Search

Objective. To examine the prevalence, predictors, and consequences of physician detection of unannounced standardized patients (SPs) in a study of the impact of direct-to-consumer advertising on treatment for depression. Data Sources. Eighteen trained SPs were randomly assigned to conduct 298 unannounced audio-recorded visits with 152 primary care physicians in three U.S. cities between May 2003 and May 2004. Study Design. Randomized controlled trial using SPs. SPs portrayed six roles, created by crossing two clinical conditions (major depression or adjustment disorder) with three medication request scripts (brand-specific request, general request for an antidepressant, or no request). Data Collection. Within 2 weeks following the visit, physicians completed a form asking whether they "suspected" conducting an office visit with an SP during the past 2 weeks; 296 (99 percent) detection forms were returned. Physicians provided contextual data, a Clinician Background Questionnaire. SPs filled in a Standardized Patient Reporting Form for each visit and returned all written prescriptions and medication samples to the laboratory. Principal Findings. Depending on the definition, detection rates ranged from 5 percent (unambiguous detection) to 23.6 percent (any degree of suspicion) of SP visits. In 12.8 percent of encounters, physicians accurately detected the SP before or during the visit but they only rarely believed their suspicions affected their clinical behavior. In random effects logistic regression analyses controlling for role, actor, physician, and practice factors, suspected visits occurred less frequently in HMO settings than in solo practice settings (p Conclusions. Trained actors portrayed patient roles conveying mood disorders at low levels of detection. There was some evidence for differential treatment of detected standardized patients by physicians with regard to referrals but not antidepressant prescribing or follow-up recommendations. Systematic assessment of detection is recommended when SPs are used in studies of clinical process and quality of care. Key Words. Standardized patients, physician--patient communication, health care delivery, Standardized patients (SPs) are people trained to portray patient roles so that practicing physicians cannot distinguish them from real patients (McLeod et al. 1997; Rosen et al. 2004). Research designs [...]

The most effective way to combat AIDS in the US is to prevent HIV infection. As of 1996, there were an estimated 700,000 to 900,000 Americans infected with HIV. One-third of AIDS cases are linked to intravenous drug use. Consequently, the need for needle exchange programs and drug treatment programs is great. Early sex education in schools may reduce heterosexual transmission of HIV. Research has shown that these educational programs do not increase promiscuous behavior in teenagers. Efforts must be made to reach blacks and Hispanics, who are most at risk for HIV infection.

Decision support is an important area of medical informatics research. Computer-based decision-support tools facilitate diagnosis and the management of patients after a diagnosis has been established. Diagnostic decision-support tools, such as Meditel, Quick Medical Reference, DXplain, Iliad, and PEM-DXP are potentially useful 'expert systems.' Other management-support tools, such as systems that use clinical practice guidelines to create reminders and alerts, also have been developed and evaluated. We do the following: 1) provide an overview of diagnostic and management decision-support systems; (2) explore the background of and motivation behind these systems; (3) survey the uses of decision-support technology in office-based and inpatient pediatric practices; and (4) discuss the virtues and problems associated with some of these tools, and current controversies and future goals for computer-based decision support., Medical diagnostic decision-support (MDDS) systems can assist doctors in making diagnoses and treating patients. MDDS systems enable doctors to manage the overwhelming amount of medical information, increase diagnostic accuracy, and make medically and financially optimal treatment decisions. Primarily, MDDS systems offer possible diagnoses in response to the doctor's input of history, clinical findings, and test results. They can also present treatment options, remind doctors of the need for screening tests or prevention information, calculate drug dosages, and warn against potential adverse reactions or complications. Fears of interference with patient rapport, loss of physician autonomy, expanse of legal liability, and the belief that it is too difficult or not worthwhile to work with an MDDS system are not justified. Several MDDS and reminder systems are described and evaluated.

Patients 50 and older account for a substantial number of persons with HIV infection. Here's how to talk about it, when to suspect it, and how to tailor treatment to [...]

As many as three out of four people who commit suicide have seen a primary-care provider within 30 days, statistics show. Yet, in a new study in which actresses portrayed [...]

Abstract Although selective serotonin reuptake inhibitors (SSRIs) are prescribed most often for depressive disorders, they are increasingly being used to treat a variety of anxiety disorders and other conditions and [...]

Part 1 of 2 * Abstract Although selective serotonin reuptake inhibitors (SSRIs) are prescribed most often for depressive disorders, they are increasingly being used to treat a variety of anxiety [...]

* Background A physician's effectiveness depends on good communication, and cognitive and technical skills used with wisdom, compassion, and integrity. Attaining the last attributes requires growth in awareness and management of one's feelings, attitudes, beliefs, and life experiences. Yet, little empiric research has been done on physicians' personal growth. * Objective To use qualitative methods to understand personal growth in a selected group of medical faculty. * Design Case study, using open-ended survey methods to elicit written descriptions of respondents' personal growth experiences. * Setting United States and Great Britain. * Participants Facilitators, facilitators-in-training, and members of a personal growth interest group of the American Academy on Physician and Patient, chosen because of their interest, knowledge, and experience in the topic area and their accessibility. * Measurements Qualitative analysis of submitted stories included initially identifying and sorting themes, placing themes into categories, applying the categories to the database for verification, and verifying findings by independent reviewers. * Results Of 64 subjects, 32 returned questionnaires containing 42 stories. Respondents and nonrespondents were not significantly different in age, sex, or specialty. The analysis revealed 3 major processes that promoted personal growth: powerful experiences, helping relationships, and introspection. Usually personal growth stories began with a powerful experience or a helping relationship (or both), proceeded to introspection, and ended in a personal growth outcome. Personal growth outcomes included changes in values, goals, or direction; healthier behaviors; improved connectedness with others; improved sense of self, and increased productivity, energy, or creativity. * Conclusions Powerful experiences, helping relationships, and introspection preceded important personal growth. These findings are consistent with theoretic and empiric adult learning literature and could have implications for medical education and practice. They need to be confirmed in other physician populations., Summary points * Lack of physicians' personal awareness can adversely affect patient care * In this study, the processes involved in growth in personal awareness were powerful experiences, helping relationships, [...]

To go in the dark with a light is to know the light. To know the dark, go dark. Go without sight, and find that the dark, too, blooms and [...]

* Defining and limiting physicians' role in intervening with victims of domestic violence increases their effectiveness * Physicians should ask patients about abuse; validate that battering is wrong; document signs, symptoms, and disclosures; and refer victims to domestic violence specialists (AVDR) * With this approach, physicians' time in providing patients quality care is greatly reduced * An AVDR approach to domestic violence could be integrated into managed care delivery systems * Universal screening, identifying risk factors, validating patients, and documenting abuse will help prevent further abuse * We are alt responsible for solving the problem of domestic violence, Physicians are called on, through guidelines such as those published by the American Medical Association in 1992,[1] to play a large role in identifying, intervening in, and following up on [...]

There is a story of a doctor in ancient China who refused to take money for his services. Instead, he asked that the patient, if satisfied, plant an apricot tree [...]