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Merga A, Yetwale F, Sisay B, Shumye M. Clients' satisfaction with cervical cancer screening services and influencing factors at public health facilities in Debre Markos town, Northwest Ethiopia, 2022/23: a convergent parallel mixed method. BMC Womens Health 2024; 24:441. [PMID: 39095758 PMCID: PMC11295363 DOI: 10.1186/s12905-024-03250-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 07/08/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Satisfaction is defined as the perceived fulfillment of patient or client needs and desires through the delivery of healthcare services. In developed countries, more than 60% of women have been screened for cervical cancer. However, only 12% of women in sub-Saharan Africa have been screened for precancerous cervical lesions. There is limited evidence on client satisfaction with cervical cancer screening services (CSCCSS) in Ethiopia, particularly, there is no study conducted by mixed method in the Amhara region. OBJECTIVE The study aimed to assess clients' satisfaction with cervical cancer screening services and influencing factors among women screened in Debre Markos town public health facilities in Northwest Ethiopia, 2022/23. METHODS A convergent parallel mixed methods design was conducted in Debre Markos town's public health facilities from October 10th, 2022 to January 10th, 2023. For the quantitative wing, a total of 401 cervical cancer screening service users were selected using a systematic random sampling technique. Data were collected using an interviewer-administered structured questionnaire. Clients were interviewed on exit in a private area far from the screening unit and the data were entered into Epi-data version 4.6.0.2, then exported to STATA version 14 for analysis. A binary logistic regression model was fitted to identify factors associated with client satisfaction with cervical cancer screening services. The qualitative data were collected through in-depth and key informant interviews using a semi-structured topic guide. The data were analyzed using a thematic analysis approach with Open code software (version 4.0.2.3). RESULT The quantitative wing revealed that overall, 65% (95% CI: 60-69) of respondents were satisfied with the cervical cancer screening services they received. Gender of the provider (AOR: 6.11, 95% CI: 3.23-11.55, p-value = 0.000), waiting time (AOR: 4.77, 95% CI: 1.32-17.31, p-value = 0.017), clients' knowledge (AOR: 0.26, 95% CI: 0.12-0.59, p-value = 0.001), and clients' attitude (AOR: 6.43, 95% CI: 3.43-12.03, p-value = 0.000) were significantly associated with CSCCSS. QUALITATIVE RESULT The thematic analysis revealed three themes. Theme 1: facility-related barriers (shortage of skilled manpower, shortage of infrastructure, providers' skill gap, unavailability of full service, leadership problem, long waiting time). Theme 2: client-related barriers (poor knowledge and attitude, gender preference). Theme 3: facility-related facilitators (free service, presence of supportive partners). CONCLUSION According to the findings of this study, two-thirds of clients were satisfied with cervical cancer screening services, which was lower than the national target of 80%. Long waiting time, male gender of the service provider, unfavorable attitude, and good knowledge of clients were identified as significant factors negatively affecting client satisfaction with cervical cancer screening.
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Affiliation(s)
- Alemu Merga
- Department of Midwifery, school of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia.
| | - Fisseha Yetwale
- Department of Clinical Midwifery, school of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Beyene Sisay
- Department of Midwifery, School of Nursing and Midwifery, College of Medicine and Health sciences, Arsi University, Asella, Ethiopia
| | - Muhabaw Shumye
- Department of Clinical Midwifery, school of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Deng S, Chen Y, Bennett KJ. The association of travel burden with prenatal care utilization, what happens after provider-selection. BMC Health Serv Res 2024; 24:781. [PMID: 38982401 PMCID: PMC11234759 DOI: 10.1186/s12913-024-11249-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 06/25/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND Birthing people in the United States face numerous challenges when accessing adequate prenatal care (PNC), with transportation being a significant obstacle. Nevertheless, previous studies that relied solely on the distance to the nearest provider cannot differentiate the effects of travel burden on provider selection and care utilization. These may exaggerate the degree of inequality in access and fail to capture perceived travel burden. This study investigated whether travel distances to the initially visited provider, to the predominant PNC provider, and perceived travel burden (measured by the travel disadvantage index (TDI)) are associated with PNC utilization. METHODS A retrospective cohort of people with live births were identified from South Carolina Medicaid claims files in 2015-2018. Travel distances were calculated using Google Maps. The estimated TDI was derived from local pilot survey data. PNC utilization was measured by PNC initiation and frequency. Repeated measure logistic regression test was utilized for categorical variables and one-way repeated measures ANOVA for continuous variables. Unadjusted and adjusted ordinal logistic regressions with repeated measure were utilized to examine the association of travel burdens with PNC usage. RESULTS For 25,801 pregnancies among those continuously enrolled in Medicaid, birthing people traveled an average of 24.9 and 24.2 miles to their initial and predominant provider, respectively, with an average TDI of -11.4 (SD, 8.5). Of these pregnancies, 60% initiated PNC in the first trimester, with an average of 8 total visits. Compared to the specialties of initial providers, predominant providers were more likely to be OBGYN-related specialists (81.6% vs. 87.9%, p < .001) and midwives (3.5% vs. 4.3%, p < .001). Multiple regression analysis revealed that every doubling of travel distance was associated with less likelihood to initiate timely PNC (OR: 0.95, p < .001) and a lower visit frequency (OR: 0.85, p < .001), and every doubling of TDI was associated with less likelihood to initiate timely PNC (OR: 0.94, p = .04). CONCLUSIONS Findings suggest that the association between travel burden and PNC utilization was statistically significant but of limited practical significance.
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Affiliation(s)
- Songyuan Deng
- University of South Carolina School of Medicine, Columbia, SC, USA.
| | - Yuche Chen
- Department of Civil and Environmental Engineering, College of Engineering and Computing, University of South Carolina, Columbia, SC, USA
| | - Kevin J Bennett
- University of South Carolina School of Medicine, Columbia, SC, USA
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Sarma H, Giang PN, Kelly M, Van Anh T, Rao C, Hoa NP. Knowledge of Medical Education on Maternal and Child Primary-Care Among Physicians: A Cross-Sectional Study. Int J Public Health 2024; 69:1606536. [PMID: 39027014 PMCID: PMC11254614 DOI: 10.3389/ijph.2024.1606536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 06/13/2024] [Indexed: 07/20/2024] Open
Abstract
Objectives To assess the pre-training knowledge of Commune Health Stations (CHSs) physicians in Vietnam on pregnancy and child care. Methods A cross-sectional study was conducted and a pre-training questionnaire was administered with physicians working at CHSs in three mountainous provinces of northern Vietnam. Calculated mean knowledge score and estimated adjusted odds ratios (AOR) to compare the relative odds of occurrence of the outcome "answering more than half of questions correct," given exposure to the physicians' characteristics. Results A total of 302 CHS physicians participated. The mean number of correct answers across all participants was 5.4 out of 11. Female physicians are 2.20 (95% CI: 1.35-3.59, p = 0.002) times more likely to answer correctly than their male counterparts. Physicians aged 35 years or more were significantly less likely to answer correctly (AOR 0.35, 95% CI: 0.15-0.81, p = 0.014). Conclusion The study found that participating physicians possessed relatively low knowledge of pregnancy and child care. The study also found significant disparities in this knowledge according to the physicians' characteristics. Thus, it is recommended the requirement for continuing targeted medical education to improve doctors' proficiency in these areas.
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Affiliation(s)
- Haribondhu Sarma
- The National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - Pham Ngan Giang
- Preventive Medicine Centre, Hanoi Medical University, Hanoi, Vietnam
| | - Matthew Kelly
- The National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - Tran Van Anh
- Preventive Medicine Centre, Hanoi Medical University, Hanoi, Vietnam
| | - Chalapati Rao
- The National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - Nguyen Phuong Hoa
- Preventive Medicine Centre, Hanoi Medical University, Hanoi, Vietnam
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Hakami NA, Al-Musawa HI, Alharbi AI, Marwahi NA, Almutlaq AS, Alghamdi RA, Alshammari SM, Almalki AA, Mojiri ME, Mahzara NK, Hakami AA, Nemri AA. Public Preferences for Surgeon Gender in Saudi Arabia: A Cross-Sectional Analysis. Healthcare (Basel) 2024; 12:1185. [PMID: 38921298 PMCID: PMC11202667 DOI: 10.3390/healthcare12121185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Revised: 05/31/2024] [Accepted: 06/10/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Gender equity in healthcare ensures equal access to services and resources for all individuals, regardless of gender. Studies show that patients' gender influences their healthcare experiences and decisions, and societal gender preferences impact surgeon selection. Therefore, the objective of this study was to address the surgeons' gender preferences among Saudi Arabia's population. METHODS This study used a cross-sectional research design and survey methodology to gather data from a representative sample of adults aged 18 and older from the general population in Saudi Arabia. This study used SPSS version 26 for statistical data entry and analysis, employing descriptive and inferential statistics, frequency distributions, descriptive statistics, and multivariate analysis using multiple logistic regression for variables significantly associated with population gender in univariate analysis. RESULTS This study involved 2085 participants, with 51.2% aged 18-25, 18.4% aged 26-35, 16.7% aged 36-45, and 13.8% aged 45 and above. The majority were Saudi Arabian, with a majority holding a university degree. The majority worked in the healthcare sector, while the remaining 29.7% were unemployed. This study found that there were significant gender preferences among survey respondents for different types of surgical procedures. Male participants preferred male surgeons for routine non-emergency visits and sensitive obstetric, genital, sexual, and minor procedures (p < 0.001). Female participants, on the other hand, had no preference for emergency surgeries and major surgical procedures (p < 0.001). This study found that participants were more likely to prefer female surgeons for regular non-emergency visits to the surgery clinic (p < 0.001; aOR = 2.344). Additionally, participants had a high preference for female surgeons for sensitive cases (p < 0.001; aOR = 7.064) and minor surgical procedures (p < 0.001; aOR = 2.489). CONCLUSION This study underscores the significance of cognizance and the incorporation of a patient's gender preferences when selecting surgical procedures, thus fostering an environment that is more accommodating and focused on the patient.
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Affiliation(s)
- Nasser A. Hakami
- General Surgery, Surgical Department, College of Medicine, Jazan University, Jazan 45142, Saudi Arabia;
| | | | - Ali I. Alharbi
- Faculty of Medicine, Jazan University, Jazan 45141, Saudi Arabia
| | - Nawaf A. Marwahi
- Faculty of Medicine, Jazan University, Jazan 45141, Saudi Arabia
| | | | - Rayan A. Alghamdi
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh 11623, Saudi Arabia
| | | | | | | | - Naif K. Mahzara
- Faculty of Medicine, Jazan University, Jazan 45141, Saudi Arabia
| | - Amro A. Hakami
- Surgery Department, King Saud University Medical City, Riyadh 12372, Saudi Arabia
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Lee CY, Lee CH, Lai HY, Yau SY. An Investigation of Patient Preferences and Gender Dynamics of Neurosurgeon Selection in Taiwan: A Mixed-Method Study. World Neurosurg 2024; 186:43-49. [PMID: 38514029 DOI: 10.1016/j.wneu.2024.03.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/13/2024] [Accepted: 03/14/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVE To investigate the influence of gender on patient preferences during the selection of neurosurgeons. METHODS A mixed-method, cross-sectional study was conducted at Linkou Chang Gung Memorial Hospital in Taiwan, involving 60 patients. The study encompassed both structured questionnaires and in-depth interviews, administered postpatient-surgeon interactions to assess the nuanced effect of surgeon gender on patient choice. A balanced representation of both genders was ensured among the neurosurgeons involved. Thematic analysis was employed for textual data, while numeric data were analyzed using descriptive and Chi-square statistics. RESULTS The majority of participants (n = 40, 66.7%) expressed no preference regarding the gender of their neurosurgeon during outpatient consultations. Nonetheless, a notable fraction, predominantly female, preferred female neurosurgeons (n = 20, 33.3%). Statistical analysis highlighted a significant correlation between the gender of the patients and their preferred neurosurgeon's gender, with female patients predominantly favouring female neurosurgeons (P < 0.05). Qualitative insights indicate that, although professional skill and experience are primary factors in selecting a neurosurgeon, a latent gender preference exists, influenced by perceived privacy, empathetic care, and the surgical finesse associated with female neurosurgeons. CONCLUSIONS Although expertise and professionalism are of paramount importance, there is a clear preference for female neurosurgeons, especially among female patients. These findings underscore the importance of recognizing and accommodating patients' preferences to ensure neurosurgical care aligns with patient comfort, expectations, and the broader movement towards gender equality.
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Affiliation(s)
- Ching-Yi Lee
- Department of Neurosurgery, Chang Gung Memorial Hospital Linkou Main Branch and School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ching-Hsin Lee
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Chang Gung, Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Hung-Yi Lai
- Department of Neurosurgery, Chang Gung Memorial Hospital Linkou Main Branch and School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Sze-Yuen Yau
- (CG-MERC), Chang Gung Medical Education Research Centre, Linkou, Taiwan.
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Alzahrani AM, Alzhrani AA, Felix HC, Alharbi KK, Shahzad MW, Arbaein TJ, Monshi SS. Patient Satisfaction with Private Community Pharmacies versus Pharmacies in Primary Health Care Centers in Saudi Arabia. Saudi Pharm J 2024; 32:102091. [PMID: 38757070 PMCID: PMC11097056 DOI: 10.1016/j.jsps.2024.102091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 04/27/2024] [Indexed: 05/18/2024] Open
Abstract
Introduction Saudi Arabia has begun reforming its government-run health care system to increase efficiency and reduce costs. One effort is the adoption of an electronic prescribing system (Wasfaty) and outsourcing pharmaceutical services from government-run clinics to community pharmacies (CP). This study aims to compare satisfaction with pharmaceutical services offered in the two systems. Materials and methods This cross-sectional observational study used existing survey data collected from patients (≥15 years of age) visiting government primary health care centers from January 2022 to June 2022. Satisfaction with three pharmaceutical services (availability of medications, pharmacist's explanation of the prescription, and waiting time to get medications) were the main outcomes. Results The study comprised 91,317 participants, 74.06 % of them were CP/Wasfaty users. CP/Wasfaty patients had lower odds of satisfaction with the three pharmaceutical services: availability of medications (OR = 0.49, 95 % CI = 0.47-0.51), pharmacists' explanation of prescription (OR = 0.55, 95 % CI = 0.53-0.58), and waiting time to get medications (OR = 0.81, 95 % CI = 0.75-0.88). Additional findings showed variations in satisfaction levels based on demographic factors and clinic types. Conclusions The significant differences observed in satisfaction levels based on demographic characteristics and type of clinics visited emphasize the importance of tailoring pharmaceutical services to meet the specific needs and expectations of different patient populations.
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Affiliation(s)
- Ali M. Alzahrani
- Department of Health Administration and Hospitals, College of Public Health and Health Informatics, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Abdulrhman A. Alzhrani
- Department of Health Administration and Hospitals, College of Public Health and Health Informatics, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Holly C. Felix
- Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Khulud K. Alharbi
- Department of Health Administration and Hospitals, College of Public Health and Health Informatics, Umm Al-Qura University, Makkah, Saudi Arabia
| | | | - Turky J. Arbaein
- Department of Health Administration and Hospitals, College of Public Health and Health Informatics, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Sarah S. Monshi
- Department of Health Administration and Hospitals, College of Public Health and Health Informatics, Umm Al-Qura University, Makkah, Saudi Arabia
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Miyawaki A, Jena AB, Rotenstein LS, Tsugawa Y. Comparison of Hospital Mortality and Readmission Rates by Physician and Patient Sex. Ann Intern Med 2024; 177:598-608. [PMID: 38648639 DOI: 10.7326/m23-3163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Little is known as to whether the effects of physician sex on patients' clinical outcomes vary by patient sex. OBJECTIVE To examine whether the association between physician sex and hospital outcomes varied between female and male patients hospitalized with medical conditions. DESIGN Retrospective observational study. SETTING Medicare claims data. PATIENTS 20% random sample of Medicare fee-for-service beneficiaries hospitalized with medical conditions during 2016 to 2019 and treated by hospitalists. MEASUREMENTS The primary outcomes were patients' 30-day mortality and readmission rates, adjusted for patient and physician characteristics and hospital-level averages of exposures (effectively comparing physicians within the same hospital). RESULTS Of 458 108 female and 318 819 male patients, 142 465 (31.1%) and 97 500 (30.6%) were treated by female physicians, respectively. Both female and male patients had a lower patient mortality when treated by female physicians; however, the benefit of receiving care from female physicians was larger for female patients than for male patients (difference-in-differences, -0.16 percentage points [pp] [95% CI, -0.42 to 0.10 pp]). For female patients, the difference between female and male physicians was large and clinically meaningful (adjusted mortality rates, 8.15% vs. 8.38%; average marginal effect [AME], -0.24 pp [CI, -0.41 to -0.07 pp]). For male patients, an important difference between female and male physicians could be ruled out (10.15% vs. 10.23%; AME, -0.08 pp [CI, -0.29 to 0.14 pp]). The pattern was similar for patients' readmission rates. LIMITATION The findings may not be generalizable to younger populations. CONCLUSION The findings indicate that patients have lower mortality and readmission rates when treated by female physicians, and the benefit of receiving treatments from female physicians is larger for female patients than for male patients. PRIMARY FUNDING SOURCE Gregory Annenberg Weingarten, GRoW @ Annenberg.
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Affiliation(s)
- Atsushi Miyawaki
- Department of Health Services Research and Department of Public Health, Graduate School of Medicine, and Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan (A.M.)
| | - Anupam B Jena
- Department of Health Care Policy, Harvard Medical School, Boston, Department of Medicine, Massachusetts General Hospital, Boston, and National Bureau of Economic Research, Cambridge, Massachusetts (A.B.J.)
| | - Lisa S Rotenstein
- Divisions of General Internal Medicine and Clinical Informatics, University of California at San Francisco, San Francisco, California, and Center for Physician Experience and Practice Excellence, Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts (L.S.R.)
| | - Yusuke Tsugawa
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, and Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California (Y.T.)
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Williams N, Griffin G, Wall M, Watson S, Warland J, Bradfield Z. Patient evaluation of gynaecological information provision and preferences. J Adv Nurs 2024; 80:1188-1200. [PMID: 37731325 DOI: 10.1111/jan.15866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/03/2023] [Accepted: 08/30/2023] [Indexed: 09/22/2023]
Abstract
AIM To evaluate gynaecological patients' preferences and satisfaction regarding information provision, exploring enablers and barriers to information access. DESIGN A descriptive cross-sectional survey design was used. METHODS A total of 293 women accessing gynaecological services responded to the survey. Quantitative analysis included descriptive and inferential statistics. Content analysis was conducted on qualitative data. RESULTS Health professionals were the most common and preferred sources of gynaecological health information. Enablers to information provision included positive communication strategies by health professionals, participants having prior knowledge and doing their own research. Despite its widespread availability, only 24.2% of women preferred the internet as an information source. Poor communication and inadequate information provision were identified as barriers to information access. Statistically significant associations were identified between location of residence, education level, year of birth, diagnostic group and health information preferences. Recommendations from women included improved communication strategies, system changes and provision of individualized information. CONCLUSION Health professionals are central to women accessing information about gynaecological diagnoses. Areas for improvement include communication strategies, facilitating access to internet-based resources for information and consideration of women's preferences when providing health information. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE Consumer co-design of gynaecological health information and communication training for health professionals is recommended. Improved communication and facilitated use of internet-based resources may improve women's understanding of information. IMPACT This study explored gynaecological patients' preferences and satisfaction regarding information provision, exploring enablers and barriers to information access. It was found that gynaecological patients preferred individualized information provided to them directly by health professionals and despite its widespread availability, the internet is an underutilized health information resource. These findings are applicable to health professionals and patients utilizing tertiary gynaecological health services in Australia but may be generalized if demographic data aligns with other jurisdictions. REPORTING METHOD The STROBE reporting method was used in the preparation of the manuscript. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Natalie Williams
- Department of Nursing and Midwifery Education and Research, King Edward Memorial Hospital, Subiaco, Australia
| | - Georgia Griffin
- Department of Nursing and Midwifery Education and Research, King Edward Memorial Hospital, Subiaco, Australia
| | - Megan Wall
- Department of Nursing and Midwifery Education and Research, King Edward Memorial Hospital, Subiaco, Australia
| | - Stuart Watson
- Women's Health, Genetics & Mental Health, King Edward Memorial Hospital, Subiaco, Australia
| | - Jane Warland
- Department of Nursing and Midwifery Education and Research, King Edward Memorial Hospital, Subiaco, Australia
- School of Nursing, Curtin University, Bentley, Australia
| | - Zoe Bradfield
- Department of Nursing and Midwifery Education and Research, King Edward Memorial Hospital, Subiaco, Australia
- School of Nursing, Curtin University, Bentley, Australia
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Wallis CJ, Jerath A, Ikesu R, Satkunasivam R, Dimick JB, Orav EJ, Maggard-Gibbons M, Li R, Salles A, Klaassen Z, Coburn N, Bass BL, Detsky AS, Tsugawa Y. Association between patient-surgeon gender concordance and mortality after surgery in the United States: retrospective observational study. BMJ 2023; 383:e075484. [PMID: 37993130 PMCID: PMC10664070 DOI: 10.1136/bmj-2023-075484] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/15/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVE To determine whether patient-surgeon gender concordance is associated with mortality of patients after surgery in the United States. DESIGN Retrospective observational study. SETTING Acute care hospitals in the US. PARTICIPANTS 100% of Medicare fee-for-service beneficiaries aged 65-99 years who had one of 14 major elective or non-elective (emergent or urgent) surgeries in 2016-19. MAIN OUTCOME MEASURES Mortality after surgery, defined as death within 30 days of the operation. Adjustments were made for patient and surgeon characteristics and hospital fixed effects (effectively comparing patients within the same hospital). RESULTS Among 2 902 756 patients who had surgery, 1 287 845 (44.4%) had operations done by surgeons of the same gender (1 201 712 (41.4%) male patient and male surgeon, 86 133 (3.0%) female patient and female surgeon) and 1 614 911 (55.6%) were by surgeons of different gender (52 944 (1.8%) male patient and female surgeon, 1 561 967 (53.8%) female patient and male surgeon). Adjusted 30 day mortality after surgery was 2.0% for male patient-male surgeon dyads, 1.7% for male patient-female surgeon dyads, 1.5% for female patient-male surgeon dyads, and 1.3% for female patient-female surgeon dyads. Patient-surgeon gender concordance was associated with a slightly lower mortality for female patients (adjusted risk difference -0.2 percentage point (95% confidence interval -0.3 to -0.1); P<0.001), but a higher mortality for male patients (0.3 (0.2 to 0.5); P<0.001) for elective procedures, although the difference was small and not clinically meaningful. No evidence suggests that operative mortality differed by patient-surgeon gender concordance for non-elective procedures. CONCLUSIONS Post-operative mortality rates were similar (ie, the difference was small and not clinically meaningful) among the four types of patient-surgeon gender dyads.
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Affiliation(s)
- Christopher Jd Wallis
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Division of Urology, Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada
- Division of Urology, Department of Surgery, University Health Network, Toronto, ON, Canada
| | - Angela Jerath
- Department of Anesthesia, Sunnybrook Health Sciences Center, Toronto, ON, Canada
| | - Ryo Ikesu
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Raj Satkunasivam
- Department of Urology, Houston Methodist Hospital, Houston, TX, USA
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, USA
- Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, TX, USA
| | - Justin B Dimick
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - E John Orav
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Ruixin Li
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Arghavan Salles
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Zachary Klaassen
- Division of Urology, Medical College of Georgia-Augusta University, Augusta, GA, USA
| | - Natalie Coburn
- Department of Surgery, Sunnybrook Health Sciences Center, Toronto, ON, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Barbara L Bass
- George Washington University, School of Medicine and Health Sciences, Washington, DC, USA
| | - Allan S Detsky
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, Mount Sinai Hospital and University Health Network, Toronto, ON, Canada
| | - Yusuke Tsugawa
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
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Si Y, Chen G, Su M, Zhou Z, Yip W, Chen X. The Impact of Physician-Patient Gender Match on Healthcare Quality: An Experiment in China. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.10.03.23296202. [PMID: 37873451 PMCID: PMC10592995 DOI: 10.1101/2023.10.03.23296202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Despite growing evidence of gender disparities in healthcare utilization and health outcomes, there is a lack of understanding of what may drive such differences. Designing and implementing an experiment using the standardized patients' approach, we present novel evidence on the impact of physician-patient gender match on healthcare quality in a primary care setting in China. We find that, compared with female physicians treating female patients, the combination of female physicians treating male patients resulted in a 23.0 percentage-point increase in correct diagnosis and a 19.4 percentage-point increase in correct drug prescriptions. Despite these substantial gains in healthcare quality, there was no significant increase in medical costs and time investment. Our analyses suggest that the gains in healthcare quality were mainly attributed to better physician-patient communications, but not the presence of more clinical information. This paper has policy implications in that improving patient centeredness and incentivizing physicians' efforts in consultation (as opposed to treatment) can lead to significant gains in the quality of healthcare with modest costs, while reducing gender differences in care.
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Affiliation(s)
- Yafei Si
- School of Risk & Actuarial Studies, University of New South Wales, Australia
- ARC Centre of Excellence in Population Ageing Research (CEPAR), University of New South Wales, Australia
| | - Gang Chen
- Centre for Health Economics, Monash Business School, Monash University, Australia
| | - Min Su
- School of Public Administration, Inner Mongolia University, China
| | - Zhongliang Zhou
- School of Public Policy and Administration, Xi’an Jiaotong University, China
| | - Winnie Yip
- Harvard T.H. Chan School of Public Health, Harvard University, USA
| | - Xi Chen
- Department of Health Policy and Management, Yale School of Public Health, USA
- Department of Economics, Yale University, USA
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Lodin HM, Bersoux S, Pannala R, Mi L, Vegunta S. Primary Care Delivery Perceptions and Their Associations with Physician and Patient Gender. J Community Health 2023; 48:711-717. [PMID: 36976390 DOI: 10.1007/s10900-023-01211-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2023] [Indexed: 03/29/2023]
Abstract
INTRODUCTION We aim to survey patients' opinions on perceived differences in patient care delivered by male and female physicians. METHODS Patients of primary care practices at Mayo Clinic, Arizona completed a survey sent through the electronic health record. The survey evaluated opinion regarding their primary care physician (PCP)'s overall healthcare provision capabilities and any perceived differences based on gender. RESULTS 4983 patients' responses were included in final analysis. Compared to male patients, most female patients preferred to have a female PCP (78.1% vs. 32.7%, p < 0.01). Having a preference for female physicians was correlated with higher overall opinion of female physicians. The majority of male patients did not hold a difference in opinion regarding male versus female physicians (p < 0.01). Male patients were half as likely to have a better opinion and nearly 2.5 times more likely to have a worse opinion of female physicians (p < 0.01) compared to female patients. Patients preferring female physicians were nearly 3 times more likely to have a better opinion of female physicians compared to patients with no preference (p < 0.01). CONCLUSION In a primary care setting, majority of female patients compared to male patients preferred female physicians as their PCP and had higher opinion of the care delivery of female physicians. These findings may influence how practices should assign primary care physicians to new patients and add underlying context to patient satisfaction ratings.
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Affiliation(s)
- Hannah M Lodin
- Mayo Clinic Alix School of Medicine, Mayo Clinic, 13400 E. Shea Blvd, Scottsdale, AZ, 85259, USA.
| | - Sophie Bersoux
- Division of Community Internal Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Rahul Pannala
- Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, AZ, USA
| | - Lanyu Mi
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Scottsdale, AZ, USA
| | - Suneela Vegunta
- Division of Women's Health Internal Medicine, Mayo Clinic, Scottsdale, AZ, USA
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AlFaris E, Irfan F, Abouammoh N, Zakaria N, Ahmed AM, Kasule O, Aldosari DM, AlSahli NA, Alshibani MG, Ponnamperuma G. Physicians' professionalism from the patients' perspective: a qualitative study at a single-family practice in Saudi Arabia. BMC Med Ethics 2023; 24:39. [PMID: 37287002 DOI: 10.1186/s12910-023-00918-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 05/23/2023] [Indexed: 06/09/2023] Open
Abstract
INTRODUCTION Professionalism is a crucial component of medical practice. It is a culturally sensitive notion that generally consists of behaviors, values, communication, and relationships. This study is a qualitative study exploring physician professionalism from the patients' perspective. METHODS Focus group discussions with patients attending a family medicine center attached to a tertiary care hospital were carried out using the four gates model of Arabian medical professionalism that is appropriate to Arab culture. Discussions with patients were recorded and transcribed. Data were thematically analyzed using NVivo software. RESULTS Three main themes emerged from the data. (1) In dealing with patients, participants expected respect but understood delays in seeing physicians due to their busy schedules. In communication, participants expected to be informed about their health conditions and to have their questions answered. (2) In dealing with tasks, participants expected proper examination and transparency of diagnosis, but some expected the physician to know everything and did not appreciate them seeking outside opinions. They expected to see the same physician at every visit. (3) In physician characteristics preferences, participants preferred friendly smiling physicians. Some cared about the outer appearance of the physician whereas others did not. DISCUSSION/CONCLUSIONS The findings of the study explained only two themes of the four gates model namely dealing with patients and dealing with tasks. Cultural competence and how to benefit from patients' perceptions to be an ideal physician should be incorporated into the process of physicians' training.
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Affiliation(s)
- Eiad AlFaris
- Department of Family and Community Medicine, College of Medicine, King Saud University Chair for Medical Education Research and Development, King Saud University, Riyadh, Saudi Arabia.
| | - Farhana Irfan
- Department of Family and Community Medicine, College of Medicine, King Saud University Chair for Medical Education Research and Development, King Saud University, Riyadh, Saudi Arabia
| | - Noura Abouammoh
- Department of Family and Community Medicine, College of Medicine, King Saud University Chair for Medical Education Research and Development, King Saud University, Riyadh, Saudi Arabia
| | - Nasriah Zakaria
- Ehealth Unit, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
- College of applied science, Al maarefa university Riyadh Saudi Arabia, Riyadh, Saudi Arabia
| | - Abdullah Ma Ahmed
- Department of Family and Community Medicine, College of Medicine, King Saud University Chair for Medical Education Research and Development, King Saud University, Riyadh, Saudi Arabia
| | - Omar Kasule
- Academic and Training Affairs, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Dina M Aldosari
- King Khalid Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Nora A AlSahli
- King Khalid Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed Ghatar Alshibani
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Gominda Ponnamperuma
- Department of Medical Education, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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Aggarwal D, Roy-Chowdhury M, Xiang N, Peacock SJ. Applications to medical and surgical specialist training in the UK National Health Service, 2021-2022: a cross-sectional observational study to characterise the diversity of successful applicants. BMJ Open 2023; 13:e069846. [PMID: 37076164 PMCID: PMC10186087 DOI: 10.1136/bmjopen-2022-069846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/21/2023] Open
Abstract
OBJECTIVES To compare success of applicants to specialty training posts in the UK by gender, ethnicity and disability status. DESIGN Cross-sectional observational study. SETTING National Health Service, UK. PARTICIPANTS All specialty training post applications to Health Education England, UK, during the 2021-2022 recruitment cycle. INTERVENTION Nil. PRIMARY AND SECONDARY OUTCOME MEASURES Comparison of success at application to specialty training posts by gender, ethnicity, country of qualification (UK vs non-UK) and disability. The influence of ethnicity on success was investigated using a logistic regression model, where country of qualification was included as a covariate. RESULTS 12 419/37 971 (32.7%) of applicants to specialty training posts were successful, representing 58 specialties. The difference in percentage of successful females (6480/17 523, 37.0%) and males (5625/19 340, 29.1%) was 7.9% (95% CI 6.93% to 8.86%), in favour of females. Segregation of applications to specialties by gender was observed; surgical specialties had the highest proportion of male applicants, while obstetrics and gynaecology had the highest proportion of female applicants. The proportion of successful recruits to specialties largely reflected the number of applications. 11/15 minority ethnic groups (excluding 'not stated') had significantly lower adjusted ORs for success compared with white-British applicants. 'Mixed white and black African' (OR 0.52, 95% CI 0.44 to 0.61, p≤0.001) were the least successful minority group in our study, while non-UK graduates had an adjusted ORs for success of 0.43 (95% CI 0.41 to 0.46, p≤0.001) compared with UK graduates. The difference in percentage of success by disabled applicants (179/464, 38.6%) and non-disabled applicants (11 940/36 418, 32.8%) was 5.79% (95% CI 1.23% to 10.4%), in favour of disabled applicants. No disabled applicants were accepted to 21/58 (36.2%) of specialties. CONCLUSIONS Despite greater success by female applicants overall, there is an attraction issue to specialties by gender. Further, most ethnic minority groups are less successful at application when compared with white-British applicants. This requires continuous monitoring and evaluation of the reasons behind observed differences. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Dinesh Aggarwal
- Department of Medicine, University of Cambridge, Cambridge, UK
- Wellcome Sanger Institute, Hinxton, UK
| | | | - Nicola Xiang
- Imperial College Healthcare NHS Trust, London, UK
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Srajer A, Wylie M, Zaver F, Lonergan K, Brain P, Lang E. Emergency physician gender is associated with early pregnancy loss management: a multisite retrospective cohort study. Emerg Med J 2023; 40:242-247. [PMID: 36868812 DOI: 10.1136/emermed-2021-212214] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 02/05/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND Patients experiencing early pregnancy loss often first present to the emergency department (ED) where they can be managed non-operatively through expectant or medical management, or surgically by the obstetrical team. Studies have reported that physician gender can influence clinical decision making, but there is limited research on this phenomenon in the ED. The objective of this study was to determine whether emergency physician gender is associated with early pregnancy loss management. METHODS Data were retrospectively collected from patients who presented to Calgary EDs with a non-viable pregnancy from 2014 to 2019. Pregnancies >12 weeks gestational age were excluded. The emergency physicians included saw at least 15 cases of pregnancy loss over the study period. The primary outcome was obstetrical consult rates by male versus female emergency physicians. Secondary outcomes included rates of initial surgical evacuation via dilation and curettage (D&C) procedures, ED returns, returns to care for D&Cs and total D&C rates. Data were analysed using χ2, Fisher's exact and Mann-Whitney U tests, as appropriate. Multivariable logistic regression models accounted for physician age, years of practice, training programme and type of pregnancy loss. RESULTS 98 emergency physicians and 2630 patients from 4 ED sites were included. 76.5% of the physicians were male accounting for 80.4% of pregnancy loss patients. Patients seen by female physicians were more likely to receive an obstetrical consultation (adjusted OR (aOR) 1.50, 95% CI 1.22 to 1.83) and initial surgical management (aOR 1.35, 95% CI 1.08 to 1.69). ED return rates and total D&C rates were not associated with physician gender. CONCLUSION Patients seen by female emergency physicians had higher rates of obstetrical consultation and initial operative management compared with those seen by male emergency physicians, but outcomes were similar. Additional research is required to determine why these gender differences exist and how these discrepancies may impact the care of early pregnancy loss patients.
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Affiliation(s)
- Amelia Srajer
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Megg Wylie
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Fareen Zaver
- Department of Emergency Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Philippa Brain
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada
| | - Eddy Lang
- Department of Emergency Medicine, University of Calgary, Calgary, Alberta, Canada
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15
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Mehta A. Challenges Facing Women in Sexual Medicine. J Sex Med 2022; 19:1502-1505. [DOI: 10.1016/j.jsxm.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 07/07/2022] [Accepted: 07/18/2022] [Indexed: 11/25/2022]
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Alkhaldi LM, Alsulaimani AI, Altalhi WA, Alghamdi GM, Alqurashi NN, Abdelrahman TM. Population Preference of Surgeon's Gender for Surgical Care and Their Attitudes Toward Female Surgeons in Taif, Saudi Arabia. Cureus 2022; 14:e28017. [PMID: 36120246 PMCID: PMC9473674 DOI: 10.7759/cureus.28017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction One contributing factor that has led to a reduction in the number of females entering the profession of surgery is discrimination against female surgeons. Little is known about the practices, attitudes, and perceptions of the Saudi population toward gender discrimination in the field of surgery. The aim of this study was to assess the practices, attitudes, and perceptions of the Taif population in choosing a surgeon based on their gender. Materials and methods An online pretested questionnaire was randomly sent to the participants living in Taif city. Collected data were subjected to scrutiny to check participants' study inclusion criteria. All the data were subjected to statistical analysis by an independent biostatistician. Pearson's chi-square test was used to search for a statistically significant association between categorical variables. Results About 49.5% of the participants preferred a surgeon of the same gender when consulting for a non-emergency visit to a surgery clinic, whereas females significantly preferred a female surgeon (p < 0.001). The most common reason to choose surgeons of the same gender was comfort, followed by ease of talking. About 71.8% of the participants preferred female surgeons for ''sensitive'' surgical cases such as genital, obstetric, or sexual disorders, whereas 12.1% preferred male surgeons. Conclusion Females have shown progress in the field of surgery, but there is still much to be done to convert the surgical workplace to be more supportive of women so that they contribute their best effort.
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Galhotra S, Smith RB, Norton T, Mahnert ND. The surgical gender gap: the impact of surgeon gender in medicine and gynecologic surgery. Curr Opin Obstet Gynecol 2022; 34:256-261. [PMID: 35895969 DOI: 10.1097/gco.0000000000000788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize the current literature evaluating the effect of surgeon gender on patient outcomes and satisfaction, and the impact of gender bias on female surgeons. RECENT FINDINGS The proportion of female physicians has increased in recent years, especially in Obstetrics and Gynecology. Recent literature assessing this impact supports equivalent or superior medical and surgical outcomes for women surgeons and physicians. It also reveals superior counseling and communication styles as perceived by patients. However, women in medicine receive lower patient ratings in competence, medical knowledge, and technical skills despite the existing evidence. Additionally, female physicians experience pay inequality, limited advancement opportunities, higher prevalence of microaggressions, and higher rates of burnout. SUMMARY Recognition of gender bias is essential to correcting this issue and improving the negative impact it has on female physicians, our patients, and the field of women's health.
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Affiliation(s)
- Sheena Galhotra
- Banner University Medical Center Phoenix, University of Arizona College of Medicine Phoenix, Phoenix, Arizona, USA
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18
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Engler ID, Ahrendt GM, Curley AJ, Musahl V. Surgeon Personality, Time Spent With the Patient, and Quality of Facilities Are the Most Important Factors to Patients in Selecting an Orthopaedic Sports Medicine Surgeon. Arthrosc Sports Med Rehabil 2022; 4:e1023-e1029. [PMID: 35747634 PMCID: PMC9210365 DOI: 10.1016/j.asmr.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/16/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose To determine the most important factors to patients across the United States in selecting an orthopaedic sports medicine surgeon. Methods In this cross-sectional survey study, adult U.S. residents were surveyed using Amazon Mechanical Turk, a validated survey tool. Data included demographics and the relative importance of both pre-office and in-office factors that determine how patients select an orthopaedic sports medicine surgeon. Results were compiled, and factors were compared by patient demographics. Results Of 1,074 respondents, 56.3% were male, and 60.0% were 25 to 40 years old. Responses were geographically diverse. The most important factors in selecting a sports medicine surgeon (graded on a 0-10 scale) were surgeon professionalism and personality (6.6), quality of the hospital/office facilities (6.4), and how much time the surgeon spends with the patient (6.4). Each of these in-office factors were more important than pre-office factors, the most important of which were reputation of the surgeon’s hospital or group (6.3), surgeon’s reviews on medical review websites (6.2), and surgeon’s educational background (6.0). The least important factors were surgeon’s sex (3.7), marketing of the surgeon (4.2), and surgeon’s social media accounts (4.3). A social media account was taken into consideration at least “a little” by nearly two-thirds of respondents. The most preferred surgeon personality was a balance of professional and lighthearted (66.9%), with strictly professional (27.6%) or largely lighthearted (5.6%) less preferred. Conclusions The most important factors to patients in selecting their orthopaedic sports medicine surgeon, regardless of patient sex, race, or geography, are related to the patient’s in-office experience, including surgeon’s professionalism/personality, how much time the surgeon spends with the patient, and quality of the hospital/office facilities. Surgeons should consider prioritizing a professional office environment and taking the time to get to know patients for the benefit of their patients and their practice. Clinical Relevance The market for orthopaedic sports medicine surgeons is competitive. It is important to know what qualities of a surgeon and his or her practice are important to patients.
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Perche PO, Ranpariya VK, Swali RN, Clarey DD, Wysong A, Feldman SR. Patient willingness to receive full-body skin exams based on the sex and/or gender and training level of provider: a survey study. Clin Exp Dermatol 2022; 47:1853-1856. [PMID: 35546559 DOI: 10.1111/ced.15260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2022] [Indexed: 11/27/2022]
Abstract
Full-body skin exams (FBSE) involve examination of patients' skin from head to toe and may be uncomfortable for some patients. While many patients prefer same-sex providers for pelvic, genital, and rectal exams, desire for same-sex providers for FBSEs is not well characterized. This may be further magnified when FBSEs are performed by medical trainees. We surveyed 566 subjects using Amazon Mechanical Turk (MTurk), an online crowdsourcing platform, to assess the public's willingness to receive FBSEs based on the sex and/or gender of provider and level of training. Overall willingness by all respondents to receive FBSEs by a dermatologist, dermatology resident, and medical student of same sex/gender was respectively 84.3%, 77.5%, 65.7%, compared with 60.6%, 54.8%, 45.7%, for providers of a different sex/gender (P <.001). In our cohort, unwillingness for FBSEs was greater when performed by providers of a different gender/sex, in female patients, and when performed by medical students.
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Affiliation(s)
- Patrick O Perche
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North, Carolina, USA
| | - Varun K Ranpariya
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North, Carolina, USA.,Department of Dermatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Ritu N Swali
- Department of Dermatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Dillon D Clarey
- Department of Dermatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Ashley Wysong
- Department of Dermatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North, Carolina, USA.,Department of Pathology, Wake Forest School of Medicine, Winston-Salem, North, Carolina, USA.,Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, North, Carolina, USA
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Responding to patient requests for women obstetrician-gynecologists. Am J Obstet Gynecol 2022; 226:678-682. [PMID: 34762865 DOI: 10.1016/j.ajog.2021.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 10/18/2021] [Accepted: 11/01/2021] [Indexed: 11/24/2022]
Abstract
Patients may request care from a woman obstetrician-gynecologist for various reasons, including privacy concerns, religious or cultural reasons, and in some cases, a history of abuse. They should be given the opportunity to voice their reasons for requesting a woman obstetrician-gynecologist but should not be compelled to do so. Respect for patient autonomy is a compelling reason to consider honoring a patient's gender-based request. When a patient requests a woman obstetrician-gynecologist, efforts should be made to accommodate the request if possible. However, medical professionals and institutions are not ethically obligated to have a woman obstetrician-gynecologist on call or to make one available at all times. If it is not feasible for a woman obstetrician-gynecologist to provide care because of staffing or other system constraints or patient safety concerns, accommodation is not required, and physicians do not have an overriding responsibility to ensure that patients receive gender-concordant care. Patients have the right to decline care and may choose to seek care elsewhere if their requested healthcare provider type is not available. Institutions and medical clinics should have policies and procedures in place for managing patient requests for women obstetrician-gynecologists, and patients should be made aware of these policies preemptively. These policies and procedures should include information about whom to contact for assistance and how to document the encounter. They should also be accessible and familiar to physicians and trainees. Care should be taken to ensure that adequate educational opportunities in obstetrics and gynecology are available for all medical trainees, regardless of gender.
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21
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Lin PL, Huang JP, Fujii T, Cho EH, Huang MC. A survey of specialty choice among obstetrics and gynecology residents in Japan, Korea, and Taiwan. J Obstet Gynaecol Res 2022; 48:1968-1977. [PMID: 35474372 DOI: 10.1111/jog.15274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 04/17/2022] [Indexed: 11/29/2022]
Abstract
AIM The percentage of medicine graduates opting for residency in obstetrics and gynecology (OB/GYN) has been decreasing in developed countries, including in Taiwan, Japan, and Korea. This multicountry study surveyed the OB/GYN residents affiliated with the Taiwan Association of Obstetrics and Gynecology (TAOG), the Japanese Society of Obstetrics and Gynecology (JSOG), and the Korean Society of Obstetrics and Gynecology (KSOG) to evaluate the factors affecting the choice of pursing OB/GYN. METHODS A 17-item questionnaire surveying the factors influencing the choice of pursuing a major medical specialty was translated into Japanese, Korean, and Chinese and administered to postgraduate OB/GYN residents between July 1, 2020, and August 31, 2020. Data on the participants' sex, age, and level of residency were collected. Responses were compared between countries and sexes. RESULTS Residents of all three countries chose OB/GYN based on personal interest, and a sense of accomplishment in saving people's life. Other positive factors include improved quality of life; higher salaries; and more opportunity for new techniques, research, and promotion. The negative factors included medical litigations, longer work hours, and unsafe working environments. Korean residents had lower ratings in several items, including "support from family," "safety of working environment," and "effectiveness of the alternative dispute resolution system," which, unlike Japan and Taiwan, is not a no-fault compensation system for childbirth accidents. CONCLUSIONS The study findings can guide strategy making, such as decreasing workload and yet maintain training quality, to increase the number of medical students pursuing OB/GYN residency.
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Affiliation(s)
- Ping-Lun Lin
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Jian-Pei Huang
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Tatsuya Fujii
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Eun H Cho
- Department of Obstetrics and Gynecology, Ewha Womans University Seoul Hospital, Ewha Womans University, Seoul, South Korea
| | - Ming-Chao Huang
- Department of Obstetrics and Gynecology, HsinChu MacKay Memorial Hospital, HsinChu, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
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Gärtner J, Bußenius L, Schick K, Prediger S, Kadmon M, Berberat PO, Harendza S. Validation of the ComCare index for rater-based assessment of medical communication and interpersonal skills. PATIENT EDUCATION AND COUNSELING 2022; 105:1004-1008. [PMID: 34389227 DOI: 10.1016/j.pec.2021.07.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/12/2021] [Accepted: 07/29/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To develop and validate a short instrument to assess undergraduate medical students' communication and interpersonal skills in videographed history taking situations with simulated patients. METHODS Sixty-seven undergraduate medical students participating in an assessment including videographed physician-patient encounters for history taking with five simulated patients were included in this study. The last video of each participant's consultation hour was rated by two independent assessors with the eight-item ComCare index for assessment of communication and interpersonal skills newly designed for the external rater perspective (ComCareR). We compared the sum scores of the ComCareR with ratings of the same videos with the Kalamazoo Communication Skills Assessment Form from an observational perspective (KCSAFd-video) and the Global Rating scale (GR), which also measure communication and interpersonal skills. RESULTS The ComCareR showed an excellent interrater reliability (ICC = .85). We found a small but significant correlation with the KCSAFd-video Interpersonal Competence (ρ = .34, 95% CI [.10,.54]) and a high positive correlation with the GR (ρ = .59, 95% CI [.40,.73]). CONCLUSIONS The ComCareR is a valid and brief index for holistic assessment of communication and interpersonal skills in physician-patient encounters. PRACTICE IMPLICATIONS The ComCareR can be used for quick rater-based assessment of physicians' communication and interpersonal skills.
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Affiliation(s)
- Julia Gärtner
- III. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lisa Bußenius
- Department of Biochemistry and Molecular Cell Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kristina Schick
- TUM Medical Education Center, Technical University of Munich, Munich, Germany
| | - Sarah Prediger
- III. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martina Kadmon
- Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Pascal O Berberat
- TUM Medical Education Center, Technical University of Munich, Munich, Germany
| | - Sigrid Harendza
- III. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Jin YP, Canizares M, Buys YM. Differences by sex in supply, payments and clinical activity of family physicians in Ontario: a retrospective population-based cohort study. CMAJ Open 2022; 10:E420-E429. [PMID: 35580888 PMCID: PMC9188800 DOI: 10.9778/cmajo.20210068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The proportion of women entering medicine has increased in recent years, and understanding the different practice patterns of female and male family physicians (FPs) will provide important information for health workforce planning. We sought to evaluate differences by sex in the supply, payments and clinical activity among FPs in Ontario. METHODS We conducted a cohort study using claims data from the Ontario Health Insurance Plan. We included all Ontario FPs who submitted claims from 1992 to 2018. We analyzed data using regression analyses for our outcomes of yearly number of FPs, payments, patient visits and distinct patients. RESULTS The number of practising FPs increased from 10 370 in 1992 to 14 329 in 2018, with an annual increase of 155 female FPs and 13 male FPs. In 2018, male FPs outnumbered female FPs by 1159. Among male FPs, 32.7% worked less than 1 full-time equivalent (FTE) position, 18.1% worked 1 FTE and 49.2% worked more than 1 FTE, with little change over the 27-year study period. Among female FPs, the percentage of those who worked less than 1 FTE position decreased over time (58.6% in 1998 to 48.3% in 2015), those who worked 1 FTE was stable (22.2%-24.3%) and those who worked more than 1 FTE increased (18.7% in 1998 to 28.0% in 2017). Yearly payments were higher for male FPs than female FPs by 40%-60% overall and by 10%-20% in FPs who worked more than 1 FTE. For FPs who worked 1 FTE or less than 1 FTE, both sexes had similar payment amounts (from 2005-2018). For FPs who worked 1 FTE, female FPs were less likely to receive payments from fee-for-service after 2004, and had 550 fewer visits and 121 fewer patients annually than male FPs. INTERPRETATION In Ontario, there are differences by sex in FP supply, payments, percentages of FTE groups, number of patient visits and number of distinct patients. Health administrators should be mindful of these differences when considering FP workforce plans to ensure a stronger primary health care system, with adequate health care delivery for the population.
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Affiliation(s)
- Ya-Ping Jin
- Department of Ophthalmology and Vision Sciences (Jin, Buys) and Dalla Lana School of Public Health (Jin), University of Toronto; Schroeder Arthritis Institute (Canizares), Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, Ont.
| | - Mayilee Canizares
- Department of Ophthalmology and Vision Sciences (Jin, Buys) and Dalla Lana School of Public Health (Jin), University of Toronto; Schroeder Arthritis Institute (Canizares), Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, Ont
| | - Yvonne M Buys
- Department of Ophthalmology and Vision Sciences (Jin, Buys) and Dalla Lana School of Public Health (Jin), University of Toronto; Schroeder Arthritis Institute (Canizares), Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, Ont
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Alsafar FA, Tehsin F, Alsaffar KM, Albukhaytan WA. Physicians' Gender Influence on the Patients' Choice of Their Treating Obstetrician-Gynecologist in the Eastern Province of Saudi Arabia. Cureus 2022; 14:e23457. [PMID: 35481330 PMCID: PMC9034848 DOI: 10.7759/cureus.23457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction Several studies have investigated the gender preference of obstetricians-gynecologists (OB-GYNs) around the globe. Obstetrics and gynecology deal with female patients exclusively, and gender selection in this special female domain bears significant cultural and religious aspects in childbirth and gynecological conditions. Methods This cross-sectional study has investigated women’s gender preferences of their OB-GYN in the Eastern Province of Saudi Arabia and assessed the factors that influenced their choice. A total of 390 female participants above 18 years of age answered a self-reported questionnaire distributed on different social media platforms from June 2021 to August 2021. Results A majority of the study participants have preferred female OB-GYN for pelvic examination, primary health screening, antenatal care, and major gynecological surgery (92.6%, 72.8%, 68.2%, and 61%, respectively). Almost one-third (31.3%) of the study females reported that they would allow the presence of a male obstetrician in the labor room. The highest three ranked factors affecting a patient's decision for choosing the gender of the OB-GYN were physician’s knowledge and experience, embarrassment with a male physician, and easiness to talk about women's issues with a female physician. Conclusion The vast majority of women in this study are inclined to choose female OB-GYN in general situations, for cesarean section, and in emergency situations.
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Nguyen BT, Streeter LH, Reddy RA, Douglas CR. Gender bias in the medical education of obstetrician-gynaecologists in the United States: A systematic review. Aust N Z J Obstet Gynaecol 2022; 62:349-357. [PMID: 35293613 PMCID: PMC9310565 DOI: 10.1111/ajo.13511] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background The number of men entering obstetrics and gynaecology (Ob/Gyn) residencies and general Ob/Gyn practice is decreasing. Gender biases against their participation may affect career decisions. Objective This systematic review examines: (i) female patients’ gender preferences and perceptions of men as Ob/Gyns and/or medical students; and (ii) the influence of gender on students’ education and career decisions. Search strategy We identified relevant research via PubMed using variations of three concepts in combination: Ob/Gyn care, gender bias/preference, and medical education or career. We conducted the initial review in 2018 and repeated the search in March 2021, adding additional references via citation review of included research. Selection criteria We restricted the review to original research from the United States between 2000–2021. Data collection Fifteen studies met inclusion criteria, categorised into three groups: (i) patient’s gender preference for Ob/Gyns; (ii) patient’s gender preference for medical students during the Ob/Gyn clerkship; and (iii) influence of gender bias on Ob/Gyn career decisions. Main results Patients prioritised their physician’s care attributes (eg technical skill, compassion, experience) over gender when choosing Ob/Gyns; however, provider gender was prioritised for medical students. Male medical students more commonly reported exclusion from clinical opportunities, although objective clinical exposure was like that of female counterparts. Despite perceived gender bias, male medical students reported increased Ob/Gyn interest post‐clerkship; interest did not translate into residency applications. These findings are limited by study quality and heterogeneity. Conclusions Real and perceived gender bias among female patients and male medical students in Ob/Gyn may underlie declining numbers of men entering the field.
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Affiliation(s)
- Brian T Nguyen
- University of Southern California, Los Angeles, California, USA
| | - Laer H Streeter
- Department of Obstetrics and Gynecology at Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Ravali A Reddy
- Department of Obstetrics and Gynecology at the Stanford University School of Medicine, Stanford, California, USA
| | - Christopher R Douglas
- Los Angeles Medical Center, Department of Obstetrics and Gynecology at the University of California, Los Angeles, California, USA
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Decisional Conflict after Deciding on Potential Participation in Early Phase Clinical Cancer Trials: Dependent on Global Health Status, Satisfaction with Communication, and Timing. Cancers (Basel) 2022; 14:cancers14061500. [PMID: 35326653 PMCID: PMC8946532 DOI: 10.3390/cancers14061500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/10/2022] [Accepted: 03/12/2022] [Indexed: 02/04/2023] Open
Abstract
When standard treatment options are not available anymore, patients with advanced cancer may participate in early phase clinical trials. Improving this complex decision-making process may improve their quality of life. Therefore, this prospective multicenter study with questionnaires untangles several contributing factors to decisional conflict (which reflects the quality of decision-making) in patients with advanced cancer who recently decided upon early phase clinical trial participation (phase I or I/II). We hypothesized that health-related quality of life, health literacy, sense of hope, satisfaction with the consultation, timing of the decision, and the decision explain decisional conflict. Mean decisional conflict in 116 patients was 30.0 (SD = 16.9). Multivariate regression analysis showed that less decisional conflict was reported by patients with better global health status (β = −0.185, p = 0.018), higher satisfaction (β = −0.246, p = 0.002), and who made the decision before (β = −0.543, p < 0.001) or within a week after the consultation (β = −0.427, p < 0.001). These variables explained 37% of the variance in decisional conflict. Healthcare professionals should realize that patients with lower global health status and who need more time to decide may require additional support. Although altering such patient intrinsic characteristics is difficult, oncologists can impact the satisfaction with the consultation. Future research should verify whether effective patient-centered communication could prevent decisional conflict.
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Moslehpour M, Shalehah A, Rahman FF, Lin KH. The Effect of Physician Communication on Inpatient Satisfaction. Healthcare (Basel) 2022; 10:healthcare10030463. [PMID: 35326941 PMCID: PMC8954154 DOI: 10.3390/healthcare10030463] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 02/22/2022] [Accepted: 02/25/2022] [Indexed: 12/16/2022] Open
Abstract
(1) Background: The importance of physician-patient communication and its effect on patient satisfaction has become a hot topic and has been studied from various aspects in recent years. However, there is a lack of systematic reviews to integrate recent research findings into patient satisfaction studies with physician communication. Therefore, this study aims to systematically examine physician communication’s effect on patient satisfaction in public hospitals. (2) Methods: Using a keywords search, data was collected from five databases for the papers published until October 2021. Original studies, observational studies, intervention studies, cross-sectional studies, cohort studies, experimental studies, and qualitative studies published in English, peer-reviewed research, and inpatients who communicated with the physician in a hospital met the inclusion criteria. (3) Results: Overall, 11 studies met the inclusion criteria from the 4810 articles found in the database. Physicians and organizations can influence two determinants of inpatient satisfaction in physician communication. Determinants of patient satisfaction that physicians influence consist of amounts of time spent with the patient, verbal and nonverbal indirect interpersonal communication, and understanding the demands of patients. The organization can improve patient satisfaction with physician communication by the organization’s availability of interpreter service and physician workload. Physicians’ communication with inpatients can affect patient satisfaction with hospital services. (4) Conclusions: To improve patient satisfaction with physician communication, physicians and organizational determinants must be considered.
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Affiliation(s)
- Massoud Moslehpour
- Department of Business Administration, College of Management, Asia University, No. 500, Liufeng Road, Wufeng District, Taichung City 41354, Taiwan; (M.M.); (A.S.)
- Department of Management, California State University, San Bernardino, CA 92407, USA
| | - Anita Shalehah
- Department of Business Administration, College of Management, Asia University, No. 500, Liufeng Road, Wufeng District, Taichung City 41354, Taiwan; (M.M.); (A.S.)
- International Relations Department, Faculty of Economy, Bussines and Politics, Universitas Muhammadiyah Kalimantan Timur, Jl. Ir. H. Juanda No. 15, Samarinda 75124, Kalimantan Timur, Indonesia
| | - Ferry Fadzlul Rahman
- Department of Public Health, College of Public Health, Universitas Muhammadiyah Kalimantan Timur, Jl. Ir. H. Juanda No. 15, Samarinda 75124, Kalimantan Timur, Indonesia;
| | - Kuan-Han Lin
- Department of Healthcare Administration, College of Medical and Health Sciences, Asia University, No. 500, Liufeng Road, Wufeng District, Taichung City 41354, Taiwan
- Correspondence:
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Improving women's experiences of perineal suturing: A pragmatic qualitative analysis of what is helpful and harmful. Women Birth 2022; 35:e598-e606. [PMID: 35216938 DOI: 10.1016/j.wombi.2022.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND Perineal trauma requiring suturing is increasing, along with the associated physiological and psychological morbidities for women. Provider training appears to focus more on technical aspects rather than respectful, relational care for women. Studies exploring women's experiences have identified that how women are cared for can significantly impact upon overall experiences. AIM To identify areas of improvement to the perineal suturing process and provide robust recommendations for urgent change by investigating what aspects are most traumatic to women and which are most supportive. METHODS A pragmatic qualitative analysis of data generated from 15 in-depth interviews with women who were sutured following birth. FINDINGS Regardless of tear severity, what was identified as helpful included anything that made the process better by increasing feelings of trust and reassurance, and providing women with a sense of being seen and heard. Harmful experiences were identified as those that worsened the experience, by increasing feelings of fear and vulnerability and leaving women with a sense of being disregarded or disrespected. CONCLUSION The study confirmed that how the suturing process is conducted can have a significant detrimental impact upon women's short- and longer-term physical and psychological well-being. IMPLICATIONS FOR PRACTICE An improved experience for women is most likely with kind professionals who explain the process as it goes along, check-in regularly and validate how the women feel. Women prefer to be sutured by a known professional, only if this provider is also kind and respectful.
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Sledz M, Kanellos P. Wie viele Patientinnen wünschen nur eine Frauenärztin? Geburtshilfe Frauenheilkd 2022. [DOI: 10.1055/a-1394-1837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
| | - Panagiotis Kanellos
- Klinik für Gynäkologie und Geburtshilfe, Kantonsspital Uri, Altdorf, Schweiz
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Dagostini CM, Bicca YDA, Ramos MB, Busnello S, Gionedis MC, Contini N, Falavigna A. Patients' preferences regarding physicians' gender: a clinical center cross-sectional study. SAO PAULO MED J 2022; 140:134-143. [PMID: 35043868 PMCID: PMC9623840 DOI: 10.1590/1516-3180.2021.0171.r1.08062021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 06/08/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Even with the significant growth of female representation within medicine, inequality and prejudice against this group persist. OBJECTIVE To analyze patients' preferences regarding the gender of physicians in general and according to different specialties, and the possible reasons behind their choice. DESIGN AND SETTING Cross-sectional study at the Clinical Center of the University of Caxias do Sul, Brazil. METHODS Over a three-month period in 2020, 1,016 patients were asked to complete a paper-based 11-item questionnaire. RESULTS The majority (81.7%; n = 830) of the patients did not have a preference regarding the gender of physicians in general. The preference rate for same-gender physicians was 14.0% (n = 142/1,016), and this preference was more common among female than among male patients (17.6% versus 7.0%; odds ratio, OR = 2.85; 95% confidence interval, CI = 1.80-4.52; P < 0.001). When asked about their preference for the gender of the specialist who they were waiting to see, the overall preference rate for a same-gender professional was 17.2% (n = 175). Preference for same-gender specialists was higher for specialties essentially based on pelvic or breast examination (i.e. gynecology, urology, proctology and mastology), compared with others (33.4% versus 9.7%; OR = 4.69; 95% CI = 3.33-6.61; P < 0.001). CONCLUSIONS The patients' model for choice of their physician does not seem to involve physicians' gender in general or in the majority of medical specialties. The data presented in this study may make it easier to understand patients' preferences and concerns.
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Affiliation(s)
- Carolina Matté Dagostini
- Undergraduate Medical Student, Department of Neurosurgery, Universidade de Caxias do Sul (UCS), Caxias do Sul (RS), Brazil.
| | - Yan De Assunção Bicca
- Undergraduate Medical Student, Department of Neurosurgery, Universidade de Caxias do Sul (UCS), Caxias do Sul (RS), Brazil.
| | - Miguel Bertelli Ramos
- Undergraduate Medical Student, Department of Neurosurgery, Universidade de Caxias do Sul (UCS), Caxias do Sul (RS), Brazil.
| | - Sabrina Busnello
- Undergraduate Medical Student, Department of Neurosurgery, Universidade de Caxias do Sul (UCS), Caxias do Sul (RS), Brazil.
| | - Murillo Cesar Gionedis
- Undergraduate Medical Student, Department of Neurosurgery, Universidade de Caxias do Sul (UCS), Caxias do Sul (RS), Brazil.
| | - Natália Contini
- Undergraduate Medical Student, Department of Neurosurgery, Universidade de Caxias do Sul (UCS), Caxias do Sul (RS), Brazil.
| | - Asdrubal Falavigna
- MD, MSc, PhD. Coordinator, Health Sciences Undergraduate Program, Universidade de Caxias do Sul (UCS), Caxias do Sul (RS), Brazil.
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Makowska M, Sillup GP. Gender differences in the medical industries’ payments to physicians: a systematic review. INTERNATIONAL JOURNAL OF PHARMACEUTICAL AND HEALTHCARE MARKETING 2021. [DOI: 10.1108/ijphm-04-2020-0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This paper aims to explore gender differences in payments made to physicians by the pharmaceutical and medical device industries via the performance of a systematic review of articles based on the Open Payments Database (OPD).
Design/methodology/approach
Three databases (Scopus, Web of Science and PubMed) were searched for articles published from September 30, 2014 to May 10, 2019, using two search terms: “Sunshine Act” and “Open Payments.” The systematic review is reported according to preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines.
Findings
The search identified 359 abstracts. Thirty-nine articles were selected for full review, and 17 of these met the inclusion criteria. Although the articles considered are based on the same database, they adopt diverse approaches and analyses are conducted in different ways. A substantial proportion of the studies show total payments from the two industries to be higher for male physicians than for female physicians. However, a few exceptions exist, higher female mean or median values occurring for payments involving research, ownership, honoraria, grants, royalties/licenses and travel/lodgings. Also, in the case of obstetric–gynecological specializations, a higher proportion of women than men are shown to cooperate with the industries.
Originality/value
There is gender inequality in terms of industries’ funding for doctors. While analyses of secondary OPD data show that a gender inequality exists, they do not provide an understanding of why this occurs. However, from the exceptions identified, it can be speculated that this phenomenon is connected with greater adherence to ethical standards on the part of female physicians and/or the likelihood that fewer opportunities for industrial cooperation are extended to them.
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Wishart D, Cruz Alvarez C, Ward C, Danner S, O'Brian CA, Simon M. Racial and Ethnic Minority Pregnant Patients with Low-Income Experiences of Perinatal Care: A Scoping Review. Health Equity 2021; 5:554-568. [PMID: 34909522 PMCID: PMC8665802 DOI: 10.1089/heq.2021.0017] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2021] [Indexed: 11/12/2022] Open
Abstract
Purpose: The maternal mortality ratio for the United States (US) has consistently risen over recent decades. This mortality is especially pronounced within minority populations who experience a maternal mortality and morbidity rate that are much higher than their non-Hispanic white counterparts. Qualitative data are critical in gaining true insight from minority pregnant and postpartum persons. Such data should serve as the basis for building interventions and programs that seek to eradicate perinatal inequities. This review examines the qualitative literature on racial and ethnic minority pregnant patients with low income and their experiences during perinatal care (PNC) to identify recurrent themes that can be addressed through targeted interventions. Methods: PubMed, CINAHL, and Web of Science databases were searched for qualitative studies on racial and ethnic minority pregnant patients with low income and their experiences during PNC. Twenty-two articles were included for analysis. Thematic synthesis was performed to identify categories and recurring themes in each article. Results: Five major categories were identified as consistent experiences of pregnant patients with PNC clinicians: support, education, connection, communication, and trust. Of these, clinician support was the most consistently coded category. Eighteen of the 23 articles discussed tangible support patients had received from their clinicians, such as care coordination and referrals to support services. The second most coded category was education, which was represented in 16 articles. Education was mostly represented negatively as lack of adequate perinatal care education given during the perinatal period. Finally, the categories of connection, communication, and trust were represented by 18, 17, and 17 articles, respectively. Conclusions: These qualitative studies provided specific examples of what racial and ethnic minority pregnant patients with low income deemed positive and negative during the perinatal period and outline ways that these experiences can be improved. Future studies can take the experiences reported in this review to help inform interventions to improve patient experiences and health outcomes that minority persons face in the perinatal period.
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Affiliation(s)
- Danielle Wishart
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA.,Center for Health Equity Transformation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Cindy Cruz Alvarez
- Center for Health Equity Transformation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA
| | - Carmenisha Ward
- Center for Health Equity Transformation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Sankirtana Danner
- Center for Health Equity Transformation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Catherine A O'Brian
- Center for Health Equity Transformation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Melissa Simon
- Center for Health Equity Transformation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois, USA
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Cheng W, Lin SY, Fan YH, Chen SW. Retrospective study of the differences in patient characteristics and revenue between male and female surgeons in Taiwan. Sci Rep 2021; 11:23744. [PMID: 34887512 PMCID: PMC8660838 DOI: 10.1038/s41598-021-03289-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 11/30/2021] [Indexed: 11/09/2022] Open
Abstract
Surgery is traditionally a male-dominated field, and gender differences exist despite the growing numbers of female surgeons. A handful of studies have evaluated the condition in Asian societies. We aimed to examine the difference between female and male surgeons in urology, general surgery, and gynecology by analyzing a nationwide, population-based database. We identified surgeons with a clinical experience of six to thirteen years between 1995 to 2013 from the National Health Insurance Research Database. We collected patient numbers and revenue per month in outpatient and inpatient care, as well as monthly numbers of surgeries conducted by female and male surgeons in urology, general surgery, and gynecology, for analysis. Original student’s t-test and wilcoxon rank sum test was used to compare the differences between female and male surgeons, and p values less than 0.05 were considered statistically significant. Female urologists and general surgeons had a significantly higher ratio of female patients in Taiwan. Female urologists had patient numbers, revenues, and numbers of surgeries comparable to male urologists. In contrast, female general surgeons had significantly less involvement in outpatient and inpatient care and had low monthly revenues. Female general surgeons contradictorily performed more oncological surgeries per month than males. However, the difference in numbers of oncological surgeries was not significant after excluding breast cancer surgeries. Female gynecologists had a similar amount of outpatients and outpatient revenue but significantly less inpatient care and numbers of surgeries per month. A gender-based gap exists among surgeons in Taiwan. The gap between females and males appeared narrower in urology than in general surgery and gynecology. Management of diseases related to female sex organs, including breast, were more common among female surgeons. Efforts should be made to decrease gender stereotypes, to ensure that patients receive the best care regardless of the sex of the surgeons.
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Affiliation(s)
- Weiming Cheng
- Division of Urology, Department of Surgery, Taipei City Hospital, Zhongxiao Branch, Taipei, Taiwan.,Program in Molecular Medicine, School of Life Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Biopharmaceutical Science, School of Life Science, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Urology, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shu-Yi Lin
- Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
| | - Yu-Hua Fan
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan. .,Program in Molecular Medicine, School of Life Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Sheng-Wen Chen
- Division of Urology, Department of Surgery, Taipei City Hospital, Zhongxiao Branch, Taipei, Taiwan. .,Urological Center, No.87, Tongde Road, Nangang District, Taipei, 11556, Taiwan.
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Marshall-Aiyelawo K, Gliner M, Pedraza O, Beekman J, Messinger S, Roshwalb A. Patient Experience in Obstetrics in a Military Patient Satisfaction Survey: Findings and Recommendations for Improvement. Mil Med 2021; 188:e1207-e1213. [PMID: 34741452 DOI: 10.1093/milmed/usab431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 08/20/2021] [Accepted: 10/13/2021] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION This study examines the care experience of obstetric patients within the Military Health System and compares them to those of medical and surgical care patients. Specifically, the study seeks to (1) examine how obstetric inpatient experience ratings differ from medical and surgical inpatient experience ratings, (2) understand specific aspects of care that drive overall experience ratings within this population, (3) test whether adherence to nursing practices such as hourly rounding and nurse leader visits affect experience ratings, and (4) describe ways that patient experience information can be presented to healthcare providers to improve performance. MATERIALS AND METHODS Data for this study include Military Health System patient experience survey data (based on the Hospital Consumer Assessment of Healthcare Providers and Systems) collected from 2011 through 2019. Analysis includes data collected from 338,124 patients aged 18 years and older. Our analysis involved z-test comparisons of patient experience measure scores, trend analysis, logistic regression-based driver analysis, and correlations. RESULTS Obstetric ratings are generally lower than those of medical and surgical patients; however, they have been improving at a slightly faster rate year over year. Effective nurse communications with patients are a particularly strong driver for improving their overall care experiences, and practices like hourly nurse rounding, nurse leader visits, and nurse-patient shift change conversations are positively correlated with obstetric patient experience ratings. CONCLUSIONS This study contextualizes how obstetric inpatient experience ratings differ from those of medical and surgical care patients. Healthcare administrators and policymakers should be aware that obstetric patients may have unique needs and expectations that lead to patient experience ratings differing from those of medical and surgical patients. Effective nurse-patient communications, hourly rounding, nurse leader visits, and nurse-patient shift change conversations could be strategies used to improve obstetric experience ratings.
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Prasad T, Buta E, Cleary PD. Is Patient-Physician Gender Concordance Related to the Quality of Patient Care Experiences? J Gen Intern Med 2021; 36:3058-3063. [PMID: 33469761 PMCID: PMC8481522 DOI: 10.1007/s11606-020-06411-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 12/07/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is great interest in identifying factors that are related to positive patient experiences such as physician communication style. Documented gender-specific physician communication and patient behavior differences raise the question of whether gender concordant relationships (i.e., both the provider and patient share the same gender) might affect patient experiences. OBJECTIVE Assess whether patient experiences are more positive in gender concordant primary care relationships. DESIGN Statewide telephone surveys. Linear mixed regression models to estimate the association of CAHPS scores with patient gender and gender concordance. SUBJECTS Two probability samples of primary care Medicaid patients in Connecticut in 2017 (5/17-7/17) and 2019 (7/19-10/19). MAIN MEASURES Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) survey augmented with questions about aspects of care most salient to PCMH-designated organizations and two questions to assess access to mental health services. KEY RESULTS There were no significant effects of gender concordance and differences in experiences by patient gender were modest. CONCLUSIONS This study did not support the suggestion that patient and physician gender and gender concordance have an important effect on patient experiences.
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Affiliation(s)
| | - Eugenia Buta
- Yale Center for Analytical Studies, Yale School of Public Health, PO Box 208034, New Haven, CT, 06520-8034, USA
| | - Paul D Cleary
- Anna M.R. Lauder Professor of Public Health, Department of Health Policy and Management, Yale School of Public Health, PO Box 208034, New Haven, CT, 06520-8034, USA.
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Igler E, Lang A, Balistreri K, Sejkora E, Drendel A, Davies WH. Parents Reliably Identify Pain Dismissal by Pediatric Providers. Clin J Pain 2021; 36:80-87. [PMID: 31764165 DOI: 10.1097/ajp.0000000000000776] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Approximately 40% of children and adolescents with chronic pain report at least 1 dismissal experience, citing medical providers and parents as the primary and most distressing dismissers. Previous research indicates sex differences in pain dismissal experience and observer pain perception. This study examined parental reactions to dismissive provider-child scenarios and the influence of provider and patient sex on perceptions. METHODS Community parents (N=326) completed an online survey. Parents were randomized to listen to 1 of 8 vignettes of a provider-child chronic pain scenario. Vignettes varied by type of scenario (appropriate vs. dismissive)×provider sex×patient sex. RESULTS Overall, parents rated the dismissive scenario more negatively. There was a significant interaction between provider sex and scenario regarding likelihood to bring their own child to this provider and a significant 3-way interaction regarding provider belief of the pain complaint. When asked how they would feel if this was their own child, parents who heard the dismissive scenario reported more negative reactions. When asked what they would say to the provider, parents in the dismissive condition were more likely to defend their child and request a second opinion. DISCUSSION Parents consistently identified the dismissive language in a child and provider scenario. Female providers and sex-matched dyads seem to be more polarizing in terms of likelihood to bring their child to the provider and belief of pain, respectively. Providers within these groups may need to be especially cautious with their language when responding to pediatric chronic pain complaints.
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Affiliation(s)
- Eva Igler
- Department of Psychology, University of Wisconsin-Milwaukee
| | - Amy Lang
- Department of Psychology, University of Wisconsin-Milwaukee
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Tsai CH, Hsieh CH, Huang JP, Lin PL, Kuo TC, Huang MC. A survey of career-decision factors for obstetrics and gynecology residents in Taiwan. Taiwan J Obstet Gynecol 2021; 60:628-633. [PMID: 34247799 DOI: 10.1016/j.tjog.2021.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2021] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE The recruitment of obstetrics and gynecology residents has been challenging in Taiwan since 2000. There are a lots factors influencing applying, including career interest and prospects, lifestyle, salary, litigation, stress level, time demands of specialty work and gender consideration. The purpose of this study was to evaluate the factors influencing the career choice of current OB/GYN residents and identify the important factors influencing recruitment. MATERIALS AND METHODS A cross-sectional questionnaire of career-decision factors was sent to all 280 residents during December, 2019. Total 16 factors were rated on a 5-point Likert and were ranking by their average score on the scale. Gender of residents was analyzed for their association with the scores by a two-sample test and two-tailed t test. RESULTS 91 (32.5%) residents responded and 61 were female and 30 were male. The top influencing factor was being interested in clinical expertise with an average score of 4.32. The second factor was having a great sense of accomplishment in saving people with an average score of 3.82, followed by it being easier to become a medical practitioner at 3.77. The lowest scoring factor was fewer hours of work, with an average score of 1.77 and a safer working environment with a score of 2.33 was the second lowest factor. Female residents agreed that it was easier to get specialist certification with a score of 3.0. This score was significantly higher than male doctors at 2.63 with p value of 0.017. CONCLUSION Career interest and prospects were key influencing factors for applying OB/GYN residents. Minimizing the influence of detracting factors like heavy workload and medical litigation was also effective. Enrolling new residents is key to maintaining adequate staffing in specialties in healthcare. Establishing a safer work environment and determining the optimal workload will be the next reforms in the future.
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Affiliation(s)
- Chin-Han Tsai
- Department of Obstetrics and Gynecology, HsinChu MacKay Memorial Hospital, HsinChu, Taiwan
| | - Ching-Hung Hsieh
- Department of Obstetrics and Gynecology, Lee Women's Hospital, Taichung, Taiwan; Mackay Medicine, Nursing and Management College, Taipei, Taiwan
| | - Jian-Pei Huang
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Ping-Lun Lin
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Tsung-Cheng Kuo
- Department of Obstetrics and Gynecology, Kuo General Hospital, Tainan, Taiwan
| | - Ming-Chao Huang
- Department of Obstetrics and Gynecology, HsinChu MacKay Memorial Hospital, HsinChu, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City, Taiwan.
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Poon Z, Lee ECW, Ang LP, Tan NC. Experiences of primary care physicians managing postpartum care: a qualitative research study. BMC FAMILY PRACTICE 2021; 22:139. [PMID: 34193053 PMCID: PMC8244666 DOI: 10.1186/s12875-021-01494-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 06/17/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND The postpartum period is redefined as 12 weeks following childbirth. Primary care physicians (PCP) often manage postpartum women in the community after uneventful childbirths. Postpartum care significantly impacts on the maternal and neonatal physical and mental health. However, evidence has revealed unmet needs in postpartum maternal care. AIM The study aimed to explore the experiences of PCPs in managing postpartum mothers. METHODS Four focus group discussions and eleven in-depth interviews with twenty-nine PCPs were conducted in this qualitative research study in urban Singapore. PCPs of both gender and variable postgraduate training background were purposively enrolled. Audited transcripts were independently coded by two investigators. Thematic content analysis was performed using the codes to identify issues in the "clinician", "mother", "postpartum care" and "healthcare system & policy" domains stipulated in "The Generalists' Wheel of Knowledge, Understanding and Inquiry" framework. FINDINGS PCPs' personal attributes such as gender and knowledge influenced their postpartum care delivery. Prior training, child caring experience and access to resource materials contributed to their information mastery of postpartum care. Their professional relationship with local multi-ethic and multi-lingual Asian mothers was impacted by their mutual communication, language compatibility and understanding of local confinement practices. Consultation time constraint, awareness of community postnatal services and inadequate handover of care from the specialists hindered PCPs in the healthcare system. DISCUSSION Personal, maternal and healthcare system barriers currently prevent PCPs from delivering optimal postpartum care. CONCLUSION Interventions to overcome the barriers to improve postpartum care will likely be multi-faceted across domains discussed.
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Affiliation(s)
- Zhimin Poon
- SingHealth Polyclinics, 167, Jalan Bukit Merah, Connection One, Tower 5, #15-10, Singapore, 150167, Singapore.
| | - Esther Cui Wei Lee
- SingHealth Polyclinics, 167, Jalan Bukit Merah, Connection One, Tower 5, #15-10, Singapore, 150167, Singapore
| | - Li Ping Ang
- SingHealth Polyclinics, 167, Jalan Bukit Merah, Connection One, Tower 5, #15-10, Singapore, 150167, Singapore
| | - Ngiap Chuan Tan
- SingHealth Polyclinics, 167, Jalan Bukit Merah, Connection One, Tower 5, #15-10, Singapore, 150167, Singapore
- SingHealth-Duke NUS Family Medicine Academic Clinical Program, Singapore, Singapore
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Riaz B, Sherwani NZF, Inam SHA, Rafiq MY, Tanveer S, Arif A, Abdullah M, Jamil H. Physician Gender Preference Amongst Females Attending Obstetrics/Gynecology Clinics. Cureus 2021; 13:e15028. [PMID: 34136321 PMCID: PMC8199845 DOI: 10.7759/cureus.15028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION The objective of our study was to explore the views and perceptions of female patients attending the obstetrics and gynecology (OB/GYN) outpatient department towards the gender of their healthcare provider, to look for any preference that might exist in this regard, and to highlight any discrimination towards male obstetricians/gynecologists. MATERIAL AND METHODS A cross-sectional study was conducted from November 2020 to March 2021 at Combined Military Hospital, Lahore. A total of 280 female patients were included in the study and interviewed consecutively. A self-designed questionnaire was administered. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 22 (IBM Corp., Armonk, NY). Chi-square test was used to determine for any statistical significance and p≤0.05 was considered significant. Numerical data were represented as percentages. RESULTS Over 280 female patients participated in our study, out of which 132 were married and 148 were single. Thirteen of these patients were uneducated, 40 had completed high school and 227 patients had obtained a bachelor's level of education; 120 patients were aged 15-25 years, 95 patients were aged 26-35 years, 30 patients were aged 36-45 years, and 35 patients were aged >46. Women with less education preferred to be seen by a female obstetrician/gynecologist, whereas those with higher education were less biased (p=0.0001). Married patients preferred to be seen by female obstetrician/gynecologists as compared to single patients (p=0.0004). A significant proportion of females were impartial in terms of physician competence but those who did have a preference preferred female obstetrician/gynecologist based on three significant variables: competence, rapport building and empathy, and personal comfort. CONCLUSION A female gender preference exists in obstetrics and gynecology clinic attendees. This is significant in those who are married and those with no formal education. Overall, a significant proportion of women feel a higher comfort level with female doctors and find it easier to discuss their medical issues and develop rapport.
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Affiliation(s)
- Bismah Riaz
- Internal Medicine, Combined Military Hospital (CMH) Lahore Medical and Dental College, Lahore, PAK
| | | | | | | | - Saman Tanveer
- Internal Medicine, Army Medical College, Lahore, PAK
| | - Anum Arif
- Vascular Surgery, Combined Military Hospital (CMH) Lahore Medical College, National University of Medical Sciences (NUMS), Lahore, PAK
| | | | - Hamza Jamil
- Internal Medicine, Army Medical College, Rawalpindi, PAK
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Anglade P, Ibrahim H, Abdel-Razig S. Does provider gender matter in endoscopy? An international perspective. Gastrointest Endosc 2021; 93:1160-1168. [PMID: 33359436 DOI: 10.1016/j.gie.2020.12.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 12/18/2020] [Indexed: 12/11/2022]
Abstract
There is a growing body of literature on the importance of provider gender on patient-related metrics, including satisfaction, compliance, follow-up, and health-related outcomes. Studies have shown that female patients are more likely to factor gender when choosing their physicians than male patients and are much more likely to choose female physicians when provided the option of selecting providers. Early studies in this field have consistently demonstrated a significant gender preference for female endoscopists by female patients. In this perspective, we review findings from United States and international literature on patient-provider gender concordance for endoscopic procedures. We present the current state, describe our experience in an international setting in the Middle East, and offer strategies to promote the advancement of women in gastroenterology, many of which have been successfully implemented to address the health preferences and needs of our female patients.
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Affiliation(s)
- Pascale Anglade
- Department of Medicine, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA; Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Halah Ibrahim
- Department of Medicine, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Sawsan Abdel-Razig
- Department of Medicine, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA; Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
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Forsgren E, Björkman I. Interactional practices in person-centred care: Conversation analysis of nurse-patient disagreement during self-management support. Health Expect 2021; 24:940-950. [PMID: 33774894 PMCID: PMC8235886 DOI: 10.1111/hex.13236] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 02/10/2021] [Accepted: 02/26/2021] [Indexed: 02/07/2023] Open
Abstract
Background Person‐centred care implies a change in interaction between care professionals and patients where patients are not passive recipients but co‐producers of care. The interactional practices of person‐centred care remain largely unexplored. Objective This study focuses on the analysis of disagreements, which are described as an important part in the co‐production of knowledge in interaction. Design A qualitative exploratory study using conversation analysis. Setting and participants Data were collected from a nurse‐led person‐centred intervention in a hospital outpatient setting. Interactions between adult patients with irritable bowel syndrome (n = 17) and a registered nurse were audio‐recorded. COREQ guidelines were applied. Results Disagreements were found after demonstration of the nurse's or patients’ respective professional or personal knowledge. Disagreements were also evident when deciding on strategies for self‐management. Although negotiations between opposing views of the nurse and patient were seen as important, the patient generally claimed final authority both in knowing how IBS is perceived and in the right to choose self‐management strategies. The nurse generally oriented towards patient authority, but instances of demonstration of nurse authority despite patient resistance were also found. Discussion and conclusions This study provides information on how co‐production of knowledge and decisions occur in the context of a person‐centred care intervention. Negotiations between nurse and patient views require a flexible approach to communication, adapting interaction to each context while bearing in mind the patients having the final authority. To facilitate co‐production, the patient's role and responsibilities in interaction should be explicitly stated.
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Affiliation(s)
- Emma Forsgren
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Ida Björkman
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
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Lindsay S. Healthcare providers' perspectives with addressing sex-related issues and sexual identity within pediatric rehabilitation: A qualitative study. Disabil Health J 2021; 14:101093. [PMID: 33775609 DOI: 10.1016/j.dhjo.2021.101093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 01/21/2021] [Accepted: 03/01/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Although having a sexual and reproductive life is a fundamental human right, people with disabilities, especially youth, often have many unaddressed needs. Healthcare providers commonly report lacking knowledge and training in how to address sexual-related topics with youth. PURPOSE The purpose of this study was to explore the perspectives of pediatric rehabilitation care providers in addressing sex and sexuality among youth with disabilities. METHOD This qualitative study involved a secondary analysis of interviews with 21 participants (18 women, 2 men, 1 trans man) from a range of pediatric rehabilitation disciplines. An open-coding thematic analysis of the transcripts was performed. FINDINGS The results highlighted the following themes regarding healthcare providers' perspective of addressing sex-related issues within pediatric rehabilitation: (1) lack of attention to sex-related issues (i.e., taboo topic); (2) coping with clients disclosing sexual identity (i.e., unpreparedness, addressing discrimination and mental health issues, creating a safe space); and (3) navigating parental concerns (i.e., resistance to sex-related issues, privacy and confidentiality, youth's reliance on parents for managing menstruation). CONCLUSIONS Pediatric rehabilitation healthcare providers encounter challenges in providing health services and advice to youth with disabilities regarding sex-related issues and may need further training.
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Affiliation(s)
- Sally Lindsay
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital & Department of Occupational Science & Occupational Therapy, University of Toronto, 150 Kilgour Road, Toronto, Ontario, M4G 1R8, Canada.
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Gärtner J, Prediger S, Harendza S. Development and pilot test of ComCare - a questionnaire for quick assessment of communicative and social competences in medical students after interviews with simulated patients. GMS JOURNAL FOR MEDICAL EDUCATION 2021; 38:Doc68. [PMID: 33824904 PMCID: PMC7994874 DOI: 10.3205/zma001464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 10/17/2020] [Accepted: 11/20/2020] [Indexed: 06/12/2023]
Abstract
Background: Physicians' communicative and social competences are highly relevant for doctor-patient relationships. Simulation-based learning is frequently used to provide students with learning experiences resembling realistic medical situations. This study aims to assess communication and interpersonal skills in medical students after simulated consultations with a newly designed short questionnaire. Methods: In 2019, 103 final year students participated in a simulated consultation hour seeing four simulated patients. Communicative and social competences were assessed by a questionnaire including items for communication (Com) and interpersonal (Care) skills. The questionnaire was used by the simulated patients (ComCareP) after each consultation and as self-assessment by the students (ComCareD) after the fourth consultation. An explorative factor analysis was performed and the results of ComCareP and ComCareD were compared with respect to students' sex and advancement in their final year. Results: All ComCareP items loaded on one factor, which explained 50.7% of the variance. The participants self-assessed their communication and interpersonal skills significantly better than the simulated patients. No significant differences were found for students' sexes or advancement in their final year except for the item "responding to patients' needs satisfactorily" which was significantly lower in students at the end of their final year. Patients' general "satisfaction with the consultation" was higher while physicians' general "satisfaction with the consultation" was lower than their total ComCare mean score. The general satisfaction with the consultation showed a significant positive correlation with both ComCares' total mean scores. Conclusion: The ComCare measures communication and interpersonal skills as one factor. It can be used directly after consultations and shows significant positive correlation with the general satisfaction with a consultation. Since simulated patients' satisfaction with the consultation was higher than their ComCare score, other factors than communication and interpersonal skills could play a role for patient satisfaction with a conversation and need to be further investigated.
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Affiliation(s)
- Julia Gärtner
- University Medical Center Hamburg-Eppendorf, Department of Internal Medicine, Hamburg, Germany
| | - Sarah Prediger
- University Medical Center Hamburg-Eppendorf, Department of Internal Medicine, Hamburg, Germany
| | - Sigrid Harendza
- University Medical Center Hamburg-Eppendorf, Department of Internal Medicine, Hamburg, Germany
- University Medical Center Hamburg-Eppendorf, III. Medical Clinic, Hamburg, Germany
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[Balint group as a mandatory training - Effects of Balint work as part of the psychosomatic basic care course]. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2021; 67:315-328. [PMID: 33653234 DOI: 10.13109/zptm.2021.67.oa2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Balint group as a mandatory training - Effects of Balint work as part of the psychosomatic basic care course Objectives: Participants in the psychosomatic basic care course often lack a genuine interest in Balint work. What effects does Balint work have on these inexperienced and less motivated participants? Are there differences between male and female participants and between surgical and non-surgical specialties? What are the relationships between the group leaders and the results achieved? Methods: Between 2004 and 2019, a total of 1,667 doctors completed the feedback form for the Balint group as part of the psychosomatic basic care course. The learning objectives included cognitive and emotional items, as well as questions about the group atmosphere and leadership, about the transfer to everyday medical practice and interest in further Balint work. Results: 170 Balint groups took place during the investigation period. The overall grade was on a scale from 1 to 6 with M = 1.80 (SD = 0.72). Good to very good ratings were awarded to the motivation and competence of the group leaders and the group atmosphere, as well as gaining knowledge and positive effects on everyday medical practice. There were hardly any differences between female and male participants and between surgical and non-surgical participants. However, there were significant correlations between the assessment of the leader and the effects of group work. Discussion: The predominantly positive assessment of Balint's work is surprising, both in terms of cognitive and emotional learning goals. In addition to the group atmosphere, the motivation and competence of the group leader, perceived by the participants, are closely related to the learning effects achieved. The survey shows that Balint work can achieve positive results even with less motivated participants on a compulsory course. Balint work should therefore remain an integral part of the qualification in psychosomatic basic care. Sound training and supervision of Balint group leaders are necessary.
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Kuraitis D, Murina A. Gender discordance of genital examination experiences among dermatology residents and attendings. J Am Acad Dermatol 2021; 86:638-640. [PMID: 33549650 DOI: 10.1016/j.jaad.2021.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 01/25/2021] [Accepted: 02/02/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Drew Kuraitis
- Department of Dermatology, Tulane University, New Orleans, Louisiana.
| | - Andrea Murina
- Department of Dermatology, Tulane University, New Orleans, Louisiana
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Lim WH, Wong C, Jain SR, Ng CH, Tai CH, Devi MK, Samarasekera DD, Iyer SG, Chong CS. The unspoken reality of gender bias in surgery: A qualitative systematic review. PLoS One 2021; 16:e0246420. [PMID: 33529257 PMCID: PMC7853521 DOI: 10.1371/journal.pone.0246420] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/19/2021] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE This study was conducted to better understand the pervasive gender barriers obstructing the progression of women in surgery by synthesising the perspectives of both female surgical trainees and surgeons. METHODS Five electronic databases, including Medline, Embase, PsycINFO, CINAHL and Web of Science Core Collection, were searched for relevant articles. Following a full-text review by three authors, qualitative data was synthesized thematically according to the Thomas and Harden methodology and quality assessment was conducted by two authors reaching a consensus. RESULTS Fourteen articles were included, with unfavorable work environments, male-dominated culture and societal pressures being major themes. Females in surgery lacked support, faced harassment, and had unequal opportunities, which were often exacerbated by sex-blindness by their male counterparts. Mothers were especially affected, struggling to achieve a work-life balance while facing strong criticism. However, with increasing recognition of the unique professional traits of female surgeons, there is progress towards gender quality which requires continued and sustained efforts. CONCLUSION This systematic review sheds light on the numerous gender barriers that continue to stand in the way of female surgeons despite progress towards gender equality over the years. As the global agenda towards equality progresses, this review serves as a call-to-action to increase collective effort towards gender inclusivity which will significantly improve future health outcomes.
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Affiliation(s)
- Wen Hui Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Chloe Wong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sneha Rajiv Jain
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Chia Hui Tai
- Division of Colorectal Surgery, Department of Surgery, University Surgical Cluster, National University Hospital, Singapore, Singapore
| | - M. Kamala Devi
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Dujeepa D. Samarasekera
- Centre for Medical Education, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Shridhar Ganpathi Iyer
- Division of Hepatobiliary & Pancreatic Surgery, Department of Surgery, University Surgical Cluster, National University Hospital, Singapore, Singapore
- Liver Transplantation, National University Centre for Organ Transplantation, National University Hospital, Singapore, Singapore
| | - Choon Seng Chong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Colorectal Surgery, Department of Surgery, University Surgical Cluster, National University Hospital, Singapore, Singapore
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Nguyen NK, Bendahmane L, Martin MJ, Tilly A, Bayen S, Messaadi N. Environnement réconfortant et respect de l’intimité. L’organisation du cabinet médical pour la consultation gynécologique. SANTE PUBLIQUE 2021; 32:347-358. [PMID: 33512101 DOI: 10.3917/spub.204.0347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Social science concepts (intimate distance, personal space) suggest that the gynecological examination environment (GEE) might influence women’s feelings during the exam.Purpose of research: We explore this hypothesis by assessing women’s preferences for the GEE. RESULTS An opinion poll was conducted, without randomization to explore women’s point of view. In 2017, questionnaires were referred to women by 14 general practitioners in the Lille region. Among 173 answers, 73% granted importance to the medical setting, especially to a comfortable ambiance and an isolated place during an exam (to respect women’s privacy). Women expected at least: a separation of consultation/examination (77%), disposal of sanitary towels (80%), a place to leave clothes and underwear (74%), a changing area (56%). Fifty-five percent judged it unnecessary to cover the lower body. Concerning the examination table: comfort was satisfactory (93%), “calm and peaceful colors” were appreciated, but clamps should be improved. CONCLUSIONS The GEE is characterized by a balance of natural comfort and a sequentially delimited spatial configuration. The study revealed cultural and subjective dimensions of privacy. Physicians need to apply psychosocial competences to perform a person-centered gynecological exam.
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Physician-patient agreement on physicians’
communication skills and visit satisfaction
in dermatology clinics: a one-with-many design. HEALTH PSYCHOLOGY REPORT 2021. [DOI: 10.5114/hpr.2021.110574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Lindsay S, Kolne K. The training needs for gender-sensitive care in a pediatric rehabilitation hospital: a qualitative study. BMC MEDICAL EDUCATION 2020; 20:468. [PMID: 33238977 PMCID: PMC7690145 DOI: 10.1186/s12909-020-02384-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 11/19/2020] [Indexed: 05/26/2023]
Abstract
BACKGROUND Gender is an important social determinant of health; however, clinicians often lack training in how to provide gender-sensitive care. Offering appropriate and relevant training could help to address some gender-based health inequalities. Our objective was to identify and describe the training needs for gender-sensitive care among pediatric rehabilitation healthcare providers. METHODS This study used an interpretive descriptive qualitative design to conduct interviews with 23 pediatric rehabilitation healthcare providers (19 women, 3 men, 1 transgender man), from a pediatric rehabilitation hospital in a large urban center, in Ontario, Canada from a range of disciplines. Interviews were transcribed verbatim and analyzed using an open-coding inductive thematic analysis. RESULTS Our analysis revealed the following themes: [1] lack of knowledge about gender-sensitive care and the need for more training; [2] content of the desired training (i.e., gender differences, effective communication and how to practice gender-sensitive care) and [3] delivery method of the training. CONCLUSIONS Enhanced gender-sensitive training for healthcare providers is required for optimizing patient outcomes and addressing gender-based health inequalities. Educators in pediatric rehabilitation should consider developing gender-sensitive care training that is embedded within post-graduate education and also continuing education within hospitals and community care centers.
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Affiliation(s)
- Sally Lindsay
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital & Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada.
| | - Kendall Kolne
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital & Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
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Lamb CC, Wang Y. PHYSICIAN CHARACTERISTICS THAT INFLUENCE PATIENT PARTICIPATION IN THE TREATMENT OF PRIMARY IMMUNODEFICIENCY. PATIENT EDUCATION AND COUNSELING 2020; 103:2280-2289. [PMID: 32475713 DOI: 10.1016/j.pec.2020.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 05/15/2020] [Accepted: 05/16/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Shared decision making (SDM) is recommended to improve healthcare quality. Physicians who use a rational decision-making style and patient-centric approach are more likely to incorporate SDM into clinical practice. This paper explores how certain physician characteristics such as gender, age, race, experience, and specialty explain patient participation. METHODS A multi-group structural equation model tested the relationship between physician decision-making styles, patient-centered care, physician characteristics, and patient participation in clinical treatment decisions. A survey was completed by 330 physicians who treat primary immunodeficiency. Sample group responses were compared between groups across specialty, age, race, experience, or gender. RESULTS A patient-centric approach was the main factor that encouraged SDM independent of physician decision-making style with both treatment protocols and product choices. The positive effect of patient-centrism is stronger for immunologists, more experienced physicians, or male physicians. A rational decision-making style increases participation for non-immunologists, older physicians, white physicians, less-experienced physicians and female physicians. CONCLUSION A patient-centric approach, rational decision-making and certain physician characteristics help explain patient participation in clinical decisions. Practice Implications Future SDM research and policy initiatives should focus on physician adoption of patient-centric approaches to chronic care diseases and the potential bias associated with physician characteristics and decision-making style.
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Affiliation(s)
- Christopher C Lamb
- BioSolutions Services, Englewood Cliffs, New Jersey, United States; Department of Management and Entrepreneurship, Silberman College of Business, Fairleigh Dickinson University, Teaneck, New Jersey, United States; Weatherhead School of Management, Case Western Reserve University, Cleveland, Ohio, USA.
| | - Yunmei Wang
- Case Cardiovascular Research Institute, Case Western Reserve University School of Medicine and Harrington Heart &Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio 44106, USA
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