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Ugeskrift For Laeger Oct 2023The attachment theory emphasises the impact of early experiences on emotional and interpersonal development, which in turn affects how one interacts in different... (Review)
Review
The attachment theory emphasises the impact of early experiences on emotional and interpersonal development, which in turn affects how one interacts in different relations. This review explores the relevance of this to the doctor-patient relationships and highlights the importance of understanding differences in strategies when feeling unsafe. This applies to the patient as well as the physician. Acknowledging the influence of attachment styles from both parties may improve communication, trust and decision making. This in turn may contribute to an overall better treatment outcome.
Topics: Humans; Patient Satisfaction; Trust; Emotions; Physician-Patient Relations; Physicians; Communication
PubMed: 37874001
DOI: No ID Found -
JAMA Network Open Oct 2023Physician burnout is widely reported to be an increasing problem in the US. Although prior analyses suggest physician burnout is rising nationally, these analyses have...
IMPORTANCE
Physician burnout is widely reported to be an increasing problem in the US. Although prior analyses suggest physician burnout is rising nationally, these analyses have substantial limitations, including different physicians joining and leaving clinical practice.
OBJECTIVE
To examine the prevalence of burnout among physicians in a large multispecialty group over a 5-year period.
DESIGN, SETTING, AND PARTICIPANTS
This survey study was conducted in 2017, 2019, and 2021 and involved physician faculty members of the Massachusetts General Physicians Organization. Participants represented different clinical specialties and a full range of career stages. The online survey instrument had 4 domains: physician career and compensation satisfaction, physician well-being, administrative workload on physicians, and leadership and diversity.
EXPOSURE
Time.
MAIN OUTCOMES AND MEASURES
Physician burnout, which was assessed with the Maslach Burnout Inventory. A binary burnout measure was used, which defined burnout as a high score in 2 of the 3 burnout subscales: Exhaustion, Cynicism, and Reduced Personal Efficacy.
RESULTS
A total of 1373 physicians (72.9% of the original 2017 cohort) participated in all 3 surveys. The cohort included 690 (50.3%) male, 921 (67.1%) White, and 1189 (86.6%) non-Hispanic individuals. The response rates were 93.0% in 2017, 93.0% in 2019, and 92.0% in 2021. Concerning years of experience, the cohort was relatively well distributed, with the highest number and proportion of physicians (478 [34.8%]) reporting between 11 and 20 years of experience. Within this group, burnout declined from 44.4% (610 physicians) in 2017 to 41.9% (575) in 2019 (P = .18) before increasing to 50.4% (692) in 2021 (P < .001).
CONCLUSIONS AND RELEVANCE
Findings of this survey study suggest that the physician burnout rate in the US is increasing. This pattern represents a potential threat to the ability of the US health care system to care for patients and needs urgent solutions.
Topics: Humans; Male; Female; Job Satisfaction; Physicians; Burnout, Professional; Massachusetts; Population Groups
PubMed: 37801314
DOI: 10.1001/jamanetworkopen.2023.36745 -
Canadian Family Physician Medecin de... May 2024
Topics: Humans; Burnout, Professional; Practice Guidelines as Topic; Preventive Medicine; Physicians
PubMed: 38744520
DOI: 10.46747/cfp.7005e63 -
Journal of the American Board of Family... Aug 2023A family physician who has long tried to prevent patients from falling victim to health scams and disinformation recently confronted an unexpected challenge of his own.
A family physician who has long tried to prevent patients from falling victim to health scams and disinformation recently confronted an unexpected challenge of his own.
Topics: Humans; Steel; Physicians
PubMed: 37468218
DOI: 10.3122/jabfm.2023.230108R1 -
Medicine, Health Care, and Philosophy Mar 2024During the last decades, shared decision making (SDM) has become a very popular model for the physician-patient relationship. SDM can refer to a process (making a...
During the last decades, shared decision making (SDM) has become a very popular model for the physician-patient relationship. SDM can refer to a process (making a decision in a shared way) and a product (making a shared decision). In the literature, by far most attention is devoted to the process. In this paper, I investigate the product, wondering what is involved by a medical decision being shared. I argue that the degree to which a decision to implement a medical alternative is shared should be determined by taking into account six considerations: (i) how the physician and the patient rank that alternative, (ii) the individual preference scores the physician and the patient (would) assign to that alternative, (iii) the similarity of the preference scores, (iv) the similarity of the rankings, (v) the total concession size, and (vi) the similarity of the concession sizes. I explain why shared medical decisions are valuable, and sketch implications of the analysis for the physician-patient relationship.
Topics: Humans; Patient Participation; Decision Making, Shared; Physician-Patient Relations; Physicians; Decision Making
PubMed: 38010578
DOI: 10.1007/s11019-023-10179-3 -
JAMA Network Open Aug 2023While a gender pay gap in medicine has been well documented, relatively little research has addressed mechanisms that mediate gender differences in referral income for...
IMPORTANCE
While a gender pay gap in medicine has been well documented, relatively little research has addressed mechanisms that mediate gender differences in referral income for specialists.
OBJECTIVE
To examine gender-based disparities in medical and surgical specialist referrals in Ontario, Canada.
DESIGN, SETTING, AND PARTICIPANTS
This cross-sectional study included referrals for specialist care ascertained from Ontario Health Insurance Plan physician billings for fiscal year 2018 to 2019. Participants were specialist physicians who received new patient consultations from April 1, 2018, to March 31, 2019, and the associated referring physicians. Data were analyzed from April 2018 to March 2020, including a 12-month follow-up period.
EXPOSURES
Specialist and referring physician gender (female or male).
MAIN OUTCOMES AND MEASURES
Revenue per referral was defined based on an episode-of-care approach as total billings for a 12-month period from the initial consultation. Mean total billings for female and male specialists were compared and the differential divided into the portion owing to referral volume vs referral revenue. Difference-in-differences multivariable regression analysis was used to estimate gender-based differences in revenue per referral. For each referring physician, gender-based differences in referral patterns were examined using case-control analysis, in which specialists who received a referral were compared with matched control specialists who did not receive a referral. This analysis considered the gender of the specialist and concordance between the gender of the referring physician and specialist, among other characteristics.
RESULTS
Of 7 621 365 new referrals, 32 824 referring physicians, of whom 13 512 (41.2%) were female (mean [SD] age, 46.3 [11.6] years) and 19 312 (58.8%) were male (mean [SD] age, 52.9 [13.5] years), made referrals to 13 582 specialists, of whom 4890 (36.0%) were female (mean [SD] age, 45.6 [11.0] years) and 8692 (64.0%) were male (mean [SD] age, 51.8 [13.0] years). Male specialists received more mean (SD) referrals than did female specialists (633 [666] vs 433 [515]), and the mean (SD) revenue per referral was higher for males ($350 [$474]) compared with females ($316 [$393]). Adjusted analysis demonstrated a -4.7% (95% CI, -4.9% to -4.5%) difference in the revenue per referral between male and female specialists. Multivariable regression analysis found that physicians referred more often to specialists of the same gender (odds ratio, 1.04; 95% CI, 1.03-1.04) but had higher odds of referring to male specialists (odds ratio, 1.10; 95% CI, 1.09-1.11).
CONCLUSIONS AND RELEVANCE
In this cross-sectional study of the gender pay gap in specialist referral income, the number and revenue from referrals received differed by gender, as did the odds of receiving a referral from a physician of the same gender. Future research should examine the effectiveness of different policies to address this gap, such as a centralized, gender-blinded referral system.
Topics: Humans; Female; Male; Middle Aged; Cross-Sectional Studies; Income; Medicine; Ontario; Physicians
PubMed: 37624601
DOI: 10.1001/jamanetworkopen.2023.28347 -
Medicine, Health Care, and Philosophy Jun 2024Phronesis is often described as a 'practical wisdom' adapted to the matters of everyday human life. Phronesis enables one to judge what is at stake in a situation and...
Phronesis is often described as a 'practical wisdom' adapted to the matters of everyday human life. Phronesis enables one to judge what is at stake in a situation and what means are required to bring about a good outcome. In medicine, phronesis tends to be called upon to deal with ethical issues and to offer a critique of clinical practice as a straightforward instrumental application of scientific knowledge. There is, however, a paucity of empirical studies of phronesis, including in medicine. Using a hermeneutic and phenomenological approach, this inquiry explores how phronesis is manifest in the stories of clinical practice of eleven exemplary physicians. The findings highlight five overarching themes: ethos (or character) of the physician, clinical habitus revealed in physician know-how, encountering the patient with attentiveness, modes of reasoning amidst complexity, and embodied perceptions (such as intuitions or gut feeling). The findings open a discussion about the contingent nature of clinical situations, a hermeneutic mode of clinical thinking, tacit dimensions of being and doing in clinical practice, the centrality of caring relations with patients, and the elusive quality of some aspects of practice. This study deepens understandings of the nature of phronesis within clinical settings and proposes 'Clinical phronesis' as a descriptor for its appearance and role in the daily practice of (exemplary) physicians.
Topics: Humans; Philosophy, Medical; Hermeneutics; Physician-Patient Relations; Physicians; Empathy
PubMed: 38453732
DOI: 10.1007/s11019-024-10198-8 -
Canadian Family Physician Medecin de... Oct 2023
Topics: Humans; Canada; Dyslipidemias; Physicians, Family
PubMed: 37833087
DOI: 10.46747/cfp.6910664 -
Frontiers in Public Health 2023Medical error is costly, in terms of the health and wellbeing of the patient, their family, and the financial burden placed on the medical system. Reducing medical error... (Review)
Review
Medical error is costly, in terms of the health and wellbeing of the patient, their family, and the financial burden placed on the medical system. Reducing medical error is paramount to minimizing harm and improving outcomes. One potential source of medical error is physician cognitive impairment. Determining how to effectively assess and mange physician cognitive impairment is an important, albeit difficult problem to address. There have been calls and attempts to implement age-based cognitive screening, but this approach is not optimal. Instead, we propose that neuropsychological assessment is the gold standard for fitness-for-duty evaluations and that there is a need for the development of physician-based, normative data to improve these evaluations. Here, we outline the framework of our research protocol in a large, academic medical center, in partnership with hospital leadership and legal counsel, which can be modeled by other medical centers. With high rates of physician burnout and an aging physician population, the United States is facing a looming public health crisis that requires proactive management.
Topics: Humans; Aging; Burnout, Psychological; Cognitive Dysfunction; Exercise; Physicians
PubMed: 37693707
DOI: 10.3389/fpubh.2023.1245770 -
Journal of Bioethical Inquiry Sep 2023Epistemic injustice has undergone a steady growth in the medical ethics literature throughout the last decade as many ethicists have found it to be a powerful tool for...
Epistemic injustice has undergone a steady growth in the medical ethics literature throughout the last decade as many ethicists have found it to be a powerful tool for describing and assessing morally problematic situations in healthcare. However, surprisingly scarce attention has been devoted to how epistemic injustice relates to physicians' professional duties on a conceptual level. I argue that epistemic injustice, specifically testimonial, collides with physicians' duty of nonmaleficence and should thus be actively fought against in healthcare encounters on the ground of professional conduct. I do so by fleshing out how Fricker's conception of testimonial injustice conflicts with the duty of nonmaleficence as defined in Beauchamp and Childress on theoretical grounds. From there, I argue that testimonial injustice produces two distinct types of harm, epistemic and non-epistemic. Epistemic harms are harms inflicted by the physician to the patient qua knower, whereas non-epistemic harms are inflicted to the patient qua patient. This latter case holds serious clinical implications and represent a failure of the process of due care on the part of the physician. I illustrate this through examples taken from the literature on fibromyalgia syndrome and show how testimonial injustice causes wrongful harm to patients, making it maleficent practice. Finally, I conclude on why nonmaleficence as a principle will not be normatively enough to fully address the problem of epistemic injustice in healthcare but nevertheless may serve as a good starting point in attempting to do so.
Topics: Humans; Beneficence; Delivery of Health Care; Physicians
PubMed: 37378755
DOI: 10.1007/s11673-023-10273-4