-
Mayo Clinic Proceedings May 2024This is the first article of a 3-part series about physician health. In this installment, we outline the unique characteristics of physicians as patients, challenges and... (Review)
Review
This is the first article of a 3-part series about physician health. In this installment, we outline the unique characteristics of physicians as patients, challenges and opportunities presented by physician-patients, and recommendations for treating physicians. Future articles will delve into role clarity, occupational considerations, mental health, and interactions with third parties such as the physician's employer or licensing board. Ultimately, this series will help treating clinicians provide the best care to their physician-patients and successfully navigate the unique challenges that may arise, especially when the diagnosis may have an impact on their ability to practice medicine.
Topics: Humans; Physician-Patient Relations; Physicians; Physician's Role; Mental Health
PubMed: 38702130
DOI: 10.1016/j.mayocp.2023.08.027 -
Sexual & Reproductive Healthcare :... Dec 2023To document physicians' beliefs about abortion safety and the associations between these beliefs and physician support for, referral for, and participation in abortion...
OBJECTIVE
To document physicians' beliefs about abortion safety and the associations between these beliefs and physician support for, referral for, and participation in abortion care.
METHODS
In a 2019 survey at the University of Wisconsin School of Medicine and Public Health, we assessed physicians' abortion attitudes, beliefs, and practices (N = 893). We conducted bivariate analyses followed by logistic regression to document relationships between physician beliefs about abortion safety and their support for, referral to, and participation in abortion care.
RESULTS
Four-in-five physicians (78%, n = 690) believed that abortion is very or extremely safe. Medical specialty (Obstetrics-Gynecology vs. other; adjusted odds ratio [aOR] = 10.58, 95% CI: 1.41-79.56), educational exposure to abortion (aOR = 1.43, 95% CI: 1.02-2.01), and religiosity (aOR = 0.59, 95% CI: 0.41-0.85) were associated with physicians' beliefs about the safety of abortion. Providers who believed that abortion was very/extremely safe were more likely to support medication (aOR = 2.99, 95% CI: 1.93-4.65) and procedural abortion (aOR = 3.56, 95% CI: 2.31-5.50) and refer patients for abortion care (aOR = 3.14, 95% CI: 1.90-5.01).
CONCLUSION
Although abortions are associated with extremely few adverse events, a sizable portion of surveyed physicians had incorrect perceptions of the safety of abortion. These beliefs were associated with decreased support and referrals for abortion care. Educational exposure to abortion is associated with more accurate assessments of abortion safety, underscoring the importance of training in this area. Considering the current abortion policy landscape, it is imperative for physicians to hold accurate knowledge about abortion so they can provide comprehensive counseling and, when indicated, referrals for safe and legal care.
Topics: Pregnancy; Female; Humans; Attitude of Health Personnel; Abortion, Induced; Physicians; Surveys and Questionnaires; Referral and Consultation
PubMed: 37722252
DOI: 10.1016/j.srhc.2023.100916 -
BMC Cancer Dec 2023Patients diagnosed with low-risk prostate cancer (PCa) are confronted with a difficult decision regarding whether to undergo definitive treatment or to pursue an active...
BACKGROUND
Patients diagnosed with low-risk prostate cancer (PCa) are confronted with a difficult decision regarding whether to undergo definitive treatment or to pursue an active surveillance protocol. This is potentially further complicated by the possibility that patients and physicians may place different value on factors that influence this decision. We conducted a qualitative investigation to better understand patient and physician perceptions of factors influencing treatment decisions for low-risk PCa.
METHODS
Semi-structured interviews were conducted among 43 racially and ethnically diverse patients diagnosed with low-risk PCa, who were identified through a population-based cancer registry, and 15 physicians who were selected to represent a variety of practice settings in the Greater San Francisco Bay Area.
RESULTS
Patients and physicians both described several key individual (e.g., clinical) and interpersonal (e.g., healthcare communications) factors as important for treatment decision-making. Overall, physicians' perceptions largely mirrored patients' perceptions. First, we observed differences in treatment preferences by age and stage of life. At older ages, there was a preference for less invasive options. However, at younger ages, we found varying opinions among both patients and physicians. Second, patients and physicians both described concerns about side effects including physical functioning and non-physical considerations. Third, we observed differences in expectations and the level of difficulty for clinical conversations based on information needs and resources between patients and physicians. Finally, we discovered that patients and physicians perceived patients' prior knowledge and the support of family/friends as facilitators of clinical conversations.
CONCLUSIONS
Our study suggests that the gap between patient and physician perceptions on the influence of clinical and communication factors on treatment decision-making is not large. The consensus we observed points to the importance of developing relevant clinical communication roadmaps as well as high quality and accessible patient education materials.
Topics: Male; Humans; Decision Making; Physicians; Prostatic Neoplasms; Physician-Patient Relations; Qualitative Research
PubMed: 38053037
DOI: 10.1186/s12885-023-11679-4 -
Global Health Research and Policy Jun 2023The emigration of physicians from low- and middle-income countries (LMICs) to high-income countries (HICs), colloquially referred to as the "brain drain", has been a... (Review)
Review
BACKGROUND
The emigration of physicians from low- and middle-income countries (LMICs) to high-income countries (HICs), colloquially referred to as the "brain drain", has been a topic of discussion in global health spheres for years. With the call to decolonize global health in mind, and considering that West Africa, as a region, is a main source of physicians emigrating to HICs, this rapid review aims to synthesize the reasons for, and implications of, the brain drain, as well as recommendations to mitigate physician emigration from West African countries to HICs.
METHODS
A literature search was conducted on PubMed, EMBASE and The Cochrane Library. Main inclusion criteria were the inclusion of West African trained physicians' perspectives, the reasons and implications of physician emigration, and recommendations for management. Data on the study design, reasons for the brain drain, implications of brain drain, and proposed solutions to manage physician emigration were extracted using a structured template. The Hawker Tool was used as a risk of bias assessment tool to evaluate the included articles.
RESULTS
A total of 17 articles were included in the final review. Reasons for physician emigration include poor working conditions and remuneration, limited career opportunities, low standards of living, and sociopolitical unrest. Implications of physician emigration include exacerbation of low physician to population ratios, and weakened healthcare systems. Recommendations include development of international policies that limit HICs' recruitment from LMICs, avenues for HICs to compensate LMICs, collaborations investing in mutual medical education, and incorporation of virtual or short-term consultation services for physicians working in HICs to provide care for patients in LMICs.
CONCLUSIONS
The medical brain drain is a global health equity issue requiring the collaboration of LMICs and HICs in implementing possible solutions. Future studies should examine policies and innovative methods to involve both HICs and LMICs to manage the brain drain.
Topics: Humans; Emigration and Immigration; Physicians; Africa, Western; Income; Delivery of Health Care
PubMed: 37370163
DOI: 10.1186/s41256-023-00307-0 -
New insights into physician burnout and turnover intent: a validated measure of physician fortitude.BMC Health Services Research Jun 2024Given the increasing prevalence of the physician burnout, this study provides new insights into the antecedents driving burnout and turnover intent. By introducing the...
BACKGROUND
Given the increasing prevalence of the physician burnout, this study provides new insights into the antecedents driving burnout and turnover intent. By introducing the concept of physician fortitude, we develop a valid and statistically-reliable measure that increases our understanding of these issues.
METHODS
A two-sample design was employed. Using a sample of 909 physicians, Advanced Practice Providers (APPs) and healthcare leaders, exploratory factor analysis was employed to create a 12-item fortitude scale. In the second study, using a sample of 212 of practicing physicians, APPs and healthcare leaders, bivariate and tetrachoric correlations, and ordinary least square regression modeling were able to establish reliability and validity.
RESULTS
The fortitude scale shows sufficient reliability. Moreover, we found significant support for convergent and criterion-related validity. Fortitude was significantly related to all three subdimensions of burnout, including emotional exhaustion (r = -.62, p < .01), depersonalization (r = -.70, p < .01) and personal accomplishment (r = .65, p < .01), and turnover intent (r = -.55, p < .01). Moreover, the fortitude measure explained more variance in all three subdimensions of burnout and turnover intent compared to common measures, including grit, hardiness, mental toughness and resilience (p < .01).
CONCLUSIONS
Results from this study empirically demonstrate that fortitude is significantly related to burnout, and turnover intent. This new fortitude measure adds a new perspective to assist in the development of more effective interventions. Opportunities for future research are discussed.
Topics: Humans; Burnout, Professional; Personnel Turnover; Physicians; Female; Male; Adult; Reproducibility of Results; Surveys and Questionnaires; Middle Aged; Job Satisfaction; Factor Analysis, Statistical; Psychometrics; Intention
PubMed: 38890733
DOI: 10.1186/s12913-024-11186-7 -
JAMA Network Open Jul 2023
Topics: Humans; Telemedicine; Physicians
PubMed: 37410468
DOI: 10.1001/jamanetworkopen.2023.21955 -
Journal of Neurosurgery Jun 2023
Topics: Humans; Neurosurgeons; Negotiating; Physicians
PubMed: 37410635
DOI: 10.3171/2023.5.JNS23952 -
Tidsskrift For Den Norske Laegeforening... May 2024
Topics: Humans; Respect; Physicians; Interprofessional Relations; Physician-Patient Relations; Ethics, Medical
PubMed: 38747655
DOI: 10.4045/tidsskr.24.0140 -
CMAJ : Canadian Medical Association... May 2024
Topics: Humans; Canada; Salaries and Fringe Benefits; Female; Sexism; Male; Physicians, Women; Physicians
PubMed: 38802131
DOI: 10.1503/cmaj.231518-f -
JAMA Network Open Jul 2023Classic statements of research ethics generally advise against dual-role consent in which physician-investigators seek consent for research participation from patients...
IMPORTANCE
Classic statements of research ethics generally advise against dual-role consent in which physician-investigators seek consent for research participation from patients with whom they have preexisting treatment relationships. Yet dual-role consent is common in clinical oncology research, as studies are often conducted in close relationship with clinical care.
OBJECTIVE
To explore key stakeholders' perspectives on dual-role consent in clinical oncology trials.
DESIGN, SETTING, AND PARTICIPANTS
This qualitative study with 43 participants was conducted at a National Cancer Institute-designated comprehensive cancer center from 2018 to 2022. Semistructured qualitative interviews of physician-investigators, research coordinators, and patients were performed. Respondents were recruited from 3 populations: (1) physician-investigators engaged in clinical oncology research; (2) research coordinators engaged in clinical oncology research; and (3) patients, with and without prior clinical trial experience, who had received a new cancer diagnosis at least 2 months prior to enrollment in this study.
MAIN OUTCOMES AND MEASURES
Interviews were audio recorded and professionally transcribed. A thematic analysis approach was used to develop a codebook that included both theory-driven, a priori codes and emergent, inductive codes. Two authors double-coded all transcripts and met regularly to compare coding, discuss discrepancies, refine the codebook, and draft memos describing relevant themes and their frequency.
RESULTS
Among the 43 respondents, 28 (65.1%) were female; 9 (20.9%) were African American, 8 (18.6%) were Asian, 6 (14.0%) were Hispanic, and 21 (48.8%) were White; 15 were physician-investigators (6 [40.0%] with 6-10 years of experience, 4 [26.7%] with at least 20 years of experience), 13 were research coordinators (5 [38.5%] with 0-5 years of experience, 5 [38.5%] with 6-10 years of experience), and 15 were patients (9 [60.0%] aged 46-64 years). Four main themes were found: interviewees (1) perceived greater potential for role synergy than for role conflict; (2) reported dual-role consent as having mixed effects on the consent process, increasing prospective participants' understanding and likelihood of agreement while also challenging voluntariness; (3) preferred a team-based approach to the consent process in which physician-investigators and research coordinators share responsibility for communicating with prospective participants and safeguarding voluntariness; and (4) offered strategies for managing tensions in dual-role consent.
CONCLUSIONS AND RELEVANCE
This qualitative study found that concerns about dual-role consent in clinical oncology, while valid, may be outweighed by corresponding advantages, particularly if appropriate mitigation strategies are in place. These findings support a team-based approach to informed consent, in which physician-investigators and research coordinators promote both the understanding and voluntariness of prospective participants.
Topics: Humans; Female; Male; Prospective Studies; Neoplasms; Medical Oncology; Informed Consent; Physicians
PubMed: 37490290
DOI: 10.1001/jamanetworkopen.2023.25477