Search

Given that presence is ineffable yet real and universal, it is no surprise that it has historically been the domain of mystics. However, presence and its cousins--shared mind, love, and [...]

The study aims to evaluate whether there are any benefits of an educational program in mindfulness, communication and self-awareness in improving the wellbeing, burnout and psychological stress of primary care physicians. The results indicate that such programs were found to be beneficial in improving the health and wellbeing of physicians.

Most practicing physicians have to assess the competence of trainees, peers, and other health professionals, but they may not be very comfortable using education assessment tools. A conceptual framework for commonly used and emerging methods of assessment is provided together with a discussion on the strengths and weaknesses of each method and the challenges of assessing physicians' professional competence and performance.

Many prior studies which suggest a relationship between physician interactional style and patient outcomes may have been confounded by relying solely on patient reports, examining very few patients per physician, or not demonstrating evidence of a physician effect on the outcomes. We examined whether physician interactional style, measured both by patient report and objective encounter ratings, is related to performance on quality of care indicators. We also tested for the presence of physician effects on the performance indicators. Using data on 100 US primary care physician (PCP) claims data on 1,21,606 of their managed care patients, survey delta on 4746 of their visiting patients, and audiotaped encounters of 2 standardized patients with each physician, we examined the relationships between claims-based quality of care indicators and both survey-derived patient perceptions of their physicians and objective ratings of interactional style in the audiotaped standardized patient encounters. Multi-level models examined whether physician effects (variance components) on care indicators were mediated by patient perceptions or objective ratings of interactional style. We found significant physician effects associated with glycohemoglobin and cholesterol testing. There was also a clinically significant association between better patient perceptions of their physicians and more glycohemoglobin testing. Multi-level analyses revealed, however, that the physician effect on glycohemoglobin testing was not mediated by patient perceived physician interaction style. In conclusion, similar to prior studies, we found evidence of an apparent relationship between patient perceptions of their physician and patient outcomes. However, the apparent relationships found in this study between patient perceptions of their physicians and patient care processes do not reflect physician style, but presumably reflect unmeasured patient confounding. Multi-level modeling may contribute to better understanding of the relationships between physician style and patient outcomes. Keywords: USA; Provider-patient communication; Quality of care; Multi-level analysis; Adherence

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2005.05.027 Byline: Peter Franks, Anthony F Jerant, Kevin Fiscella, Cleveland G Shields, Daniel J Tancredi, Ronald M Epstein Keywords: USA; Provider-patient communication; Quality of care; Multi-level analysis; Adherence Abstract: Many prior studies which suggest a relationship between physician interactional style and patient outcomes may have been confounded by relying solely on patient reports, examining very few patients per physician, or not demonstrating evidence of a physician effect on the outcomes. We examined whether physician interactional style, measured both by patient report and objective encounter ratings, is related to performance on quality of care indicators. We also tested for the presence of physician effects on the performance indicators. Using data on 100 US primary care physician (PCP) claims data on 1,21,606 of their managed care patients, survey data on 4746 of their visiting patients, and audiotaped encounters of 2 standardized patients with each physician, we examined the relationships between claims-based quality of care indicators and both survey-derived patient perceptions of their physicians and objective ratings of interactional style in the audiotaped standardized patient encounters. Multi-level models examined whether physician effects (variance components) on care indicators were mediated by patient perceptions or objective ratings of interactional style. We found significant physician effects associated with glycohemoglobin and cholesterol testing. There was also a clinically significant association between better patient perceptions of their physicians and more glycohemoglobin testing. Multi-level analyses revealed, however, that the physician effect on glycohemoglobin testing was not mediated by patient perceived physician interaction style. In conclusion, similar to prior studies, we found evidence of an apparent relationship between patient perceptions of their physician and patient outcomes. However, the apparent relationships found in this study between patient perceptions of their physicians and patient care processes do not reflect physician style, but presumably reflect unmeasured patient confounding. Multi-level modeling may contribute to better understanding of the relationships between physician style and patient outcomes. Author Affiliation: Department of Family and Community Medicine, Universtiy of California Davis, UC Davis Medical Center, 2329 ACC, Sacramento, CA 95817, USA

In our view, the biopsychosocial model is a vision and an approach to practice rather than an empirically verifiable theory, a coherent philosophy, or a clinical method. In some cases, [...]

The goal of patient-centered communication (PCC) is to help practitioners provide care that is concordant with the patient's values, needs and preferences, and that allows patients to provide input and participate actively in decisions regarding their health and health care. PCC is widely endorsed as a central component of high-quality health care, but it is unclear what it is and how to measure it. PCC includes four communication domains: the patient's perspective, the psychosocial context, shared understanding, and sharing power and responsibility. Problems in measuring PCC include lack of theoretical and conceptual clarity, unexamined assumptions, lack of adequate control for patient characteristics and social contexts, modest correlations between survey and observational measures, and overlap of PCC with other constructs. We outline problems in operationalizing PCC, choosing tools for assessing PCC, choosing data sources, identifying mediators of PCC, and clarifying outcomes of PCC. We propose nine areas for improvement: (1) developing theory-based operational definitions of PCC; (2) clarifying what is being measured; (3) accounting for the communication behaviors of each individual in the encounter as well as interactions among them; (4) accounting for context; (5) validating of instruments; (6) interpreting patient ratings of their physicians; (7) doing longitudinal studies; (8) examining pathways and mediators of links between PCC and outcomes; and (9) dealing with the complexity of the construct of PCC. We discuss the use of observational and survey measures, multi-method and mixed-method research, and standardized patients. The increasing influence of the PCC literature to guide medical education, licensure of clinicians, and assessments of quality provides a strong rationale for further clarification of these measurement issues. Keywords: Patient-centered: Communication: Measurement: Doctor patient communication

A study is conducted to ascertain the effect of patients' direct-to-consumer (DTC)-related requests on physicians' initial treatment decisions in patients with depressive symptoms. The conclusions showed that the patients' request have a profound effect on physician prescribing in major depression and adjustment disorder.

Informed patients, are more likely to actively participate in their care, make wiser decisions, and coming to a common understanding with their physicians. The ways to communicate evidence that improve patient understanding, involvement in decisions, and outcomes are identified.

In this first of a 2-part series of articles, mindfulness is defined as a purposeful, non-anxious, reflective presence that can be applied to any aspect of practice. More than an [...]

Habits of mind, such as attentiveness, curiosity, and presence, are fundamental to effective medical practice and physician well-being. In this second of two articles about mindfulness, I propose an 8-fold [...]

A definition of professional competence is presented along with current and proposed techniques for measuring it. Competence includes not only knowledge and skills but also interpersonal skills, lifelong learning, professionalism, and the integration of knowledge into clinical practice., Context: Current assessment formats for physicians and trainees reliably test core knowledge and basic skills. However, they may underemphasize some important domains of professional medical practice, including interpersonal skills, lifelong learning, professionalism, and integration of core knowledge into clinical practice. Objectives: To propose a definition of professional competence, to review current means for assessing it, and to suggest new approaches to assessment. Data Sources: We searched the MEDLINE database from 1966 to 2001 and reference lists of relevant articles for English-language studies of reliability or validity of measures of competence of physicians, medical students, and residents. Study Selection: We excluded articles of a purely descriptive nature, duplicate reports, reviews, and opinions and position statements, which yielded 195 relevant citations. Data Extraction: Data were abstracted by 1 of us (R.M.E.). Quality criteria for inclusion were broad, given the heterogeneity of interventions, complexity of outcome measures, and paucity of randomized or longitudinal study designs. Data Synthesis: We generated an inclusive definition of competence: the habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflection in daily practice for the benefit of the individual and the community being served. Aside from protecting the public and limiting access to advanced training, assessments should foster habits of learning and self-reflection and drive institutional change. Subjective, multiple-choice, and standardized patient assessments, although reliable, underemphasize important domains of professional competence: integration of knowledge and skills, context of care, information management, teamwork, health systems, and patient-physician relationships. Few assessments observe trainees in real-life situations, incorporate the perspectives of peers and patients, or use measures that predict clinical outcomes. Conclusions: In addition to assessments of basic skills, new formats that assess clinical reasoning, expert judgment, management of ambiguity, professionalism, time management, learning strategies, and teamwork promise a multidimensional assessment while maintaining adequate reliability and validity. Institutional support, reflection, and mentoring must accompany the development of assessment programs.

Medical schools and residency programs should consider a series of workshops and discussion groups to help physicians understand their own communication patterns. This could improve their relationships with their patients. Physicians should examine their own beliefs and attitudes as well as family influences. They should explore how they react to difficult patients, dying patients and medical errors. They should understand how they react to and manage stress. Group discussions, support groups and Balint groups can assist in this process., Physicians' personal characteristics, their past experiences, values, attitudes, and biases can have important effects on communication with patients; being aware of these characteristics can enhance communication. Because medical training and continuing education programs rarely undertake an organized approach to promoting personal awareness, we propose a "curriculum" of 4 core topics for reflection and discussion. The topics are physicians' beliefs and attitudes, physicians' feelings and emotional responses in patient care, challenging clinical situations, and physician self-care. We present examples of organized activities that can promote physician personal awareness such as support groups, Balint groups, and discussions of meaningful experiences in medicine. Experience with these activities suggests that through enhancing personal awareness physicians can improve their clinical care and increase satisfaction with work, relationships, and themselves.

The article discusses the importance of patient-centered care as the major basis of providing high-quality health care. The different ways in which physicians can reconcile patient-centered care with the complex ways in which physicians and patients construct preferences are highlighted.

Medical family therapy grew out of the experiences of family therapists working with other professionals to provide comprehensive, integrated healthcare for patients (McDaniel, Hepworth, & Doherty, 1992). This is the story of one such patient, her son, and those of us who were the three primary participants on her treatment team. To provide an account that comes closest to the experience itself, we have taken quotes from videotaped sessions and electronic mail communications that occurred throughout the course of therapy.(1) Each provider tells part of the story in his or her own voice. The commentary is provided by Susan McDaniel.

Fam Syst & Health 18:123-124, 2000 Malka's asthma started before it had a name. Even trying to trace backward, the beginnings are obscure. She was a healthy baby. No one [...]

The article discusses the circumstances in which physicians tend to withhold information from patients, so as not to cause them additional cognitive and emotional burden. The right to autonomy needs to be balanced with the ethical obligations as well as physicians need to ensure that there is no conscious or unconscious bias in their withholding of information.

In this very engaging and well-researched book, Jerome Groopman, a practicing oncologist with expertise in AIDS-related malignancies, explores the interior landscape of the physician's mind. The explicit purpose of How [...]

Many physicians do not allow patients to voice all of their concerns. A study of 264 patient-physician interviews recorded by 29 family physicians found that the physicians asked about patient concerns 75% of the time, but allowed patients to voice all of their concerns only 28% of the time. The physicians redirected the conversation after an average of only 23 seconds. However, patients who were allowed to voice all their concerns took only 6 seconds more on average than those who were not.