whether payment options affected these relationships. METHODS: Using an existing administrative database from WHA for the period 1999 to 2002, relationships between staffing levels and service provision were investigated. We looked at the relationship between total physician levels and the number of patients seen per family medicine clinic. We also studied the relationships between total physician staffing levels and the number of patients seen in clinic, in the emergency department (ED), and per ED shift. We also looked at some proxy measures for the level of intensity of the work, including the number of hospital inpatients, the number of medevacs per ED shift and the number of ED shifts per physician. Exploratory graphical analysis was conducted and was followed by linear regression for associations of interest. RESULTS AND CONCLUSION: During periods of decreased staffing, physicians saw more patients per clinic and ED shift, despite the lack of financial incentives. The study also clearly demonstrates the increased intensity of the workloads carried by rural physicians in times of staffing shortages as noted by increased numbers of ED shifts, increased numbers of medevacs per ED shift and the lack of a decline in inpatient numbers. This highlights the need for ongoing recruitment and retention efforts in rural and remote locations to ensure adequate physician staffing levels, if burnout is to be avoided.

Ambulatory Care Facilities↗
PubMed1987

Physician reimbursement by salary or fee-for-service: effect on physician practice behavior in a randomized prospective study.

We used a resident continuity clinic to compare prospectively the impact of salary v fee-for-service reimbursement on physician practice behavior. This model allowed randomization of physicians into salary and fee-for-service groups and separation of the effects of reimbursement from patient behavior. Physicians reimbursed by fee-for-services scheduled more visits per patient than did salaried physicians (3.69 visits v 2.83 visits, P less than .01) and saw their patients more often (2.70 visits v 2.21 visits, P less than .05) during the 9-month study. Almost all of this difference was because fee-for-service physicians saw more well patients than salaried physicians (1.42 visits and .99 visits per enrolled patient, respectively, P less than .01). Evaluating visits by American Academy of Pediatrics' guidelines indicated that fee-for-service physicians saw more patients for well-childcare than salaried physicians because they missed fewer recommended visits and scheduled visits in excess of those recommendations. Fee-for-service physicians also provided better continuity of care than salaried physicians by attending a larger percentage of all visits made by their patients (86.6% of visits v 78.3% of visits, P less than .05), and by encouraging fewer emergency visits per enrolled patient (0.12 visits v 0.22 visits, P less than .01). Physicians' interest in private practice, as determined by their career plans, correlated significantly with total number of patients enrolled (r = .48, P less than .05) and total clinic patients seen by each resident during the study (r = .40, P less than .05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Physician communication in managed care organizations: opinions of primary care physicians.

BACKGROUND: One method of achieving appropriate patient treatment and continuity of care is to ensure good communication between primary care physicians and specialist physicians. We undertook an exploratory study designed to assess primary care physicians' opinions regarding communication patterns between primary care physicians and specialist physicians participating in fee-for-service and managed care health insurance plans. METHODS: A 26-question survey instrument was mailed to 110 general internists on the clinical faculty of a university hospital. Each question solicited a response for "managed care plans" and "nonmanaged care plans," with responses scored on a 5-point Likert scale ranging from 1 = never to 5 = always. Results were analyzed using the Wilcoxon signed-ranks test of the difference between responses for managed care and nonmanaged care settings. RESULTS: Eighty-four physicians (76%) responded to the survey. Forty-one of these physicians participated in both managed and nonmanaged care plans and thus were eligible for the analysis. These primary care physicians reported that patients were referred more often to an unknown specialist for managed care (MC) plans than for nonmanaged care (NMC) plans (MC mean = 2.8, NMC mean = 1.4; P < .01). They also reported that when referring patients in managed care plans to a specialist, they spoke personally with specialists less often (MC mean = 2.8, NMC mean = 3.5; P < .01) and sent a written summary to specialists less often (MC mean = 2.6, NMC mean = 2.9; P < .05). Primary care physicians in this study perceived that patients in managed care plans charged primary care providers much more frequently than did those in nonmanaged care plans (MC mean = 3.8, NMC mean = 2.2; P < .01). CONCLUSIONS: In this exploratory study, we found that communication between primary care and specialist physicians may be impaired when multiple health insurance plans with restricted panels of participating physicians are implemented in communities. Further research is required to confirm these findings and to assess how patient-related communication is managed.

Adult↗
PubMed1995

Are patients of women physicians screened more aggressively? A prospective study of physician gender and screening.

OBJECTIVE: To determine the effects of physician gender on rates of Pap testing, mammography, and cholesterol testing when identifying and adjusting for demographic, psychosocial, and other patient variables known to influence screening rates. DESIGN: A prospective design with baseline and six-month follow-up assessments of patients' screening status. SETTING: Twelve community-based group family practice medicine offices in North Carolina. PARTICIPANTS: 1,850 adult patients, aged 18-75 years (six-month response rate, 83%), each of whom identified one of 37 physicians as being his or her regular care provider. MAIN RESULTS: Where screening was indicated at baseline, the patients of the women physicians were 47% more likely to get a Pap test [odds ratio (OR) = 1.47, 95% confidence interval (CI) = 1.05, 2.04] and 56% more likely to get a cholesterol test (OR = 1.56, 95% CI = 1.08, 2.24) during the study period than were the patients of the men physicians. For mammography, the younger patients (aged 35-39 years) of the women physicians were screened at a much higher rate than were the younger patients of the men physicians (OR = 2.69, 95% CI = 0.98, 7.34); however, at older ages, the patients of the women and the men physicians had similar rates of screening. CONCLUSIONS: In general, the patients of the women physicians were screened at a higher rate than were the patients of the men physicians, even after adjusting for important patient variables. These findings were not limited to gender-specific screening activities (e.g., Pap testing), as in some previous studies. However, the patients of the women physicians were aggressively screened for breast cancer at the youngest ages, where there is little evidence of benefit from mammography. Larger studies are needed to determine whether this pattern of effects reflects a broader phenomenon in primary care.

Adolescent↗
PubMed2004

The use of patient and physician reminders for preventive services: results from a National Study of Physician Organizations.

BACKGROUND: Clinical preventive services improve patient health, and reminder systems can increase the use of such services. However, physician organizations often underutilize clinical preventive service reminders. Little is known about the incentives, capabilities, and organizational characteristics associated with the use of reminders by physician organizations. METHODS: The predictors of patient and physician reminder system use were examined in a sample of 1,104 US physician organizations. The cross-sectional sample was obtained through a telephone survey with a 70% response rate. RESULTS: Fifty-one percent of physician organizations used mammogram reminders, 41% used influenza immunization reminders, and 26% used eye exam reminders for patients. Eighteen percent of physician organizations used computer-generated reminders to physicians. Required reporting of data (P = 0.0006), public recognition for quality (P = 0.0002), and IT capabilities (P < 0.0001) were strongly associated with patient reminder use. Medical groups were more likely to use patient-level reminders than independent practice associations (IPAs) (P < 0.0001). Physician reminder use was related to required reporting of data (P < 0.0001) and IT capabilities (P < 0.0001). CONCLUSIONS: Physician organizations have relatively low use of preventive service reminders to patients and physicians. Offering quality incentives to physician organizations and improving their IT capabilities may increase the use of preventive service reminders and improve the delivery of preventive care.

Adult↗
PubMed2002

Attitudes of osteopathic physicians toward physician-assisted suicide.

The use of physician-assisted suicide (PAS) in the care of terminally ill patients is controversial. While there are published surveys assessing the attitudes and views of physicians in certain specialties, both nationally and in targeted geographic areas, no such data are available specifically pertaining to osteopathic physicians, who deliver 9% of the primary care in the United States. This article describes a study whose purpose was to identify the views and perspectives of osteopathic physicians on PAS through a national survey. Questionnaires were forwarded to all board-certified internists who are members of the American College of Osteopathic Internists and all surgeons and a random sample of family physicians who are members of the American Osteopathic Association. Physicians were surveyed with initial and follow-up mailings. The 49-item questionnaire was a modified version of the Physician Survey, Center for Ethics in Health Care: Oregon Health Sciences University. Of the 2910 questionnaires that were mailed, 1028 were returned in a usable form, for a 35% response rate. Respondents were predominantly (81%) male and from all parts of the country. Most (58%) would not be willing to prescribe a medication for a competent, terminally ill patient to use with the primary intention of ending his or her own life, and most (55%) would oppose the legalization of PAS. Thirty-three percent of osteopathic physicians admit to receiving requests by terminally ill patients for PAS. Most (53%) osteopathic physicians indicate that the osteopathic principle of holistic care has influenced their decision-making on this issue, and a significant minority (44%) responded that the osteopathic oath influenced their view on PAS. Religion and the degree of prayer frequency were important predictors of the decisions to support or oppose PAS. When compared to other physician surveys, this survey of osteopathic physicians demonstrates some similarities in response but also significant differences. These data suggest that osteopathic education and training may result in a perspective on PAS that reflects the distinctiveness of the osteopathic profession.

Adult↗
PubMedDate not supplied

[Profile of the physician registered in the National Program of Continuous Academic Development for the General Physician].

A descriptive, transversal study was done on 881 physicians taking the National Program of Continuous Academic Development for the General Physician (PRONADAMEG) at 27 sites during the second semester of 2002. The general purpose of the study was to determine the sociodemographic, academic, and professional profile of the physician enrolled in the program, as well as their opinion on the program and their need for education. Age of enrolled physicians is between 35 and 54 years (70.6%), sex distribution is equal, and 66% of physicians are married. Ninety four percent have a medical practice that takes up the majority of their time. The study showed that 66.4% of physicians worked at public institutions, mainly at the Mexican Institute of Social Security (IMSS) and the Mexican Health Ministry (SSa). One physician trainied outside of Mexico, and 12.2% have a speciality in family medicine. Of physicians in the study, 32% participated informal continuous medical education and used medical journals for this purpose. The program was seen as helpful by 89% of physicians in the study, and the study suggests that knowing the profile of physicians enrolled in the program will allow academic planning for the program and the true needs for education general physicians.

Education, Medical, Continuing↗
PubMed2001

Physician perceptions about administration of immunizations outside of physician offices.

BACKGROUND: Expanding nonphysician participation in the administration of immunizations has been suggested as a means of increasing immunization rates. However, there is little information about physician interest in collaborating with nonphysicians to provide out-of-office immunizations. METHODS: All active members of the Iowa Academy of Family Physicians were surveyed by mail. Physicians reported on their collaboration histories, their willingness to collaborate in the future, their concerns with collaboration, and whether they approved of their patients' using nonphysicians for immunizations. RESULTS: Of 898 eligible physicians, 476 (53%) returned questionnaires that were analyzed. Seventy-five percent (n = 357) of the physicians reported that they had voluntarily collaborated with a person outside their office to provide immunizations. Ninety-five percent (n = 452) of physicians indicated a willingness to collaborate in some form in the future. However, physicians had concerns about (a) being able to be kept informed about immunizations their patients receive outside of their offices, (b) adequate training of the nonphysician to administer immunizations and respond to complications of immunization, and (c) loss of preventive health opportunities if patients ceased coming to physicians for routine immunizations. CONCLUSION: The majority of family physicians have collaborated to deliver immunizations and indicate support for nonphysician participation. Almost all physicians would consider future collaborative arrangements although they have concerns about record keeping and the safety of out-of-office immunization programs.

Adult↗
PubMed1998

Why physician gender matters in shaping the physician-patient relationship.

Societal values regarding the nature and consequences of patient autonomy and medical paternalism underscore the current debates surrounding informed consent and shared decision making. The debate is significant in that it both reflects and determines normative expectations for physician and patient conduct as well as the nature and form of the therapeutic relationship. Analysis of the literature describing communication differences between physicians of different genders indicates that female physicians show a greater affinity for collaborative models of patient-physician relationship than do their male colleagues. Female physicians spend more time with their patients, are more likely to engage their patients in discussions of their social and psychologic context, and deal more often with feelings and emotions. Moreover, female physicians facilitate partnership and patient participation in the medical exchange more effectively than do male physicians. The authors propose that the quality of the interactive process is critical to the establishment of a therapeutic relationship and that this process is related to physician gender. They also suggest that physician gender matters in the shaping of the patient-physician relationship through this interactive process.

Communication↗
PubMed2003

Rural and urban physicians' perceptions regarding the role and practice of the nurse practitioner, physician assistant, and certified nurse midwife.

CONTEXT: There is a dearth of literature citing the differences in rural and urban physicians' perceptions of the role and practice of nurse practitioners, physician assistants, and certified nurse midwives (nonphysician providers). PURPOSE: The purpose of this study was to investigate and compare differences, if any, between rural and urban primary care physicians' perceptions of the role and practice of nonphysician providers. RESULTS: Despite a 15.55% response rate using a mail-out survey in South Carolina, data from 681 rural and urban primary care physicians indicated that they perceived that nonphysician providers possess the necessary skills and knowledge to provide primary care to patients, are an asset to a physician's practice, free the physician's time to handle more critically ill patients, and increase revenue for the practice, but increase the risk of patient care mistakes and a physician's time in administrative duties. Urban physicians' mean scores were higher for perceiving that nonphysician providers are able to see as many patients in a given day as a physician but experience impediments in the delivery of patient care. CONCLUSIONS: Results will be used to clarify physicians' perceptions regarding the role and practice of nonphysician providers to reduce impediments to patient care access.

Attitude of Health Personnel↗
PubMed2006

State of HIV treatment: Results of the International Association of Physicians in AIDS Care surveys of HIV-positive patients and HIV-treating physicians in the United States.

BACKGROUND: There are few reports about physician and patient attitudes about antiretroviral therapy. Reports on physician perceptions of HIV-positive patients and patients' perceptions of their physicians are even scarcer. METHODS: The International Association of Physicians in AIDS Care conducted surveys of HIV-treating physicians, and a separate set of HIV-positive patients. Physicians completed an online questionnaire. Patients completed a written questionnaire. RESULTS: Physicians and patients agreed on several issues, including the priority of viral suppression when making treatment decisions and the treatment-limiting impact of side effects. However, they had diverging treatment goals in mind and differing impressions of the type and incidence of side effects. There were also sharp differences in physicians' estimates of how well patients understand HIV disease and its treatment. CONCLUSIONS: The differences revealed through these surveys underline the need to conduct a systematic study of physician and patient attitudes about antiretroviral therapy, as well as physician-patient communication.

Adult↗
PubMed2001

Non-primary care physicians and smoking cessation counseling: Women Physicians' Health Study.

OBJECTIVES: The Women Physicians' Health Study (WPHS) offers a unique opportunity to examine the counseling and screening practices of women physicians in various specialties. In this study we describe the prevalence of self-reported counseling on smoking cessation among non-primary care women physicians and examine the association between their demographic, professional, and personal characteristics and such counseling on smoking cessation. METHODS: Conducted in 1993-1994, WPHS is a nationally representative cross-sectional mailed survey of U.S. women physicians with 4,501 respondents representing all major specialties. Physicians in 9 specialty areas were grouped in 6 categories: (1) anesthesiology; (2) general surgery and surgical subspecialties; (3) emergency medicine; (4) medical subspecialties; (5) psychiatry; and (6) other. Frequent counseling was defined as having counseled patients who were known smokers at every visit or at least once a year. RESULTS: Overall, 45% of the physicians frequently counseled smokers to quit. Medical subspecialists (80%) were most likely and psychiatrists (29%) least likely to counsel frequently. Specialty, perceived relevance of counseling to the physician's practice, and self-confidence in counseling about smoking cessation were associated with frequent counseling. CONCLUSION: Cessation counseling by non-primary care physicians can reduce tobacco-related morbidity and mortality. Increasing perceived relevance and self-confidence among this group of physicians, combined with implementation of system changes and the creation of physician accountability can facilitate the provision of such counseling.

Adult↗
PubMed1978

Physicians and non-physician health practitioners: the characteristics of their practices and their relationships.

Six primary care practices which utilize both physician and non-physician practitioner types were studied to measure differences between practitioner types in the care of patients. By chart review 1,369 patient-practitioner encounters were examined. Physicians identified less symptoms and signs in their patients and prescribed less non-drug therapies than did non-physicians. Likewise, at follow-up visits, physicians tended to document less follow-up of these types of problems and therapies than non-physicians. When examining the interaction between practitioners, the highest rates of follow-up of all types of problems and therapies were found when the same practitioner saw the patient at two successive visits to the same clinic. When a physician saw a patient following a previous visit to a nurse practitioner, there was a significant drop-off in the follow-up rate of problems and therapies. However, when a nurse practitioner saw the patient following a previous visit to a physician, the drop-off in follow-up rates was not as striking. These findings indicate that the skills of physician and nonphysician practitioners are potentially complementary. However, this potential is not fully exploited, particularly by physicians.

Diagnosis↗