1
|
Im DS, Tamarelli CM, Shen MR. Experiences of Physicians Investigated for Professionalism Concerns: a Narrative Review. J Gen Intern Med 2024; 39:283-300. [PMID: 38051480 PMCID: PMC10853115 DOI: 10.1007/s11606-023-08550-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/17/2023] [Indexed: 12/07/2023]
Abstract
Growing attention is being paid to physician health and behavior, including the occurrence of mental health issues and burnout in medical providers, physician impairment, and alleged disruptive behavior in physicians. In any of these areas, a physician may become the subject of an investigation. Studying the experience of investigated physicians is important to identify and mitigate any potential adverse personal and practice impacts, which in turn can hinder patient care. The purpose of this review is to (1) summarize the published scientific literature to date regarding the experiences of physicians who have been investigated, and (2) based on these findings consider strategies to mitigate any adverse effects of the investigatory process for physicians. A search of the databases PubMed and Ovid MEDLINE was conducted in June 2023 using relevant search terms. After reviewing titles, abstracts, full-length articles, and reference lists, 16 articles were identified and reviewed. Physicians in multiple countries who had been investigated commonly described short-term (feelings of anger, depression, anxiety, shame, powerlessness, isolation, being betrayed, less confidence in clinical decision-making) and long-term (increase in defensive practice, retiring early) impacts of the investigatory process. Physicians found the most difficult aspects of the investigation process to be the length of time involved, lack of transparency/communication regarding the process, feelings of isolation, and dealing with vexatious complaints. While complaints about physicians have the potential to portend constructive individual practice and systemic changes, research suggests that the investigatory process for physicians is associated with negative short- and long-term emotional and practice impacts. Strategies to mitigate the unintended adverse effects of investigatory processes are proposed. Further research is warranted to clarify the investigation experience for physicians, including physicians underrepresented in medicine, and to systematically assess the effectiveness of strategies to mitigate unhealthy or disruptive components of the investigatory process.
Collapse
Affiliation(s)
- David S Im
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA.
| | - Carrie M Tamarelli
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Mary R Shen
- Department of Psychiatry, Brigham & Women's Hospital, Boston, MA, USA
| |
Collapse
|
2
|
Bahji A. Guilty until proven innocent. CANADIAN MEDICAL EDUCATION JOURNAL 2023; 14:149. [PMID: 38045091 PMCID: PMC10689991 DOI: 10.36834/cmej.77204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Affiliation(s)
- Anees Bahji
- Department of Psychiatry, University of Calgary, Alberta, Canada
| |
Collapse
|
3
|
Anees A, McAlister EG, Garber AM, Calderon AS, Butler J, Mallin E, Levine D, Sanders ML, Kwan B, Clewing JM, Barczi S, Mateja C, Ismail N. Bridging the Gap in Competency Assessment During Transition from Undergraduate Medical Education to Graduate Medical Education: A Perspective Piece. Am J Med 2023; 136:941-945.e1. [PMID: 37339726 DOI: 10.1016/j.amjmed.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 06/03/2023] [Indexed: 06/22/2023]
Affiliation(s)
- Amna Anees
- Department of Medicine, Charleston Area Medical Center/WVU-Charleston Division, Charleston, WV.
| | | | - Adam M Garber
- Virginia Commonwealth University School of Medicine, Richmond
| | | | | | - Emily Mallin
- Department of Medicine, University of Arizona College of Medicine - Phoenix and Banner - University Medical Center Phoenix
| | | | - M Lee Sanders
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City
| | | | - J Marietta Clewing
- Weill Cornell Medical College, Department of Medical Education, Texas A&M College of Medicine, College Station
| | - Steven Barczi
- University of Wisconsin School of Medicine and Public Health, Madison; Madison VA Geriatric Research Education and Clinical Center, Wm. S. Middleton Memorial VA Hospital, Madison, Wis
| | | | - Nadia Ismail
- Baylor College of Medicine School of Medicine, Houston, Texas
| |
Collapse
|
4
|
Niles KM, Jain V, Chan C, Choo S, Dore S, Kiely DJ, Lim K, Roy Lacroix ME, Sharma S, Waterman E. Guideline No. 441: Antenatal Fetal Health Surveillance. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:665-677.e3. [PMID: 37661122 DOI: 10.1016/j.jogc.2023.05.020] [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] [Indexed: 09/05/2023]
Abstract
OBJECTIVE To summarize the current evidence and to make recommendations for antenatal fetal health surveillance (FHS) to detect perinatal risk factors and potential fetal decompensation in the antenatal period and to allow for timely intervention to prevent perinatal morbidity and/or mortality. TARGET POPULATION Pregnant individuals with or without maternal, fetal, or pregnancy-associated perinatal risk factors for antenatal fetal decompensation. OPTIONS To use basic and/or advanced antenatal testing modalities, based on risk factors for potential fetal decompensation. OUTCOMES Early identification of potential fetal decompensation allows for interventions that may support fetal adaptation to maintain well-being or expedite delivery. BENEFITS, HARMS, AND COSTS Antenatal FHS in pregnant individuals with identified perinatal risk factors may reduce the chance of adverse outcomes. Given the high false-positive rate, FHS may increase unnecessary interventions, which may result in harm, including parental anxiety, premature or operative birth, and increased use of health care resources. Optimization of surveillance protocols based on evidence-informed practice may improve perinatal outcomes and reduce harm. EVIDENCE Medline, PubMed, Embase, and the Cochrane Library were searched from inception to January 2022, using medical subject headings (MeSH) and key words related to pregnancy, fetal monitoring, fetal movement, stillbirth, pregnancy complications, and fetal sonography. This document represents an abstraction of the evidence rather than a methodological review. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and weak recommendations). INTENDED AUDIENCE All health care team members who provide care for or education to obstetrical patients, including maternal fetal medicine specialists, obstetricians, family physicians, midwives, nurses, nurse practitioners, and radiologists. SUMMARY STATEMENTS RECOMMENDATIONS.
Collapse
|
5
|
Niles KM, Jain V, Chan C, Choo S, Dore S, Kiely DJ, Lim K, Roy-Lacroix MÈ, Sharma S, Waterman E. Directive clinique n o 441 : Surveillance prénatale du bien-être fœtal. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:678-693.e3. [PMID: 37661123 DOI: 10.1016/j.jogc.2023.05.021] [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] [Indexed: 09/05/2023]
Abstract
OBJECTIF Résumer les données probantes actuelles et formuler des recommandations pour la surveillance prénatale du bien-être fœtal afin de détecter les facteurs de risque périnatal et toute potentielle décompensation fœtale et de permettre une intervention rapide en prévention de la morbidité et la mortalité périnatales. POPULATION CIBLE Personnes enceintes avec ou sans facteurs maternels, fœtaux ou gravidiques associés à des risques périnataux et à la décompensation fœtale. OPTIONS Utiliser des examens prénataux par technologie de base et/ou avancée en fonction des facteurs de risque de décompensation fœtale. RéSULTATS: La reconnaissance précoce de toute décompensation fœtale potentielle permet d'intervenir de façon à favoriser l'adaptation fœtale pour maintenir le bien-être ou à accélérer l'accouchement. BéNéFICES, RISQUES ET COûTS: Chez les personnes enceintes ayant des facteurs de risque périnatal confirmés, la surveillance du bien-être fœtal contribue à réduire le risque d'issue défavorable. Compte tenu du taux élevé de faux positifs, la surveillance du bien-être fœtal peut augmenter le risque d'interventions inutiles, ce qui peut avoir des effets nuisibles, dont l'anxiété parentale, l'accouchement prématuré ou assisté et l'utilisation accrue des ressources de soins de santé. L'optimisation des protocoles de surveillance d'après des pratiques fondées sur des données probantes peut améliorer les issues périnatales et réduire les effets nuisibles. DONNéES PROBANTES: Des recherches ont été effectuées dans les bases de données Medline, PubMed, Embase et Cochrane Library, de leur création jusqu'à janvier 2022, à partir de termes MeSH et de mots clés liés à la grossesse, à la surveillance fœtale, aux mouvements fœtaux, à la mortinaissance, aux complications de grossesse et à l'échographie fœtale. Le présent document est un résumé des données probantes et non pas une revue méthodologique. MéTHODES DE VALIDATION: Les auteurs ont évalué la qualité des données probantes et la force des recommandations en utilisant le cadre méthodologique GRADE (Grading of Recommendations Assessment, Development and Evaluation). Voir l'annexe A en ligne (tableau A1 pour les définitions et tableau A2 pour l'interprétation des recommandations fortes et faibles). PROFESSIONNELS CONCERNéS: Tous les membres de l'équipe de soins qui prodiguent des soins ou donnent de l'information aux patientes en obstétrique, notamment les spécialistes en médecine fœto-maternelle, les obstétriciens, les médecins de famille, les sages-femmes, les infirmières, les infirmières praticiennes et les radiologistes. DÉCLARATIONS SOMMAIRES: RECOMMANDATIONS.
Collapse
|
6
|
Fanikos J, Tawfik Y, Almheiri D, Sylvester K, Buckley LF, Dew C, Dell'Orfano H, Armero A, Bejjani A, Bikdeli B, Campia U, Davies J, Fiumara K, Hogan H, Khairani CD, Krishnathasan D, Lou J, Makawi A, Morrison RH, Porio N, Tristani A, Connors JM, Goldhaber SZ, Piazza G. Anticoagulation-Associated Adverse Drug Events in Hospitalized Patients Across Two Time Periods. Am J Med 2023; 136:927-936.e3. [PMID: 37247752 DOI: 10.1016/j.amjmed.2023.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 05/05/2023] [Accepted: 05/14/2023] [Indexed: 05/31/2023]
Abstract
PURPOSE Anticoagulants often cause adverse drug events (ADEs), comprised of medication errors and adverse drug reactions, in patients. Our study objective was to determine the clinical characteristics, types, severity, cause, and outcomes of anticoagulation-associated ADEs from 2015-2020 (a contemporary period following implementation of an electronic health record, infusion device technology, and anticoagulant dosing nomograms) and to compare them with those of a historical period (2004-2009). METHODS We reviewed all anticoagulant-associated ADEs reported as part of our hospital-wide safety system. Reviewers classified type, severity, root cause, and outcomes for each ADE according to standard definitions. Reviewers also assessed events for patient harm. Patients were followed up to 30 days after the event. RESULTS Despite implementation of enhanced patient safety technology and procedure, ADEs increased in the contemporary period. In the contemporary period, we found 925 patients who had 984 anticoagulation-associated ADEs, including 811 isolated medication errors (82.4%); 13 isolated adverse drug reactions (1.4%); and 160 combined medication errors, adverse drug reactions, or both (16.2%). Unfractionated heparin was the most frequent ADE-related anticoagulant (77.7%, contemporary period vs 58.3%, historical period). The most frequent anticoagulation-associated medication error in the contemporary period was wrong rate or frequency of administration (26.1%, n = 253), with the most frequent root cause being prescribing errors (21.3%, n = 207). The type, root cause, and harm from ADEs were similar between periods. CONCLUSIONS We found that anticoagulation-associated ADEs occurred despite advances in patient safety technologies and practices. Events were common, suggesting marginal improvements in anticoagulant safety over time and ample opportunities for improvement.
Collapse
Affiliation(s)
- John Fanikos
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
| | - Yahya Tawfik
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Danya Almheiri
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Katelyn Sylvester
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Leo F Buckley
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Chris Dew
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Heather Dell'Orfano
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Andre Armero
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Antoine Bejjani
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Behnood Bikdeli
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Umberto Campia
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Julia Davies
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Karen Fiumara
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Heather Hogan
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Candrika Dini Khairani
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Darsiya Krishnathasan
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Junyang Lou
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Alaa Makawi
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Ruth H Morrison
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Nicole Porio
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Anthony Tristani
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Jean M Connors
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Samuel Z Goldhaber
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Gregory Piazza
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| |
Collapse
|
7
|
Haight MA, Bahner I, Belovich AL, Bonaminio G, Brooks WS, Chin C, Habal S, El-Sawi N, Haudek SB, Ikonne U, McAuley RJ, McKell D, Porter R, Rowe R, Taylor TAH, Thesen T. The Struggle Is Real: Breaking Barriers that Limit Student Success. MEDICAL SCIENCE EDUCATOR 2023; 33:311-315. [PMID: 37008441 PMCID: PMC10060487 DOI: 10.1007/s40670-023-01732-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/09/2023] [Indexed: 06/19/2023]
Affiliation(s)
- Michele A. Haight
- John A. Burns School of Medicine, University of Hawai’i, Honolulu, HI USA
| | - Ingrid Bahner
- Morsani College of Medicine, University of South Florida, Tampa, FL USA
| | | | | | - William S. Brooks
- University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL USA
| | - Cassie Chin
- International Association of Medical Science Educators, Huntington, WV USA
| | - Shafik Habal
- Philadelphia College of Osteopathic Medicine, Suwanee, GA USA
| | | | | | - Uzoma Ikonne
- Eastern Virginia Medical School, Norfolk, VA USA
| | - Robert J. McAuley
- Oakland University William Beaumont School of Medicine, Rochester, MI USA
| | | | | | - Rebecca Rowe
- University of New England College of Osteopathic Medicine, Biddeford, ME USA
| | | | - Thomas Thesen
- University of Houston College of Medicine, Houston, TX USA
| |
Collapse
|
8
|
Yahyavi ST, Hoobehfekr S, Tabatabaee M. Exploring the hidden curriculum of professionalism and medical ethics in a psychiatry emergency department. Asian J Psychiatr 2021; 66:102885. [PMID: 34700180 DOI: 10.1016/j.ajp.2021.102885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 09/22/2021] [Accepted: 10/13/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE To investigate the hidden curriculum of professionalism in the emergency department. DESIGN AND METHODS This is a qualitative study that consisted of six in-depth semi-structured interviews and a focus group with psychiatry residents of a teaching hospital program about their perception of professionalism in emergency department. A simple content analysis method has been conducted for the extraction of findings. FINDINGS Common themes that were detected in the hidden curriculum were "Disregarding the priority of the patients"; "Overriding patient autonomy"; "Non-empathetic care"; "Breaching Confidentiality"; "Injustice in providing care"; and "Dishonesty" PRACTICE IMPLICATIONS: Professional behaviors are mostly learned through the hidden curriculum. The hidden and formal curricula of professionalism are different in several domains. Paying attention to organizational culture and social environment is critical for promoting professionalism.
Collapse
Affiliation(s)
- Seyyed Taha Yahyavi
- Department of Psychiatry, Roozbeh Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Saba Hoobehfekr
- Department of Psychiatry, Roozbeh Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Tabatabaee
- Department of Psychiatry, Roozbeh Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
9
|
Hope AA, Munro CL. Dialogue as a Disruptive Discourse Oriented Toward Justice. Am J Crit Care 2020; 29:415-417. [PMID: 32954403 DOI: 10.4037/ajcc2020334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Aluko A. Hope
- Aluko A. Hope is coeditor in chief of the American Journal of Critical Care. He is an associate professor at Albert Einstein College of Medicine and an intensivist and assistant bioethics consultant at Montefiore Medical Center, both in New York City
| | - Cindy L. Munro
- Cindy L. Munro is coeditor in chief of the American Journal of Critical Care. She is dean and professor, School of Nursing and Health Studies, University of Miami, Coral Gables, Florida
| |
Collapse
|