Physicians' opinions on patients' requests for specific treatments and examinations

Do clinical and communication skills scores on credentialing exams predict potentially inappropriate antibiotic prescribing?

BACKGROUND

There is considerable variation among physicians in inappropriate antibiotic prescribing, which is hypothesized to be attributable to diagnostic uncertainty and ineffective communication. The objective of this study was to evaluate whether clinical and communication skills are associated with antibiotic prescribing for upper respiratory infections and sinusitis.

METHODS

A cohort study of 2,526 international medical graduates and 48,394 U.S. Medicare patients diagnosed by study physicians with an upper respiratory infection or sinusitis between July 2014 and November 2015 was conducted. Clinical and communication skills were measured by scores achieved on the Clinical Skills Assessment examination administered by the Educational Commission for Foreign Medical Graduates (ECFMG) as a requirement for entry into U.S residency programs. Medicare Part D data were used to determine whether patients were dispensed an antibiotic following an outpatient evaluation and management visit with the study physician. Physician age, sex, specialty and practice region were retrieved from the ECFMG databased and American Medical Association (AMA) Masterfile. Multivariate GEE logistic regression was used to evaluate the association between clinical and communication skills and antibiotic prescribing, adjusting for other physician and patient characteristics.

RESULTS

Physicians prescribed an antibiotic in 71.1% of encounters in which a patient was diagnosed with sinusitis, and 50.5% of encounters for upper respiratory infections. Better interpersonal skills scores were associated with a significant reduction in the odds of antibiotic prescribing (OR per score decile 0.93, 95% CI 0.87-0.99), while greater proficiency in clinical skills and English proficiency were not. Female physicians, those practicing internal medicine compared to family medicine, those with citizenship from the US compared to all other countries, and those practicing in southern of the US were also more likely to prescribe potentially unnecessary antibiotics.

CONCLUSIONS

Based on this study, physicians with better interpersonal skills are less likely to prescribe antibiotics for acute sinusitis and upper respiratory infections. Future research should examine whether tailored interpersonal skills training to help physicians manage patient expectations for antibiotics could reduce unnecessary antibiotic prescribing.

Clinicians' experiences on patients' demands and shared decision making in Finnish specialized mental health care

PURPOSE

Psychiatric patients' awareness of treatments options and their possibilities to influence their care has increased. For the clinicians, the management of evidence-based care, as well as organizational and resource aspects, set different goals for the clinical encounter. In this article we are focusing on the clinicians' experiences and ask: How do the clinicians view situations in which there is a conflict between patients' individual needs and goals and other aspects in decision-making?

MATERIALS AND METHODS

We implemented a qualitative study of 13 thematic semi-structured interviews with clinicians working in psychiatry. We used discourse analysis to investigate how the clinician view the doctor-patient interaction.

RESULTS

We identified three discources which were termed the medical standpoint, the psychodynamic standpoint and the standpoint of the patient's experience.

CONCLUSIONS

In their talk, the clinicians use the three discources to make sense of the diverse expectations from both the patient and the mental health care system. The three discources also reflect different aspects in psychiatric treatment cultures, such as evidence-based medicine, the ideal of patient-centeredness, therapeutic interaction and organizational requirements.

Clinical supervision among family physicians: prevalence, needs, and attitudes

BACKGROUND

Clinical supervision (CS) is not an established support system among physicians. Family physicians (FPs) have used Balint groups as a form of clinical supervision. In all, not much is known about the prevalence of physicians' attendance to or needs for CS.

OBJECTIVE

We studied what proportion of FPs compared with other physicians have attended or report they would need CS and whether having patients who request certain tests or medicines is associated with FPs' attendance to or need for CS.

DESIGN

A postal survey for all working-aged Finnish physicians was performed in 2008. Special questions concerning CS (eg, Balint) and patients' requests were included.

RESULTS

Response rate for the survey was 74% (N = 13 708). Special questions were responded by 10 559 physicians of whom 1252 were FPs. FPs had attended CS more often than other physicians (42% vs 29%, P < .001). Of FPs, 25% reported a need for CS with no availability of it. FPs experienced with or needing for CS were more often than other FPs females, had participated in continuing medical education, and reported that patients with requests have increased in recent years.

CONCLUSION

Both experience of CS and a need for CS with no availability are common among Finnish FPs. Experiences of patients with requests may reflect a need for CS among FPs. Studies on the content, significance and effectiveness CS among FPs are needed.

What is important for patient centred care? A qualitative study about the perceptions of patients with cancer

BACKGROUND

This article deals with one of the themes from interviews in a larger qualitative study about cancer patients' perceptions of good caring. It is widely recognized today that patient centred care is important. Patients' values and perceptions must be acknowledged in order to make care evidence based and to meet the demands of quality improvement processes.

AIM

The aim was to get insight in patients with cancers' perceptions of the importance of being respected as partners and share control of decisions about interventions and management of their health problems and the reasons behind their wishes.

METHOD

Giorgio's scientific approach to phenomenology was used. Twenty cancer inpatients with various cancer diagnoses at different stages and with different prognoses were interviewed. The sampling was purposive.

ETHICAL ISSUES

Permission to carry out the research was given by a Regional Committee of Research Ethics in Western Norway and the data collection followed the guidelines of the Data Inspectorate of Norway.

MAIN FINDINGS

The units of meaning identified could be clustered into three themes with significance for patient centred care from patients' perspectives: (1) empowerment (being respected, listened to, given honest information, being valued); (2) shared decision making about the treatment of the disease (discussing the treatment, but letting the doctor decide in the end); and (3) partnership in nursing care.

CONCLUSION

Health care professionals can practise patient centred care by treating patients with respect, giving honest information, making them feel valued as persons and by inviting them to take part in all decisions about their daily life and care. However, cancer patients' desire to make decisions about their treatments must not be taken for granted. Doctors must find out the extent to which each patient wants to participate and then give the necessary information.

A survey of neurologists on bothersome patient behaviors

CONTEXT

Although much has been published on patient complaints about physicians, little is known about patient behaviors that physicians find bothersome.

OBJECTIVE

To obtain more information about bothersome patient behaviors, we performed a pilot survey of neurologists.

METHODS

A survey was performed among neurologists attending the Texas Neurological Society Winter Conference in 2006 in Austin, Texas. Using 5-point Likert scales, respondents rated 30 patient behaviors on how often they observed or experienced the behavior in the last year and how bothersome the behavior was to them. Respondents were asked to list their top 5 most bothersome patient behaviors, provide examples of unnecessary phone calls received after hours, and provide any other comments about the survey.

RESULTS

The response rate was 42.3% (78 respondents). Almost all of the patient behaviors were found to be bothersome or very bothersome. The top 5 most bothersome patient behaviors from most to least were the following: no show for appointment, verbally abusive with your staff, poor compliance with medications or treatment, late for appointment, and do not know the medications that they are taking. Of the 30 items, those behaviors as well as answering cell phones during office visits and unnecessary phone calls after hours were among the most highly rated as bothersome.

CONCLUSIONS

Some of the bothersome patient behaviors may have deleterious effects on patient care, whereas others may make the practice of medicine unpleasant for physicians. A number of the behaviors may be reduced by providing patients with practice policies. Others are best addressed through ongoing communication and education.