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JMIR MHealth and UHealth Oct 2019Mobile health (mHealth) is becoming more popular as a way of sharing medical information. For the patient, it saves time, reduces the need for travel, reduces the cost...
BACKGROUND
Mobile health (mHealth) is becoming more popular as a way of sharing medical information. For the patient, it saves time, reduces the need for travel, reduces the cost of searching for information, and brings medical services "to your fingertips." However, it also brings information overload and makes the patient's choice of physician more difficult.
OBJECTIVE
This study aimed to identify the types of physician information that play a key role in patients' choice of physician and to explore the mechanism by which this information contributes to this choice.
METHODS
Based on the stimulus-organism-response (SOR) model and online trust theory, we proposed a research model to explain the influence of physician information on patients' choice of physician. The model was based on cognitive trust and affective trust and considered the moderating role of patient expertise. Study 1 was an eye-tracking experiment (n=42) to identify key factors affecting patients' choice of physician. Study 2 was a questionnaire study (n=272); Partial Least Squares Structural Equation Modeling was used to validate the research model.
RESULTS
The results of Study 1 revealed that seven types of physician information played a key role in patients' choice of physician. The results of Study 2 revealed that (1) physicians' profile photo information affected patients' choice of physician by positively influencing affective trust (P<.001); (2) physicians' nonprofile photo information affected patients' choice of physician by positively influencing cognitive trust (P<.001); (3) patient-generated information affected patients' choice of physician by positively affecting cognitive trust (P<.001) and affective trust (P<.001), and patient expertise played a positive moderating role on both (P=.04 and P=.01, respectively); and (4) cognitive trust and affective trust both positively affected patients' choice of physician, with affective trust playing a more significant role (P<.001 and P<.001, respectively).
CONCLUSIONS
Seven types of physician information were mainly used by patients when choosing physicians offering mHealth services; trust played an important role in this choice. In addition, the level of patient expertise was an important variable in moderating the influence of physician information and patients' trust. This paper supports the theoretical basis of information selection and processing by patients. These findings can help guide app developers in the construction of medical apps and in the management of physician information in order to facilitate patients' choice of physician.
Topics: Adult; China; Choice Behavior; Eye Movement Measurements; Female; Humans; Male; Mobile Applications; Physician-Patient Relations; Physicians; Surveys and Questionnaires
PubMed: 31647466
DOI: 10.2196/15544 -
Journal of General Internal Medicine Jan 2019In 2016, over 65 million individuals were displaced from their homes due to human rights abuses, and 262,000 people applied for asylum in the USA. Individuals who have... (Review)
Review
In 2016, over 65 million individuals were displaced from their homes due to human rights abuses, and 262,000 people applied for asylum in the USA. Individuals who have experienced persecution are present in many primary and specialty clinics. A medical forensic evaluation can increase the likelihood of a successful asylum case. This paper reviews the legal framework for asylum and the contribution forensic evaluations can make to this vulnerable population. Physicians without asylum expertise can help these patients by recognizing their legal right to residential protection and referring them to lawyers and physicians with expert skills. Performing forensic examinations of asylum seekers offers physicians the opportunity to collaborate with attorneys, immigration officials, and human rights experts. Clinicians who do this work find it personally and professionally rewarding, especially when they impart their expert knowledge and skills to future clinicians by involving trainees in these evaluations. Physicians who encounter refugees or asylum seekers in their roles as providers or as preceptors should have familiarity with the field of asylum medicine to enhance the comprehensive care they deliver.
Topics: Human Rights; Humans; Physician's Role; Physicians; Refugees; United States; Vulnerable Populations
PubMed: 29907914
DOI: 10.1007/s11606-018-4524-5 -
Postgraduate Medical Journal Jul 2007Generally physicians have a legal and ethical obligation of keeping confidentiality regarding their communication with patients and it is clear that we all have rights.... (Review)
Review
Generally physicians have a legal and ethical obligation of keeping confidentiality regarding their communication with patients and it is clear that we all have rights. The application of rights theorem, which usually refers to the recognition of individual human rights, to the deceased offers possible answers to the problematic question of patient confidentiality after death. Philosophical considerations broadly support utilitarian ideals concerning the 'common good'. However, it may be possible to rank rights according to a hierarchy of need and thus preserve individual rights where they do not impinge upon the public's right to protection from harm and the physician's right to tell the truth. This has broad implications for confidentiality, anonymity and health care information in general for patients, their families and healthcare workers. We discuss these issues, with specific reference to an individual case.
Topics: Attitude to Death; Autopsy; Confidentiality; Ethics, Medical; Human Rights; Humans; Physician-Patient Relations; Physicians; Professional-Family Relations; Public Opinion
PubMed: 17621617
DOI: 10.1136/pgmj.2006.050534 -
Academic Medicine : Journal of the... Jun 2023It is widely accepted that negative social determinants of health (e.g., poverty) are underlying drivers of poor health and health disparities. There is overwhelming...
PURPOSE
It is widely accepted that negative social determinants of health (e.g., poverty) are underlying drivers of poor health and health disparities. There is overwhelming support among physicians to screen for patient-level social needs, but only a minority of clinicians actually do so. The authors explored potential associations between physician beliefs about health disparities and behaviors to screen and address social needs among patients.
METHOD
The authors used 2016 data from the American Medical Association Physician Masterfile database to identify a purposeful sample of U.S. physicians (n = 1,002); data obtained in 2017 were analyzed. Chi-squared tests of proportions and binomial regression analyses were employed to investigate associations between the belief that it is a physician's responsibility to address health disparities and perceptions of physician behaviors to screen for and address social needs, accounting for physician, clinical practice, and patient characteristics.
RESULTS
Of 188 respondents, respondents who felt that physicians have a responsibility to address health disparities were more likely than their peers (who did not feel that physicians have such a responsibility) to report that a physician on their health care team would screen for social needs that were psychosocial (e.g., safety, social support) (45.5% vs 29.6%, P = .03) and material (e.g., food, housing) (33.0% vs 13.6%, P < .0001). They were also more likely to report that a physician on their health care team would address both psychosocial needs (48.1% vs 30.9%, P = .02) and material needs (21.4% vs 9.9%, P = .04). With the exception of screening for psychosocial needs, these associations persisted in adjusted models.
CONCLUSIONS
Engaging physicians to screen for and address social needs should couple efforts to expand infrastructure with educational efforts about professionalism and health disparities, especially underlying drivers such as structural racism and the social determinants of health.
Topics: United States; Humans; Physicians; Housing; Poverty; Social Support; Data Collection
PubMed: 36811973
DOI: 10.1097/ACM.0000000000005180 -
Surgical Neurology Mar 2009
Topics: Humans; Morale; Neurosurgery; Physicians; Professional Autonomy; Public Opinion; State Medicine; United States
PubMed: 18617234
DOI: 10.1016/j.surneu.2008.05.005 -
European Review For Medical and... 2016Eight years since the last revision, in May 2014 the Italian code of medical ethics has been updated. Here, the Authors examine the reform in the light of the increasing... (Review)
Review
Eight years since the last revision, in May 2014 the Italian code of medical ethics has been updated. Here, the Authors examine the reform in the light of the increasing difficulties of the medical profession arising from the severity of the Italian law Courts. The most significant aspects of this new code are firstly, the patient's freedom of self-determination and secondly, risk prevention through the disclosure of errors and adverse events. However, in both areas the reform seems to be less effective if we compare the ethical codes of France, the United Kingdom and the United States. In particular, the non-taking into consideration of the said code quality standards and scientific evidence which should guide doctors in their clinical practice is to say the least questionable. Since these are the most significant changes in the new code, it seems inevitable to conclude that the 2014 edition is essentially in line with previous versions. Now more than ever it is necessary that medical ethics acknowledges that medicine, society and medical jurisprudence have changed and doctors must be given new rules in order to protect both patients' rights and dignity of the profession. The physician's right to refuse to perform treatment at odds with his own clinical beliefs cannot be the only mean to safeguard the dignity of the profession. A clear boundary must also be established between medicine and professionalism as well as the criteria in determining the scientific evidences that physicians must follow. This has not been done in the Italian code of ethics, despite all the controversy caused by the Stamina case.
Topics: Codes of Ethics; Ethics, Medical; France; Humans; Italy; Physicians; United Kingdom; United States
PubMed: 26914136
DOI: No ID Found -
The British Journal of General Practice... Feb 2022Empathy in primary care settings has been linked to improved health outcomes. However, the operationalisation of empathy differs between studies, and, to date, no study...
BACKGROUND
Empathy in primary care settings has been linked to improved health outcomes. However, the operationalisation of empathy differs between studies, and, to date, no study has concurrently compared affective, cognitive, and behavioural components of empathy regarding patient outcomes. Moreover, it is unclear how gender interacts with the studied dimensions.
AIM
To examine the relationship between several empathy dimensions and patient-reported satisfaction, consultation's quality, and patients' trust in their physicians, and to determine whether this relationship is moderated by a physician's gender.
DESIGN AND SETTING
Analysis of the empathy of 61 primary care physicians in relation to 244 patient experience questionnaires in the French-speaking region of Switzerland.
METHOD
Sixty-one physicians were video-recorded with two male and two female patients. Six different empathy measures were assessed: two self-reported measures, a facial recognition test, two external observational measures, and a Synchrony of Vocal Mean Fundamental Frequencies (SVMFF), measuring vocally coded emotional arousal. After the consultation, patients indicated their satisfaction with, trust in, and quality of the consultation.
RESULTS
Female physicians self-rated their empathic concern higher than their male counterparts did, whereas male physicians were more vocally synchronised (in terms of frequencies of speech) to their patients. SVMFF was the only significant predictor of all patient outcomes. Verbal empathy statements were linked to higher satisfaction when the physician was male.
CONCLUSION
Gender differences were observed more often in self-reported measures of empathy than in external measures, indicating a probable social desirability bias. SVMFF significantly predicted all patient outcomes, and could be used as a cost-effective proxy for relational quality.
Topics: Empathy; Female; Humans; Male; Patient Satisfaction; Physician-Patient Relations; Physicians; Surveys and Questionnaires; Trust
PubMed: 34990388
DOI: 10.3399/BJGP.2021.0193 -
Proceedings of the Japan Academy.... 2012Physicians have been required to possess high ethical standards, as medical practice is directly involved with patients' lives. Although ethics arise out of an... (Review)
Review
Physicians have been required to possess high ethical standards, as medical practice is directly involved with patients' lives. Although ethics arise out of an individual's consciousness, ethical regulations imposed by the nation/government together with self-regulation by physician groups are important in the practice of ethics, for which reason countries around the world undertake various initiatives. This paper investigates physician licensure, organizations governing physician status, the role of physician groups, and the actual conditions of lifelong learning and ethics education in developed countries worldwide, in contrast with which it throws problems in the situation in Japan into relief. Organizations governing physician status, the form of medical associations, and the improvement of lifelong learning are pointed out as critical issues especially in Japan.
Topics: Ethics, Medical; Government; Government Regulation; Japan; Physicians; Societies, Medical
PubMed: 22498978
DOI: 10.2183/pjab.88.144 -
Mayo Clinic Proceedings Apr 2018Online physician reviews have become increasingly prevalent and are a common means by which patients explore medical options online. Currently, there are no data...
Online physician reviews have become increasingly prevalent and are a common means by which patients explore medical options online. Currently, there are no data comparing physicians with negative online reviews and those without negative reviews. We sought to compare industry-vetted patient satisfaction surveys (PSSs), such as Press Ganey (PG) PSSs, between those physicians with negative online reviews and those without negative reviews. Overall, there were 113 unique individuals with negative online reviews from September 1, 2014, to December 31, 2014, with 8 being nonphysicians. We matched 113 physicians in similar departments/divisions. We obtained PG PSS scores of both groups and compared the mean scores of the 2 groups. Press Ganey PSS scores were available for 98 physicians with negative online reviews compared with 82 matched physicians without negative online reviews. The mean raw PG PSS scores were not different between the 2 groups (4.05; 95% CI, 3.99-4.11 vs 4.04; 95% CI, 3.97-4.11; P=.92). We also noted no difference in mean scores on questions related to physician-patient communication and interaction skills between those with poor online reviews and those without (4.38; 95% CI, 4.32-4.43 vs 4.41; 95% CI, 4.35-4.47; P=.42). However, there was a significantly lower non-physician-specific mean in those with negative online reviews (3.91; 95% CI, 3.84-3.97) vs those without negative online reviews (4.01; 95% CI, 3.95-4.09) (P=.02). Here, we provide data indicating that online physician reviews do not correlate to formal institutional PG PSS. Furthermore, physicians with negative online reviews have lower scores on non-physician-specific variables included in the PG PSSs, emphasizing that these discrepancies can negatively affect overall patient experience, online physician reviews, and physician reputation. It is prudent that an improved mechanism for online ratings be implemented to better inform patients about a physician's online reputation.
Topics: Health Care Surveys; Humans; Internet; Patient Satisfaction; Physician-Patient Relations; Physicians; Retrospective Studies; Social Media; Surveys and Questionnaires
PubMed: 29622095
DOI: 10.1016/j.mayocp.2018.01.021 -
JAMA Network Open Sep 2021Men and women should earn equal pay for equal work. An examination of the magnitude of pay disparities could inform strategies for remediation.
IMPORTANCE
Men and women should earn equal pay for equal work. An examination of the magnitude of pay disparities could inform strategies for remediation.
OBJECTIVE
To examine gender-based differences in pay within a large, comprehensive physician population practicing within a variety of payment systems.
DESIGN, SETTING, AND PARTICIPANTS
This cross-sectional study used data from the Ontario Health Insurance Plan (OHIP) in the 2017 to 2018 fiscal year to estimate differences in gross payments between men and women physicians in Ontario, Canada. Pay gaps were calculated annually and daily. Regression analyses were used to control for observable practice characteristics that could account for individual differences in daily pay. In Canada's largest province, Ontario, medical services are predominantly provided by self-employed physicians who bill the province's single payer, OHIP. All physicians who submitted claims to OHIP were included. Data were analyzed from January 2020 to July 2021.
EXPOSURES
Physician gender, obtained from the OHIP Corporate Provider Database. Gender is recorded as male or female.
MAIN OUTCOMES AND MEASURES
Gross clinical payments were tabulated for individual physicians on a daily and annual basis in conjunction with each physician's practice characteristics, setting, and specialty.
RESULTS
A total of 31 481 physicians were included in the study sample (12 604 [40.0%] women; 18 877 [60.0%] men; mean [SD] time since graduation, 23.3 [13.6] years), representing 99% of active physicians in Ontario. The unadjusted differences in clinical payments between male and female physicians were 32.8% (95% CI, 30.8%-34.6%) annually and 22.5% (95% CI, 21.2%-23.8%) daily. After accounting for practice characteristics, region, and specialty, the overall daily payment gap was 13.5% (95% CI, 12.3%-14.8%). The pay gap persisted with differing magnitudes when examined by specialty (ranging from 6.6% to 37.6%), practice setting (8.3% to 17.2%), payment model (13.4% to 22.8% for family medicine; 8.0% to 11.6% for other specialties), and rurality (8.0% to 16.5%).
CONCLUSIONS AND RELEVANCE
This cross-sectional study examined differences in magnitude of annual and daily payment gaps and between unadjusted and adjusted gaps. Comparing the gaps for different specialties, geography, and payment systems illustrated the complexity of the issue by showing that the pay gap varied for physicians in different practice settings. As such, multiple directed interventions will be necessary to ensure that all physicians are paid equally for equal work, regardless of gender.
Topics: Cross-Sectional Studies; Female; Humans; Income; Male; Ontario; Physicians; Physicians, Women; Salaries and Fringe Benefits; Sex Distribution; Sexism
PubMed: 34546369
DOI: 10.1001/jamanetworkopen.2021.26107