Search

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.

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.

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.

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.

Importance: Encouraging primary care patients to address depression symptoms and care with clinicians could improve outcomes but may also result in unnecessary treatment.Objective: To determine whether a depression engagement video (DEV) or a tailored interactive multimedia computer program (IMCP) improves initial depression care compared with a control without increasing unnecessary antidepressant prescribing.Design, Setting, and Participants: Randomized clinical trial comparing DEV, IMCP, and control among 925 adult patients treated by 135 primary care clinicians (603 patients with depression and 322 patients without depression, defined by Patient Health Questionnaire-9 [PHQ-9] score) conducted from June 2010 through March 2012 at 7 primary care clinical sites in California.Interventions: DEV targeted to sex and income, an IMCP tailored to individual patient characteristics, and a sleep hygiene video (control).Main Outcomes and Measures: Among depressed patients, superiority assessment of the composite measure of patient-reported antidepressant drug recommendation, mental health referral, or both (primary outcome); depression at 12-week follow-up, measured by the PHQ-8 (secondary outcome). Among nondepressed patients, noninferiority assessment of clinician- and patient-reported antidepressant drug recommendation (primary outcomes) with a noninferiority margin of 3.5%. Analyses were cluster adjusted.Results: Of the 925 eligible patients, 867 were included in the primary analysis (depressed, 559; nondepressed, 308). Among depressed patients, rates of achieving the primary outcome were 17.5% for DEV, 26% for IMCP, and 16.3% for control (DEV vs control, 1.1 [95% CI, -6.7 to 8.9], P = .79; IMCP vs control, 9.9 [95% CI, 1.6 to 18.2], P = .02). There were no effects on PHQ-8 measured depression score at the 12-week follow-up: DEV vs control, -0.2 (95% CI, -1.2 to 0.8); IMCP vs control,  0.9 (95% CI, -0.1 to 1.9). Among nondepressed patients, clinician-reported antidepressant prescribing in the DEV and IMCP groups was noninferior to control (mean percentage point difference [PPD]: DEV vs control, -2.2 [90% CI, -8.0 to 3.49], P = .0499 for noninferiority; IMCP vs control, -3.3 [90% CI, -9.1 to 2.4], P = .02 for noninferiority); patient-reported antidepressant recommendation did not achieve noninferiority (mean PPD: DEV vs control,  0.9 [90% CI, -4.9 to 6.7], P = .23 for noninferiority; IMCP vs control,  0.3 [90% CI, -5.1 to 5.7], P = .16 for noninferiority).Conclusions and Relevance: A tailored IMCP increased clinician recommendations for antidepressant drugs, a mental health referral, or both among depressed patients but had no effect on mental health at the 12-week follow-up. The possibility that the IMCP and DEV increased patient-reported clinician recommendations for an antidepressant drug among nondepressed patients could not be excluded.Trial Registration: clinicaltrials.gov Identifier: NCT01144104. [ABSTRACT FROM AUTHOR]

Presents letters to the editor as of April 3, 2002. Drug therapy for patients with type-2 diabetes; Treatment decisions for type-2 diabetes; Costs of making practice more cost-effective; Poliomyelitis and Parkinson Disease.

The author explores how physicians might reconcile the imperative to provide patient-centered care with the complex ways in which clinicians and patients construct preferences. Patient-centered communication promotes healing relationships which elicit and consider patients' perspectives. Construct preferences are affected by cognitive, emotional and relationship factors. According to reason-based choice theories, good decisions require logical consideration of options without emotional interference. However, the importance of emotions has been highlighted in neurocognitival research. Libertarian paternalism also indicates that leaders should influence patients' preferences to achieve desired goals while leaving the choice to the individual.

The article presents the authors' views on diagnosis and treatment of people suffering from chronic pain, and presents a case of a patient who went years with out a diagnosis, and no one understood why she seemed to get every possible complication from her treatments. It is opined that such cases illustrates how suffering can persist in patients who live with chronic illnesses and how persistent suffering can make physicians feel helpless.

A letter to the editor and a response are presented regarding the article "Association of an Education Program in Mindful Communication With Burnout, Empathy, and Attitudes Among Primary Care Physicians," by M. S. Krasner and colleagues published in a 2009 issue.

A letter to the editor is presented in response to the article "So much to do, so little time: care for the socially disadvantaged and the 15-minute visit," by Fiscella and Epstein in the 2008 issue.

Presents a letter to the editor in reply to readers' criticism of the authors' research methods.