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Accessing care in the Emergency Department is often fraught with stress and heightened emotions due to illness or injury, and the complexity of navigating an often busy and overwhelming healthcare setting. For people who identify as trans (binary and non-binary), accessing Emergency Department care is often associated with additional stress or avoided due to fears of discrimination, or previous negative experiences (1). The aim of this integrative review was to identify and review the literature relating to the experiences of trans (binary and non-binary) people accessing Emergency Department care, to guide practice and future research. A structured search process was used to identify 11 articles published between January 2013 and November 2023. These articles were appraised using the mixed methods appraisal tool (MMAT) (2) and included in this review. Utilising the methodology outlined by Whittemore & Knafl (3), a constant comparison analytic approach identified five key themes; 1. emergency department context; 2. interactions with staff and language; 3. health professional knowledge; 4. advocacy; and 5. disclosing trans status. This review identified a perceived lack of competence for healthcare providers to deliver gender affirming healthcare in the Emergency Department due to perceptions of inadequate healthcare provider knowledge, and structural barriers founded on cisgender processes. [ABSTRACT FROM AUTHOR]

Public health physicians (PHPs) are trained in both medicine and public health, yet practice models in each of these fields incompletely describe their work. A model of practice for public health physicians would better enable training and professional development in the specialty. The objective of this study was to develop an empirically grounded method of the practice of public health medicine by public health physicians. This was designed as a constructivist grounded theory (CGT) study. Semistructured interviews with 18 public health physicians in Canada were conducted over the course of 1 year. Transcribed interviews were coded in three stages (line-by-line, focused, and theoretical). Constant comparison, theoretical sampling, reflective and analytic memos, and team discussion on reflexivity were used to ensure rigor and the proper application of CGT methods. The key finding of this study is the population-centered medical method (POP-CMM), an empirically grounded method of PHP practice. In this model, PHPs bring values, knowledge, and stances to their practice of medicine with populations as patients. They work to diagnose and intervene on public health issues, with a focus on prevention and systems. Essential to this work is knowledge sharing and relationship building between physicians and populations. POP-CMM represents a method of practice for PHPs. Further exploration of this method in other countries and systems would bring insight into PHP practice globally. The model has important connections to the practice of medicine and presents the possibility of developing a general model of physician practice for a range of patients, from individuals to populations. [ABSTRACT FROM AUTHOR]

The social and technological mutation of our contemporary period disrupts the traditional dyad that prevails in the relationship between physicians and patients. The solicitation of a second opinion by the patient may potentially alter this dyad and degrade the mutual trust between the stakeholders concerned. The doctor-patient relationship has often been studied from the patient's perspective, but data are scarce from the spine surgeon's point of view. This qualitative study used the grounded theory approach, an inductive methodology emphasizing field data and rejecting predetermined assumptions. We interviewed spine surgeons of different ages, experiences, and practice locations. We initially contacted 30 practitioners, but the final number (24 interviews; 11 orthopedists and 13 neurosurgeons) was determined by data saturation (the point at which no new topics appeared). Themes and subthemes were analyzed using semistructured interviews until saturation was reached. Data were collected through individual interviews, independently analyzed thematically using specialized software, and triangulated by three researchers (an anthropologist, psychiatrist, and neurosurgeon). Index surgeons were defined when their patients went for a second opinion and recourse surgeons were defined as surgeons who were asked for a second opinion. Data analysis identified five overarching themes based on recurring elements in the interviews: (1) analysis of the patient's motivations for seeking a second opinion; (2) impaired trust and disloyalty; (3) ego, authority, and surgeon image; (4) management of a consultation recourse (measurement and ethics); and (5) the second opinion as an avoidance strategy. Despite the inherent asymmetry in the doctor-patient relationship, surgeons and patients share two symmetrical continua according to their perspective (professional or consumerist), involving power and control on the one hand and loyalty and autonomy on the other. These shared elements can be found in index consultations (seeking high-level care/respecting trust/closing the loyalty gap/managing disengagement) and referral consultations (objective and independent advice/trusting of the index advice/avoiding negative and anxiety-provoking situations). The second opinion often has a negative connotation with spine surgeons, who see it as a breach of loyalty and trust, without neglecting ego injury in their relationship with the patient. A paradigm shift would allow the second opinion to be perceived as a valuable resource that broadens the physician-patient relationship and optimizes the shared surgical decision-making process. [ABSTRACT FROM AUTHOR]

• The Hippocratic medical doctrine was grounded on three interacting elements of the "art" of medicine: the disease, the patient, the physician, • At the core of the physician-patient relationship lies the principle "to help, or at least to do no harm," encapsulating the contemporary ethical principles of "beneficence" and "non-maleficence," • This principle reminds physicians that they should act solely for the benefit of their patient and should take care not to harm, • Physicians should first assess the risks of potential harm associated with any attempt to heal. Hippocrates' teaching on the ethical and moral values of medicine have captivated physicians, scholars, and historians for over twenty-five centuries, enduring despite the challenges of applying moral guidance across diverse cultures. At the core of Hippocratic ethics is the human relationship between the physician and the patient, with an emphasis on the physician's responsibility to assess potential harm involved in any attempt to heal. The Hippocratic principle "to help, or at least to do no harm" remains as relevant today as it was 2,500 years ago. In the modern context, it serves as a deontological imperative, reminding physicians to evaluate the risks of harm associated with any healing attempt. This concept aligns with the ethical principles of beneficence and non-maleficence, which are at the heart of Hippocratic medical ethics with timeless significance. [ABSTRACT FROM AUTHOR]

Depression is one of the costliest and most prevalent health conditions in the U.S. with 21 million adults having experienced at least one major depressive episode. Despite the availability of evidence-based treatments for depression, a large proportion of people with new diagnoses fail to initiate formal mental health treatment. Although individuals across all racial and ethnic groups fail to initiate treatment for depression, historically minoritized racial/ethnic groups are at even greater risk. Thirty-four participants representing historically underserved racial and ethnic populations from two large health care systems in the U.S. participated in qualitative interviews or focus group to identify factors that impede and facilitate depression treatment initiation in primary care settings. Participants identified individual and systemic barriers and facilitators of treatment initiation for depression and suggested several ideas for increasing treatment engagement (i.e., increased communication and education from providers, community events, information on social media). Novel interventions are needed to improve treatment initiation following initial diagnosis of depression in primary care settings. Findings from this study offer suggestions for improving treatment initiation in traditionally underserved communities. • Depression treatment initiation is inhibited by patient and systemic level barriers. • Historically minoritized groups recommend community-based efforts. • A strong patient-primary care provider alliance can facilitate treatment initiation. [ABSTRACT FROM AUTHOR]

This study aimed to assess the level of public trust in general practitioners (GPs) and its association with primary care contract services (PCCS) in China. Cross-sectional study. Between September and December 2021, 4158 residents across eastern, central, and western China completed a structured self-administered questionnaire. Trust was assessed using the Chinese version of Wake Forest Physician Trust Scale. Multivariable linear regression models were established to identify predictors of trust. The effect size of PCCS on trust was estimated by the average treatment effect for the treated (ATT) through propensity score matching. The study participants had a mean Wake Forest Physician Trust Scale score of 36.82 (standard deviation = 5.45). Enrollment with PCCS (β = 0.14, P < 0.01), Han ethnicity (β = 0.03, P < 0.05), lower educational attainment (β = −0.06, P < 0.01), higher individual monthly income (β = 0.03, P < 0.05), better self-rated health (β = 0.04, P < 0.05), chronic conditions (β = 0.07, P < 0.01), and higher familiarity with primary care services (β = 0.12, P < 0.01) and PCCS (β = 0.21, P < 0.01) were associated with higher trust in GPs. The ATT of PCCS exceeded 1 (P < 0.05). PCCS are associated with higher levels of trust in GPs. PCCS may become an effective tool to attract public trust in GPs, although the relationship between the two may be bi-directional. [ABSTRACT FROM AUTHOR]

Patients who frequently present to Emergency Department (ED) experience complex health and social needs. While research has examined interventions that aim to decrease frequent ED attendances, there is a need to understand the types of interventions provided to patients by hospital clinicians during presentations. Using qualitative content analysis, 82 management plans were evaluated to understand the scope and type of interventions provided by clinicians for patients frequently presenting to the ED at the Royal Melbourne Hospital, Australia. Patients often presented to the ED due to mental and psychological distress, substance use and physical health concerns alongside psychosocial vulnerabilities. The goals of care documented in plans focussed on management of health issues, aggression within the ED, and coordinating care with community services. Recommended interventions addressed presenting needs with multi-disciplinary approach to respond to distress and aggression. Finally, the plans provided insight into service coordination dynamics between the ED and community-based health and social care services. The plans recommended interventions that sought to provide holistic care for patients in collaboration with relevant community-based services. The findings suggest that clinicians in the ED can provide appropriate and meaningful care for patients who experience frequent presentations. [ABSTRACT FROM AUTHOR]

The periodic certification of health professionals has been in place since January 1st, 2023. However, the entire system is not yet operational, but the regulatory texts are being finalized and communication on the system is important right now. The periodicity of certification is 6 years (9 years for the first cycle of doctors already in practice). This periodic certification will be recorded by the Professional Orders, which will be able to take corrective measures in the event of professional insufficiency. The good practices frameworks are being developed by the national professional councils, one for each profession or specialty. They will include a menu of actions in four areas: updating knowledge and skills, strengthening the quality of practices, improving doctor-patient relationships, and taking greater account of his(her) own personal health. The actions will be recorded over time in a computer portal, in the simplest and most automated way possible to make the certification system accessible to all and efficient. The goal is to improve the quality of care. [ABSTRACT FROM AUTHOR]

Telemedicine has the potential to increase access to and decrease the cost of care. However, it also alters the nature of the physician-patient relationship and the interaction of patients with the healthcare system, which may limit access to care in some circumstances. Regardless of the modality of care delivery, the basic tenets of medical ethics and the obligations of physicians to their patients still hold. [ABSTRACT FROM AUTHOR]

Doctor-patient interaction is a criterion for patient satisfaction in Online Health Consultation (OHC), influencing success in the patient's healing process. The interaction between doctors and patients in OHC is done asynchronously, where doctors and patients communicate indirectly through text. This communication process is challenging for doctors, who must apply competence in doctor-patient communication effectively and efficiently. A text segmentation method is needed to evaluate aspects of doctor-patient communication. This study proposes a methodology for segmenting text on six Indonesian language doctor-patient communication aspects and building a specific domain corpus as a word embedding corpus to create a word embedding model. [ABSTRACT FROM AUTHOR]

Fibromyalgia (FM) is a chronic disease characterized by widespread pain. Although much is known about this disease, research has focused on diagnosis and treatment, leaving aside factors related to patient's experience and the relationship with healthcare system. The aim was to analyze the available evidence on the experience of FM patients from the first symptoms to diagnosis, treatment, and follow-up. A scoping review was carried out. Medline and the Cochrane Library were searched for original studies or reviews dealing with FM and focusing on "patient journey". Results were organized using a deductive classification of themes. Fifty-four articles were included in the qualitative synthesis. Five themes were identified: the patient journey, the challenge for the health systems, a complex doctor–patient relationship, the importance of the diagnosis, and the difficulty of standardizing the treatment. This scoping review confirms the negative impact of FM on the patient, their social environment, and health systems. It is necessary to minimize the difficulties encountered throughout the diagnosis and follow-up of patients with FM. [ABSTRACT FROM AUTHOR]

• Females with FH are undertreated compared with males. • Sex differences in perception of FH as a disease was assessed in patients with FH. • We found no differences in the perception of ASCVD risk between males and females. • Females expressed more concerns about high LDL-C and safety of statins. • Physician's perception of ASCVD risk in males and females with FH is to be examined. Familial hypercholesterolemia (FH), a common genetic condition, is characterized by elevated low-density lipoprotein cholesterol (LDL-C) and premature atherosclerotic cardiovascular disease (ASCVD). Recent data indicate an undertreatment of females with FH. To characterize the role of sex in the perception of FH, its associated ASCVD risk and treatment. A survey investigating for sex differences in the perception of FH was sent to 1073 patients with FH using a cross sectional study design. A total of 412 patients (51.9 % male) responded to the survey; mean age was 56.2 ± 14.4 years. There was a higher proportion of males with ASCVD than females (41.5 % vs. 16.5 %, respectively, p <0.001). Analyses of the survey responses showed that a majority of both males and females agreed that their risk of ASCVD is higher than healthy individuals of same age (70.8 % vs. 74.7 %, respectively, p = 0.434). Females were more concerned about having high LDL-C levels (67.5 % vs. 56.5 % in males, p = 0.024), especially those in secondary prevention programs. As for treatment of FH, approximately 75 % of both sex groups considered statins to be efficient in reducing the risk of myocardial infarction, but less than half of the females considered statins to be safe (44.8 % vs. 60.0 % in males, p = 0.003). No major sex differences were noted regarding the influence of the doctor in their understanding of FH as a disease. Overall, both males and females with FH were well informed about FH, although females were more concerned about having high LDL-C levels and they feared the safety of statins. [Display omitted] [ABSTRACT FROM AUTHOR]

Reverse shoulder arthroplasty (RSA) recognition and acceptance is growing as patients report improved pain and function. Therefore, it is crucial to identify and modify factors that affect outcomes, some of the current aspects under discussion are subscapularis (SSc) management and postoperative rehabilitation (rehab) protocols. Our study seeks to evaluate the practices of American Shoulder and Elbow Surgeons members in managing the SSc during surgery and determining the best approach for postoperative rehab after RSA. An eight-question survey was distributed to 1217 members of the American Shoulder and Elbow Surgeons, inquiring about SSc management and rehab practices following RSA. The survey included multiple-choice questions that evaluated characteristics of surgeon's approach to rehab and perspectives of formal supervised outpatient therapy programs. The cohort was divided based on yearly RSA case volume and whether SSc is routinely repaired during RSA. More than one third of surgeons (35.3%) reported ordering formal rehab due to patient expectations, but did not believe it was critical, and only 8.9% believed formal rehab to be critical in the recovery of patient strength. Almost two thirds (60.7%) of surgeons did not place a limitation on internal rotation. Of the 72.3% of surgeons that repaired the SSc, 49.7% restrict external rotation. When separating the cohort based on surgical volume, surgeons who performed more than 100 cases were significantly more likely to immobilize patients for more than 4 weeks postoperatively (P =.041). Surgeons who repaired the SSc were significantly more likely to immobilize patients for more than 4 weeks compared to surgeons who did not repair SSc (P <.001). Management of the SSc and surgeon case volume are critical factors in postoperative rehab after RSA. The majority of surgeons tend to repair the SSc, while only half of those that repair it immobilize it after surgery. Further studies that better evaluate the impact of postoperative immobilization on patient reported outcomes and satisfaction scores are needed in order to develop a more standardized approach and definitive guidelines. [ABSTRACT FROM AUTHOR]

Recent guidelines from the Centers for Disease Control and Prevention emphasize the importance of access to comprehensive family planning services and recommend patient-centered contraceptive counseling be incorporated into routine primary care visits for reproductive-age individuals. This study aims to describe family planning service provision in outpatient care settings and assess differences by facility and clinician characteristics. Using National Ambulatory Medical Care Survey data, a nationally representative survey of outpatient care visits, we assessed family planning service provision by facility location, facility type, physician specialty, types of clinicians seen, and whether the patient was seen by their primary care provider. We used random intercept logistic regression with robust standard errors, adjusting for patient characteristics, and state and year fixed effects. The analytic sample included 53,489 patient visits with reproductive-age (15–49 years) individuals between 2011 and 2019. Family planning services were provided at 8% of total sampled visits and were more likely to be provided in urban compared with rural areas (adjusted odds ratio, 1.45; p =.02) and at community health centers compared with private physician practices (adjusted odds ratio, 1.74; p =.00). Family planning services were also more likely to be provided when the patient saw a physician assistant or nurse compared with only a physician. After controlling for observed covariates, measures of between-clinician heterogeneity indicate wide variation in which clinicians provided family planning services. Family planning services were more likely to be provided in urban areas, at community health centers, and when patients received team-based care. The wide variation between clinicians suggests a need to better incorporate family planning services into primary care and other outpatient settings to meet patient needs and preferences. [ABSTRACT FROM AUTHOR]

This systematic review aims to explore the association between abusive behaviour and physician–patient relations in healthcare settings. Systematic review. We searched for related studies on databases such as PubMed, Embase, and the Cochrane library, without restrictions on language, from inception until July 15, 2022. The risk of bias and the methodological quality was evaluated using the Newcastle–Ottawa Scale and Risk of Bias in Non-randomised Studies of Interventions tool. Ten studies were included in this systematic review, the participants of which were physicians and patients. The research from all the studies highlighted the detrimental effects of abusive behaviour on the relationship between physicians and patients, regardless of who the abusers were. Abusive behaviour in a clinical setting has a negative influence on the physician–patient relationship, whoever the perpetrator might be. The research sheds light on the importance of teaching communication skills to physicians and training them to manage conflicts and aggressive behaviours in healthcare settings. [ABSTRACT FROM AUTHOR]

Quels enjeux porte la question de l'observance thérapeutique d'un point de vue sociologique ? Si les causes de la mauvaise observance sont maintenant bien identifiées dans le rapport conflictuel au traitement, dans le manque de ressources du patient et dans les interactions médecin–malade déséquilibrées, elle interroge la capacité du patient à être autonome. Dans un contexte de désinstitutionalisation et de déclin des relations thérapeutiques asymétriques, l'autonomie du patient est à la fois une revendication, une nécessité organisationnelle et une injonction morale. Le malade doit pouvoir s'insérer dans une nouvelle division du travail médical qui fait de la maladie un espace collaboratif, et du patient un coproducteur de soin ayant une place spécifique dans la chaîne thérapeutique. Ce mouvement de professionnalisation et de retournement du « locus of contrôle » conduit aussi à des formes d'épuisement moral dans le cas des pathologies au long cours. From a sociological point of view, what are the challenges involved in the question of therapeutic compliance? While the causes of non-compliance have now been well identified in the opposing relationship with the treatment, in the patient's lack of resources, and in unequal doctor-patient interactions, it also raises questions about the patient's ability to be autonomous. In a context of deinstitutionalization and decline of asymmetrical therapeutic relationships, patient autonomy is at once a demand, an organizational necessity and a moral injunction. The patient must be able to fit into a new division of medical treatment protocols that transform the illness into a collaborative space, and the patient into a co-producer of care with a specific place in the therapeutic chain. This move toward professionalization and the inversion of the "locus of control" also leads to forms of moral exhaustion in the case of long-term chronic illness. [ABSTRACT FROM AUTHOR]

Improved communication can optimize treatment outcomes and patient satisfaction. Findings emphasize the need for tailored communication strategies based on patient characteristics. Implementing communication courses can enhance patient-centered care and reduce conflicts. Therefore, this study examined the feasibility of integrating doctor-patient communication education in Taiwan's dental education system. Using interviews and questionnaires, we conducted descriptive statistics and generalized linear mixed-effects model analysis on the importance of doctor-patient communication from the dentist and patient perspectives. More than 600 patient surveys and four interviewed dentists with 20+ years of experience stressed doctor-patient communication in dentistry. Patients' age and income were positively related to the emphasis on physician-patient communication but negatively associated with dental assistants' communication. Dentists valued communication education but differed in its execution and importance. It is recommended to initiate dentist-patient communication education during university studies and continue its practice to adapt to the changing societal dynamics. Individuals with higher socioeconomic status and older age show a greater appreciation for dentist-patient communication, potentially driven by self-promotion, thereby highlighting the diverse nature of doctor-patient relationships. Based on our findings, we suggest to implement the doctor-patient communication courses in Taiwan. [ABSTRACT FROM AUTHOR]

This study aims to assess the quality and readability of online resources regarding postoperative pain control for patients having undergone total shoulder arthroplasty (TSA), along with identifying gaps among the types of information. Three search engines were used to conduct internet searches utilizing a combination of TSA and pain management search phrases. The top 20 web pages from each search engine were gathered, reviewed, and scored by five different evaluators. Scoring was performed using 30-point criteria, integrated into an overall quality of resource (QR) score considered significant for patient education about TSA and pain management according to American Pain Society and American Academy of Orthopaedic Surgeons' published recommendations (Table I). Domain scores (route of administration, type of analgesia, opioid-specific, and general guidance) were calculated by summing the total points and dividing by the total possible score for each domain. The reading level of the Flesch-Kinkaid grade level, the Flesch reading ease, and the simple measure of gobbledygook index was also assessed. The overall readability was low, with a mean Flesch-Kincaid grade level score of 10.3 ± 2.0 and Simple Measure of Gobbledygook score of 9.9 ± 1.5. According to this index, only one website (2.3%) was written below the suggested 6th grade reading level. There was a mean QR score of 9.6/30 points, ranging from 2 to 22 (Table II). Most resources (90.9%) did not achieve greater than 50% of the total available points (greater than 15 out of 30). Of the domains, the mean score for route of administration was 31.8%, types of analgesia was 43.6%, opioid-specific was 11.4%, and general guidance was 43.2%. Opioid-specific scores were lower than all three other domain scores (all P <.001). According to our findings, current online resources for pain management following TSA are written above the average literacy level for adults in the United States and lack educational content, especially regarding opioid-specific discussion and recommendations. Resources must target gaps in online patient education to better inform patients of postoperative pain control, convey expectations, and encourage patient-physician conversations and decision-making. [ABSTRACT FROM AUTHOR]

Neurosurgery is regarded as a skilled specialty practice within medicine and poetry is regarded as a therapeutic art within the health humanities. The utilization of poetry in neurosurgery can be used to unite physician and patient to the experience of living through chronic illness while facing mortality. The purpose of this scoping review is to highlight the effect of utilizing poetry in neurosurgical care, and to explore the value of this integration. This scoping review was conducted through 2 bibliographic databases (PubMed and SCOPUS). The keywords "poetry" AND "neurosurgery" were utilized to find all publications. Poems by 2 influential neurosurgeon-poets were also included for analysis. The search defined 32 publications (21 results in PubMed and 11 in Scopus). Two of the results were selected poems by influential neurosurgeon-poets. After removing 9 duplicates and 1 non-English result, 22 publications and 2 poems were reviewed. Eight articles addressed the use of poetry for neurosurgeons and 2 examined the utilization of poetry for neurosurgery patients. Fourteen publications addressed poetry, or other humanities disciplines, that were not specifically directed toward neurosurgeons or neurosurgery patients. In a field involved with life-altering diagnoses or treatments, poetry can enhance the therapeutic connection between surgeon and patient, empowering neurosurgeons to understand their patient's predicament beyond diagnosis while granting them a way to process challenging experiences. Though limited in description in the research literature, implementation of therapeutic poetry into neurosurgical practice may hold potential to contribute meaningfully to physician-patient relationships. [ABSTRACT FROM AUTHOR]

To evaluate the clinical value of mixed reality-assisted puncture navigation (MRAPN) in percutaneous nephrolithotripsy (PCNL). Two hundred patients undergoing PCN were enrolled, all of whom had kidney stones to be subjected to lithotripsy by PCNL and grouped according to surgical procedure into the MRAPN (n = 100) and non-mixed reality-assisted puncture (non-MRAPN) (n = 100) groups. CT data in DICOM format for all patients in the MRAPN group were imported into 3D reconstruction and mixed reality (MR) post-processing workstations, and holographic 3D visualization modelling. Comparing parameters such as the operative time (OT), puncture time (PT), number of attempts, and estimated blood loss (EBL), a Likert scale was used to assess the clinical value of MRAPN. The Cohen κ coefficient (k) was employed to evaluate consistency among assessors; safety was assessed. There were no significant differences in patient demographic indicators or preoperative general information between the MRAPN and non-MRAPN groups (P >.05). The clinical value of MRAPN was higher for subjective scores regarding surgical planning, intraoperative navigation, didactic guidance and physician–patient communication (all P <.001). The PT was significantly shorter in the MRAPN group (P <.001), with a shorter overall OT and lower EBL (P <.001). There were no significant differences in the overall comparison, length of hospital stay, or preoperative or postoperative creatinine (all P >.05). MRAPN can safely and effectively improve the success of PCN, reduce complications, and decrease the PT, OT, and EBL. [ABSTRACT FROM AUTHOR]

Les examens cliniques objectifs structurés (ECOS) ont été introduits pour évaluer les étudiants non seulement sur leur savoir, mais aussi sur leur savoir-faire et savoir-être. Les objectifs de cette étude étaient d'étudier la corrélation entre les notes obtenues aux ECOS et celles obtenues aux épreuves de connaissances et d'analyser des facteurs associés à une meilleure réussite aux ECOS chez les étudiants de DFASM1 et 2 au CHU de Dijon. Il s'agit d'une étude prospective observationnelle conduite auprès de l'ensemble des étudiants en médecine DFASM1/2 de Dijon. Les notes aux épreuves facultaires d'ECOS (2022) et la note moyenne aux épreuves de connaissances (2021–2022) ont été recueillies et leur corrélation recherchée. Un questionnaire interrogeait les étudiants sur leurs caractéristiques démographiques, leur investissement aux ECOS formatives et en stage, leur niveaux d'empathie (questionnaire de Jefferson) et leurs traits de personnalité (NEO-Pi-R). Parmi 549 étudiants, 513 ont réalisét l'ensemble des épreuves. Les notes aux ECOS et aux épreuves de connaissances facultaires étaient corrélées (r = 0,39, p < 0,001). Parmi eux, 111 (20 %) étudiants ont répondu au questionnaire, dont 97 ont été analysés. Nous n'avons pas observé de différence significative entre les étudiants ayant mieux réussi aux ECOS qu'aux épreuves de connaissance et les autres, concernant leur âge, leus investissement aux épreuves formatives, leurs traits de personnalité ou leur niveau d'empathie. Nos résultats suggèrent qu'il est impératif d'optimiser l'évaluation du savoir-être et du savoir-faire lors des épreuves d'ECOS, par de nouveaux outils, afin de mieux discriminer les étudiants sur ces compétences. Objective structured clinical examinations (OSCEs) were introduced to evaluate students not only on their knowledge, but also on their clinical skills and attitudes. The objectives were to study the correlation between OSCE scores and scores obtained to traditional knowledge examinations and to analyse factors associated with better OSCE performance in DFASM1 and 2 students at Dijon university hospital. This was a prospective observational study conducted among all fourth and fifth year medical students in Dijon. The scores on the OSCE elective tests (2022) and the average score on the knowledge tests (2021–2022) were collected and their correlation measured. A questionnaire asked students about their demographic characteristics, their investment in formative and practicum OSCEs, their level of empathy (Jefferson questionnaire) and their personality traits (NEO-Pi-R). Of 549 students, 513 completed all tests. Scores on OSCE and faculty knowledge tests were correlated (r = 0.39, P < 0.001). Of these, 111 (20%) students responded to the questionnaire, and 97 were analized. We did not observe any significant difference between students who performed better on OSCEs than on knowledge tests and those who did not, regarding their age, their investment in formative tests, their personality traits or their level of empathy. Our results underline the need to optimize the evaluation of empathy and clinical skills in OSCE tests, using new tools, in order to better discriminate between students on these skills. [ABSTRACT FROM AUTHOR]

Clinical equipoise exists regarding early-stage lung cancer treatment among patients as trials comparing stereotactic body radiation therapy (SBRT) and surgical resection are unavailable. Given the potential differences in treatment effectiveness and side-effects, we sought to determine the associations between treatment type, decision regret and depression. A multicentre, prospective study of patients with stage IA–IIA non-small cell lung cancer (NSCLC) with planned treatment with SBRT or surgical resection was conducted. Decision regret and depression were measured using the Decision Regret Scale (DRS) and Patient Health Questionnaire-4 (PHQ-4) at 3, 6 and 12 months post-treatment, respectively. Mixed linear regression modelling examined associations between treatment and decision regret adjusting for patient sociodemographics. Among 211 study participants with early-stage lung cancer, 128 (61%) patients received SBRT and 83 (39%) received surgical resection. The mean age was 73 years (standard deviation = 8); 57% were female; 79% were White non-Hispanic. In the entire cohort at 3 months post-treatment, 72 (34%) and 57 (27%) patients had mild and severe decision regret, respectively. Among patients who received SBRT or surgery, 71% and 46% of patients experienced at least mild decision regret at 3 months, respectively. DRS scores increased at 6 months and decreased slightly at 12 months of follow-up in both groups. Higher DRS scores were associated with SBRT treatment (adjusted mean difference = 4.18, 95% confidence interval 0.82 to 7.54) and depression (adjusted mean difference = 3.49, 95% confidence interval 0.52 to 6.47). Neither patient satisfaction with their provider nor decision-making role concordance was associated with DRS scores. Most early-stage lung cancer patients experienced at least mild decision regret, which was associated with SBRT treatment and depression symptoms. Findings suggest patients with early-stage lung cancer may not be receiving optimal treatment decision-making support. Therefore, opportunities for improved patient–clinician communication probably exist. • Early-stage lung cancer patients have high decision regret levels after treatment. • One in four early-stage lung cancer patients has severe levels of decision regret. • Radiation therapy and depression are associated with increased decision regret. • Lung cancer patients may not be receiving optimal treatment decision-making support. [ABSTRACT FROM AUTHOR]

Analizar las necesidades, el impacto y la perspectiva actual de las personas con espondiloartritis (EspA) incluyendo la artritis psoriásica (APs). Encuesta nacional en formato electrónico dirigida a pacientes con EspA y APs. Se abrió en abril de 2021 utilizando los distintos canales de la Coordinadora Española de Asociaciones de Espondiloartritis para comunicarse con sus socios, y se cerró en junio de 2021. Se recogieron variables sociodemográficas y clínicas, y variables relacionadas con los objetivos propuestos. Se realizó un análisis descriptivo. Se incluyeron 834 pacientes: 543 con EspA (sin APs) y 291 con APs. En el último mes, la media de fatiga, rigidez matutina y problemas de sueño fue > 8 (0: nada; 10: mucho). Casi el 80% de los pacientes con EspA refieren dolor lumbar bajo, y el 82,5% de los pacientes con APs, afectación de rodillas, tobillos, pies y/o manos, y el 51%, dactilitis. El grado de satisfacción con el tratamiento fue medio-bajo: media 5,5 en las EspA y 6,2 en la APs (escala 0-10), y más alto con las terapias biológicas (medias > 6-7). El 70,2% de los pacientes con EspA y el 66% con APs se han acostumbrado a vivir con dolor diario. El 43,8% de los encuestados con EspA y el 31,2% con APs refieren que no marcan los objetivos del tratamiento con el médico. Actualmente el impacto de la EspA y de la APs en múltiples aspectos del día a día sigue siendo muy alto. Existen áreas de mejora en la relación médico-paciente y con los tratamientos. To analyse the current needs of patients with spondyloarthritis (SpA) and psoriatic arthritis (PsA), and the impact of the conditions. National survey in electronic format for patients with SpA and PsA. The survey was launched on April 28, 2021, using the channels of the Coordinadora Española de Asociaciones de Espondiloartritis (Spanish Coordinator of Associations of Spondyloarthritis) to communicate with members and followers, and was closed on June 30, 2021. Sociodemographic and clinical variables were collected (age, sex, disease duration, treatments), and variables related to the objectives. A descriptive analysis was performed. A total of 543 patients with SpA and 291 with PsA were included. In the previous month, on a scale from 0-10 (0: none; 10: very high) the mean scores of fatigue, morning stiffness, and sleep problems were all > 8. Almost 80% of the patients with SpA reported low back pain and 82.5% of the patients with PsA reported involvement of the knees, ankles, feet and/or hands, and 51% dactylitis. The level of satisfaction with the treatment was low, mean 5.5 in SpA and 6.2 in PsA (scale 0-10). It was higher with biological therapies. We found that 70.2% of patients with SpA and 66% with PsA were used to living with pain every day. Finally, 43.8% of participants with SpA and 31.2% of those with PsA reported that they did not set the treatment goals with their doctors. Currently the impact of SpA and PsA on multiple aspects of daily life is still very high. There are areas for improvement in the doctor-patient relationship and in treatments. [ABSTRACT FROM AUTHOR]

Maintaining a thriving dermatology practice requires thoughtful and intentional investment in relationships with patients, staff, and industry. Growing the patient–physician relationship involves optimizing patient satisfaction and outcomes, which can provide improved ratings and reimbursement. Cultivating an environment of employee engagement is also essential for promotion of patient satisfaction, employee satisfaction, and practice productivity. Additionally, relationships with industry require careful navigation to maximize its great potential for medical advancement and benefit for all parties. There are inherent conflicts of interest between physician motivation for improved patient outcomes and industry goals of increased profits. Successful management of these relationships can be a difficult task, but it remains important. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVES: Previous studies have demonstrated associations between patient experience scores and physician's demographic characteristics such as gender and race. There is a paucity of data, however, on the effect of broader pediatrician characteristics on caregivers' experience of their children's care. This study assessed pediatric caregiver experience of care ratings within a children's hospital and examined the effects of pediatricians' interpersonal and personality traits on caregiver experience ratings. METHODS: This cross-sectional study included caregivers of children under 18 years old (n = 26,703) and physicians within children's hospital system (n = 65). Caregivers of children who received care from 2017 to 2019 provided their rating (0-10) of care experience via the standardized National Research Corporation Health Survey. Top box provider ratings were used for analyses. Physician's interpersonal and personality data were collected. Multilevel logistic regression analyses were used to examine the effects of physician interpersonal characteristics (empathy, compassion) and personality (perfectionism, Big Five personality traits [openness, conscientiousness, extraversion, agreeableness, neuroticism]) on experience of care rating. RESULTS: The odds of caregivers of Spanish-speaking children to provide a high physician rating were 75% higher than the odds for non-Spanish-speaking patients. At the physician level, lower agreeableness (odds ratio [OR] = 0.63, P = .002), and lower narcissistic perfectionism (OR = 0.98, P = .016) were associated with an increased likelihood of a high care experience rating. The odds of nonemergency medicine pediatricians receiving high ratings were approximately 4.17 times higher than that of EM pediatricians. CONCLUSIONS: Current results may inform future interventions that address pediatrician personality characteristics associated with caregivers of children experience outcomes. [ABSTRACT FROM AUTHOR]

The escalation of the opioid epidemic in the United States has sparked sweeping legislation meant to regulate physicians' opioid prescribing practices. The demands of such policies force physicians to initiate discussions that could jeopardize the collaborative doctor–patient relationships necessary for curbing inappropriate opioid prescriptions. Drawing on sociopragmatics, this discourse analysis study of primary care interactions examines the face-saving linguistic features employed by physicians in negotiating the line between policy demands and maintaining collaborative relationships. The findings reveal several face-saving acts—pseudo requests, downtoners, broadening, redirection, tag questions, impersonalization, listing, and (negative) imagery—used by physicians when enacting the three most prominent policies: (1) monitoring opioid use, (2) prescribing anti-overdose medication, and (3) transitioning patients from opioids to alternative treatment. Informed by Goffman's concept of "face-work," this study provides evidence of the communicative burden placed on physicians implementing disagreeable opioid policies, as well as opening up discussions on how policymakers and medical institutions can support physicians in implementing opioid policies. • Discourse analysis of medical consultations surrounding opioids and chronic pain. • Physicians comply with policies patients may disagree with. • Physicians use face-saving strategies to mitigate contentious discourse from enacting policies. • Guidance on language could help ease physicians' communicative burden. [ABSTRACT FROM AUTHOR]

Home visits have become increasingly uncommon although evidence suggests they improve healthcare quality and reduce overall expenditures. This study identifies the primary care physicians delivering home visits at patients' end of life in Ontario, Canada, describes characteristics of primary care physicians delivering end-of-life home visits, and explores associations with delivery. Identify the primary care physicians delivering home visits at patients' end of life in Ontario, Canada, describe characteristics of primary care physicians delivering end-of-life home visits, and explore associations with delivery. A retrospective cohort design using population-level health administrative data housed at ICES. The cohort was composed of primary care physicians in Ontario, Canada between April 1, 2014 and March 31, 2019, who were registered in the College of Physicians and Surgeons of Ontario database dataset on or after January 1, 1990 and as of March 31, 2016. A total of 9884 physicians were identified, of which 2568 (25.7%) delivered at least one end-of-life home visit. Physician characteristics showing increased odds ratio (OR) of home visit delivery were older age (OR 1.01 [95% Confidence Interval (CI): 1.00–1.02]) international training (OR 1.28 [95% CI:1.04–1.59]), previous home visit experience (OR 1.02 [95% CI: 1.01–1.02]), capitation models of remuneration; namely enhanced fee-for-service models (OR 1.5 [95%CI: 1.17–2.00]) and mainly capitation model (OR 1.4 [95% CI:1.11–1.79]), and population size of practice location with highest odds in small rural or remote areas (<9000 residents) (OR 1.38 [95%CI: 1.02–1.88]) and large metropolitan areas (OR 1.84 [95%CI: 1.46–2.57]). This research confirms previous evidence and identifies novel primary care physicians' characteristics associated with home visit practice patterns. Furthermore, it highlights characteristics amenable to policy or system-level changes (e.g., remuneration model, training, and experience) that could increase the provision of home visits which may greatly improve the dying experience of Canadians. [ABSTRACT FROM AUTHOR]

Artefactual skin disease (ASD) or dermatitis artefacta (DA) is a factitious disorder uncommonly reported in the paediatric population. It is a psychocutaneous condition where patients present with externally induced skin (hair or nail) lesions that do not fit recognised patterns of organic disease. Patients classically deny any involvement in the pathogenesis of their skin lesions and will not be inclined to divulge their origin. Individuals may present with acute (e.g. blistering), intermittent (e.g. petechiae) or chronic (e.g. panniculitis) skin changes often having consulted with different health care professionals in their illness journey. The underlying drivers of the behaviour are variable and sometimes complex, lesions may have been produced consciously or in the dissociated state. When formulating a management plan for this vulnerable group of patients it is important to understand " why " this is happening rather than " how ". The prognosis in children and adolescents is generally good but depends on eliciting the underlying psychosocial precipitators. Establishing a strong physician-patient-family relationship is key in managing this condition. The authors advocate a multidisciplinary team approach in this group of patients. [ABSTRACT FROM AUTHOR]

• While exact incidence rates and duration are a matter of debate, antidepressant discontinuation syndrome (ADS) represents a quite frequent and burdensome outcome. • ADS encompasses both physical and psychological symptoms not to be confused with relapse of depression. • The management of ADS includes slow tapering of the antidepressant and supportive psychosocial care to enhance treatment adherence and doctor-patient relationship. • Future studies should rely on validated operational criteria to inform the clinical practice. Antidepressant drugs are prescribed to patients with depressive, anxiety disorders, and other conditions. Evidence about antidepressant discontinuation syndrome (ADS) and related outcomes is sparse, although potentially burdensome in some patients. The present state-of-the-art review aims to appraise the most current evidence about ADS critically. ADS has been documented for most antidepressant drugs, although most literature focuses on selective serotonin reuptake inhibitors prescribed for depression. While down-titration cannot exclude the chance of ADS, it is nonetheless warranted in the clinical setting, especially for short half-life and sedative compounds such as paroxetine. Integrative management with concurrent pharmacotherapy and psychotherapy may minimize the eventual unpleasant effects arising within the discontinuation process. In addition, patient-tailored interventions and education should be part of the discontinuation strategy. Future research must rely on broadly accepted definitions for ADS and related phenomena such as antidepressant withdrawal and shed further light on the underpinning neurobiology. Discriminating between ADS-related phenomena and relapse of depression is likewise warranted, along with a neuroscience-based nomenclature instead of a class one. [ABSTRACT FROM AUTHOR]

French law does not make it obligatory to obtain the consent of minors for suggested treatments. This situation can put the practitioner in difficulty, especially when trying to work on the issue of autonomy with an adolescent. It is not just the adolescent's autonomy that is only partially recognised during their treatment - that of their parents may also be overlooked by the physician in the child's best interest. In this situation, what can the physician do when working on areas related to autonomy, which are of the utmost importance during adolescence, and which become even more important during any treatment for potential psychiatric disorders? This opinion paper provides a focus on the concepts of autonomy, discernment, and the child's best interest, using a triple philosophical, legal, and medical approach, in order to provide guidance to practitioners confronted in their clinical practice with this central, complex and paradoxical issue. The modern-day philosophical approach ties the concept of autonomy to that of vulnerability. The interplay between the free exercise of the subject's rights and their protection is at issue in French law, which proposes to gradually provide new rights, and thus progressive autonomy, to minors, according to an evaluation of their level of discernment. It is similar to clinical practice and biomedical research which tend to objectively evaluate the level of discernment of children and adolescents. This evaluation is partially influenced by the physician's own values, which they need to be conscious of, in order to better accompany patients. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether patient-physician gender concordance influences the patient's perceptions of interpersonal processes of care and patient outcomes in Muslim patients with diabetes.Methods: We conducted a cross-sectional telephone survey involving 4152 randomly selected patients using electronic diabetes records. Outcome measures included perceptions of interpersonal processes of care, adherence to medications, and HbA1c. Linear mixed regression models were used to explore the associations between the outcome variables and patient gender and gender concordance.Results: The best processes of care were observed consistently for female concordant dyads. In adjusted mixed models, lower Hurried Communication was associated with female concordant (-0.91, p < 0.001) and female physician-male patient dyads (-0.82, p = 0.007). Higher Elicited Concerns was associated with female concordant (0.65, p = 0.003) and female physician-male patient dyads (0.59, p = 0.013). Higher Explained Results and Compassionate/Respectful were associated with female concordant dyads (0.83, p < 0.001, and 0.55, p = 0.010 respectively). Lower HbA1c was independently linked with female concordant dyads (-0.84, p < 0.001).Conclusion: This study highlights the importance of female gender concordance on perceptions of interpersonal processes of diabetes care and glycemic control.Practice Implications: Strengthening physicians' communication skills with female patients should be taken into consideration. [ABSTRACT FROM AUTHOR]

Objective: Existing studies on shared decision-making (SDM) have hardly taken into consideration that patients could have independently developed expectations prior to their consultation with a healthcare provider, nor have studies explored how such expectations affect SDM. Therefore, we explore how pre-consultation expectations affect SDM in patients with low back pain.Methods: We performed a qualitative study through telephone interviews with 10 patients and seven care professionals (physicians, nurse, physician assistants) and 63 in-person observations of patient-physician consultations in an outpatient clinic in the Netherlands. Transcripts were analyzed through an open coding process.Results: A discrepancy existed between what patients expected and what care professionals could offer. Professionals perceived they had to undertake additional efforts to address patients' 'unrealistic' expectations while attempting SDM. Patients, in turn, were often dissatisfied with the outcomes of the SDM encounter, as they believed their own expectations were not reflected in the final decision.Conclusion: Unaddressed pre-consultation expectations form a barrier to constructive SDM encounters.Practical Implications: Patients' pre-consultation expectations need to be explored during the SDM encounter. To achieve decisions that are truly shared by care professionals and patients, patients' pre-consultation expectations should be better incorporated into SDM models and education. [ABSTRACT FROM AUTHOR]

Objective: To test the impact of varied physician recommendations on COVID-19 vaccine hesitancy.Methods: We conducted a vignette-based experimental survey on Prolific, an online research platform. COVID-19 vaccine hesitant, adult panel members were assigned to one of five messages that varied by recommendation style (participatory vs explicit) and strategy (acknowledgement of concerns; comparison to the flu shot; statement that millions of people have already received it; emphasis on protecting others). Vaccine hesitancy was re-assessed with the question, "Would you get vaccinated at this visit?".Results: Of the 752 participants, 60.1% were female, 43.4% Black, 23.6% Latino, and 33.0% White; mean age was 35.6 years. Overall, 33.1% of the initially "not sure" and 13.1% of the initially "no" participants became less hesitant following any recommendation. Among the "not sure" participants, 20.3% of those who received a participatory recommendation became less hesitant compared with 34.3%- 39.5% for the explicit recommendations. The "protect others" message was most effective among initially "no" participants; 19.8% become less hesitant, compared to 8.7% for the participatory recommendation.Conclusion: A physician recommendation may reduce COVID-19 vaccine hesitancy.Practice Implications: An explicit recommendation and "protect others" message appear to be important elements of a physician recommendation for COVID-19 vaccination. [ABSTRACT FROM AUTHOR]

The article focuses on the update regarding mistreatment and burnout in pediatric residents, particularly exploring the increased prevalence during the pandemic and changing social norms. The topics include the epidemiology of mistreatment in health professionals, the need for clear definitions and examples of specific behaviors in surveys, the under-reporting of mistreatment due to concerns about inaction or retaliation, and suggested strategies to address mistreatment and burnout.

Objectives: Examine the association of coder ratings of cardiologist behaviors and global scores of cardiologist communication style with patient participation in clinic encounters.Methods: We coded transcripts of clinic encounters for patient participatory behaviors: asking questions, assertive statements, and expressing negative emotions; clinician behavior counts: reflective statements, open-ended questions, empathic statements, and eliciting questions. We used general linear regression models to examine associations of mean number of patient participatory behaviors with clinician behaviors.Results: Our sample included 161 patients of 40 cardiologists. Patient female gender was associated with on average 2.1 (CI: 0.06, 4.1; p = 0.04) more patient participatory behaviors. In an adjusted model, clinician reflective statements were associated with on average 0.3 (CI: 0.04, 0.4; p = 0.02) more patient participatory behaviors. A clinician making at least one empathic statement was associated with on average 3.7 (CI: 0.2, 7.1; p = 0.04) more patient participatory behaviors.Conclusions: These results demonstrate that some individual clinician behaviors are associated with higher patient participation in cardiology encounters.Practice Implications: Clinician reflective and empathic statements may be important targets in communication training to increase patient participation.Section: Communication Studies. [ABSTRACT FROM AUTHOR]

For patients with advanced cancer, early access to palliative care can have numerous psychosocial and disease management benefits. However, it can be difficult for clinicians to initiate these initial conversations about palliative care. The aim of the present study was to beta test an intervention to facilitate timely conversations about palliative care between patients and clinicians. The study reported forms one stage of a complex intervention development study following Medical Research Council guidance for developing complex interventions. Feasibility was explored from patient and clinician perspectives in an oncology outpatient setting. Sixteen patients and 18 clinicians participated. Three phases of the intervention were assessed through patient and clinician interviews. The analysis produced three themes in each phase: (i) Preparation (patient preparedness; healthcare professionals' perspectives on palliative care; administration, data and communication); (ii) STEP consultation (defining perspectives on palliative care; how palliative care fits with the current treatment plan; permission to explore future care); (iii) Outcomes (changes in perspective and approaches to coping; opening the door to future conversations; referrals and involvement of palliative services). The STEP intervention generated important early conversations about end-of-life care that may otherwise not have occurred. No patients regretted having the STEP consultation, which resulted in palliative care referrals for some. Others felt better informed about the support services available and better able to have further conversations. Participating clinicians found the structured conversation guide useful, as it acted as a prompt for areas to cover, as well as providing an explicit way to open discussion about difficult topics. • Early discussion about palliative care can be beneficial for patients and clinicians, but there are barriers to this process. • Patients and clinicians have individual orientations to conversations about death and dying. • There are worthwhile outcomes to discussing palliative care, even if this does not lead to a specific referral. • Early palliative care conversations can benefit from being systematic and structured. • Exploring individual patient typologies could better target future interventions. [ABSTRACT FROM AUTHOR]

Few studies have focused on determinants of women's ratings of care experiences in primary care. We assessed associations between availability of women's health services and women veterans' ratings of care experiences. In a cross-sectional analysis, we linked Fiscal Year (FY) 2017 (October 1, 2016, to September 30, 2017) survey data from 126 Veterans Health Administration (VA) primary care leaders to 4,254 women veterans' ratings of care from VA's Survey of Healthcare Experiences of Patients-Patient Centered Medical Home (FY 2017). The dependent variables were ratings of optimal access (appointments, information), care coordination, comprehensiveness (behavioral health assessment), patient–provider communication, and primary care provider. Key independent variables were number of women's health services 1) routinely available all weekday hours (compared with some hours or not available) and 2) available in VA general primary care vs. other arrangements. In multilevel logistic regression models, we adjusted for patient-, facility-, and area-level characteristics. A greater number of women's health services routinely available in VA primary care was associated with a higher likelihood of optimal ratings of care coordination (adjusted odds ratio [AOR], 1.06; 95% confidence interval [CI], 1.01–1.10), provider communication (AOR, 1.08; 95% CI, 1.002–1.16), and primary care provider (AOR, 1.07; 95% CI, 1.02–1.13). A greater number of services available in VA primary care was associated with a lower likelihood of optimal ratings for access (AOR, 0.94; 95% CI, 0.88–0.99). For the most part, routine availability of women's health services in VA primary care clinics enhanced women's healthcare experiences. These empirical findings offer healthcare leaders evidence-based approaches for improving women's care experiences. [ABSTRACT FROM AUTHOR]

Objective: This study aims to examine the structure of communication about complementary medicine (CM) between patients with cancer and clinicians during oncology consultations.Methods: Previously, consultations between 29 clinicians and 80 patients with advanced cancer were recorded in six hospitals in the Netherlands. The present study considers a secondary analysis. References to CM during the consultation were coded using a self-developed observational coding scheme.Results: At least one reference to CM was observed in 35 out of 80 consultations (44 %), with a total of 73 references. In most cases, CM was initially referred to by patients. Clinicians often did not elaborate on the subject of CM. Relevant aspects related to CM (e.g., safety, effectiveness) were infrequently discussed. Both patients and clinicians showed predominantly neutral to positive attitudes towards CM.Conclusions: This study shows that patients are still the main initiators of discussions about CM and the topic is not consistently discussed in daily oncology practice.Practice Implications: If exploration of patients' interest in CM or its use became routine in oncology practice, it may relieve patients of the burden of introducing the topic, decrease potential risks of CM use and increase access to evidence-based CM for all patients with cancer. [ABSTRACT FROM AUTHOR]

Objective: To explore how costs of care are discussed in real clinical encounters and what humanistic elements support them.Methods: A qualitative thematic analysis of 41 purposively selected transcripts of video-recorded clinical encounters from trials run between 2007 and 2015. Videos were obtained from a corpus of 220 randomly selected videos from 8 practice-based randomized trials and 1 pre-post prospective study comparing care with and without shared decision making (SDM) tools.Results: Our qualitative analysis identified two major themes: the first, Space Needed for Cost Conversations, describes patients' needs regarding their financial capacity. The second, Caring Responses, describes humanistic elements that patients and clinicians can bring to clinical encounters to include good quality cost conversations.Conclusion: Our findings suggest that strengthening patient-clinician human connections, focusing on imbalances between patient resources and burdens, and providing space to allow potentially unexpected cost discussions to emerge may best support high quality cost conversations and tailored care plans.Practice Implications: We recommend clinicians consider 4 aspects of communication, represented by the mnemonic ABLE: Ask questions, Be kind and acknowledge emotions, Listen for indirect signals and (discuss with) Every patient. Future research should evaluate the practicality of these recommendations, along with system-level improvements to support implementation of our recommendations. [ABSTRACT FROM AUTHOR]

Les médecins généralistes sont les acteurs privilégiés du repérage des troubles des conduites alimentaires (TCA) qui touchent entre 0,6 et 4,5 % de la population au cours de sa vie. Alors qu'un dépistage précoce améliore le pronostic, moins de la moitié des patients concernés sont repérés en ambulatoire. Explorer les représentations des médecins généralistes au sujet des TCA et les obstacles ressentis à leur abord en pratique. Une étude qualitative a été réalisée par focus group afin de comprendre ce sous-dépistage. Les cinq focus group nécessaires à l'atteinte de la saturation des données ont été transcrits et le verbatim a été analysé par théorie ancrée après un double codage. L'anorexie mise au premier plan, un BED méconnu et l'idée erronée que l'obésité appartient aux TCA constituaient les représentations les plus présentes chez les MG interrogés. Ils considéraient les TCA comme relatifs à l'intime du patient au même titre que la sexualité, craignant d'être trop intrusifs en les abordant et de mettre à mal la relation patient-médecin. L'aspect chronophage de la consultation, la méconnaissance des outils, le sentiment de manquer de compétences en communication et en psychologie, d'être démuni et la carence de réseau d'aval psychiatrique faisaient obstacle à l'abord des TCA en consultation. Une formation brève à des techniques communicationnelles, l'organisation d'une consultation de dépistage dédiée, une filière de prise en charge formalisée ou le remboursement des psychothérapies seraient des pistes pour un meilleur repérage des TCA. Étudier les représentations de la psychiatrie serait un premier pas pour vaincre la défiance à son égard. General practitioners (GP) are the most suitable candidates to screen for eating disorders (ED), which affect 0.6 to 4.5% of the population over their lifetime. 13% of adolescents are concerned if we consider sub-syndromic form. The outcome of ED improves with early detection but 50% of patients are still not identified in primary care. To explore GP's representations of ED and the barriers they face while broaching the subject in practice and to understand this under-screening of ED. It was a qualitative study by focus groups. The five focus-group need for data saturation were transcribed and the verbatim was double coded and analyzed by the grounded theory. The focus on anorexia nervosa, a BED remaining unrecognized and the misidentification of obesity as an ED were the main representations of the asked GPs. They considered ED as being bound to the intimacy of patients, just as sexuality would be, they feared to be too intrusive while approaching them and to compromise the patient-doctor relationship. The time-consuming part of such consults, the unknown assessment tools, a perceived lack of communication and psychological skills, the feeling of helplessness and lack of a psychiatric support stood in the way of approaching ED in general practice. Training for time-saving communication techniques, organizing a dedicated screening consult, a well identified psychiatric network or free psychotherapy sessions are ways to improve screening of ED. To study how psychiatry can be more positively perceived would be a first step to overcome its induced mistrust. [ABSTRACT FROM AUTHOR]

The purpose of this study was to assess perceptions about the inclusion of biopsychosocial and active care recommendations during chiropractic clinical encounters between doctors of chiropractic (DCs) and their midlife and older adult patients and to identify whether there were any discrepancies between their recollections. This descriptive cross-sectional survey was part of a mixed-methods research project designed to gather information about the role of electronic health interventions for midlife and older adults who use chiropractic care. For this study, a convenience sample of 29 DCs and 48 chiropractic patients aged 50 years and older from 2 metropolitan areas in the United States completed online surveys between December 2020 and May 2021. The survey matched questions about components of chiropractic care discussed by patients and providers over 12 months. We used descriptive statistics to explore congruence in perceptions between groups and qualitative content analysis to describe DC perceptions of working with this population. Doctors of chiropractic and patients agreed (>90%) that pain management was the top reason midlife and older adults seek chiropractic care, yet differed in their prioritization of maintenance/wellness care, physical function/rehabilitation, and injury treatment as care drivers. While DCs reported frequent discussions about psychosocial recommendations, fewer patients reported talking about treatment goals (51%), self-care (43%), stress reduction (33%), or the impact of psychosocial factors (23%) and beliefs/attitudes (33%) on spinal health. Patients reported varied recollections about discussing activity limitations (2%) and exercise promotion (68%), being taught exercises (48%), or reassessing exercise progress (29%), which differed from higher levels reported by DCs. Qualitative themes from DCs included psychosocial considerations in patient education, importance of exercise/movement, role of chiropractic in lifestyle changes, and reimbursement limitations for older patients. Doctors of chiropractic and their patients reported discrepant perceptions about biopsychosocial and active care recommendations during clinical encounters. Patients reported modest emphasis on exercise promotion and limited discussion on self-care, stress reduction, and psychosocial factors related to spine health compared to the recollections of DCs who reported frequent discussions of these topics. [ABSTRACT FROM AUTHOR]

Despite the pressing need for primary care-based suicide prevention initiatives and growing acknowledgement of recruitment difficulties and Institutional Review Board (IRB) challenges in suicide research, we are aware of no illustrative examples describing how IRB decisions in the design of a primary care trial can compound recruitment challenges. The CDC-funded trial (NCT02986113) of Men and Providers Preventing Suicide aimed to examine the effects of a tailored computer program encourage men with suicidal thoughts (n = 304, ages 35–64) to discuss suicide with a primary care clinician and accept treatment. Before a visit, participants viewed MAPS or a non-tailored control video. Post-visit, both arms were offered telephone collaborative care, as mandated by the institutional review board (IRB). We previously showed that exposure to MAPs led to improvements in communication about suicide in a primary care visit. In this paper, we report data on the study's primary outcome, suicide preparatory behaviors. After screening nearly 4100 men, 48 enrolled. Recruitment challenges, which were exacerabted by an IRB mandate narrowing post-intervention patient management differences between trial arms, limited detection of the effects of MAPS on suicide preparatory behaviors. While primary care settings are key sites for suicide prevention trials, issues such as recruitment difficulties and overly restrictive IRB requirements may limit their utility. Methodological innovation to improve recruitment and ethical guidance to inform IRB decision-making are needed. [ABSTRACT FROM AUTHOR]

Objective: In a recent study, we explored what kind of existential concerns patients with advanced cancer disclose during a routine hospital consultation and how they communicate such concerns. The current study builds on these results, investigating how the physicians responded to those concerns.Methods: We analyzed video-recorded hospital consultations involving adult patients with advanced cancer. The study has a qualitative and exploratory design, using procedures from microanalysis of face-to-face-dialogue.Results: We identified 185 immediate physician-responses to the 127 patient existential utterances we had previously identified. The responses demonstrated three approaches: giving the patient control over the content, providing support, and taking control over the content. The latter was by far the most common, through which the physicians habitually kept the discussion around biomedical aspects and rarely pursued the patients' existential concerns.Conclusions: Although the physicians, to some extent, allowed the patients to talk freely about their concerns, they systematically failed to acknowledge and address the patients' existential concerns.Practice Implications: Physicians should be attentive to their possible habit of steering the agenda towards biomedical topics, hence, avoiding patients' existential concerns. Initiatives cultivating behavior enhancing person-centered and existential communication should be implemented in clinical practice and medical training. [ABSTRACT FROM AUTHOR]

Objectives: While the development of artificial intelligence (AI) and virtual reality (VR) technologies in medicine has been significant, their application to doctor-patient communication is limited. As communicating risk is a challenging, yet essential, component of shared decision-making (SDM) in surgery, this review aims to explore the current use of AI and VR in doctor-patient surgical risk communication.Methods: The search strategy was prepared by a medical librarian and run in 7 electronic databases. Articles were screened by a single reviewer. Included articles described the use of AI or VR applicable to surgical risk communication between patients, their families, and the surgical team.Results: From 4576 collected articles, 64 were included in this review. Identified applications included decision support tools (15, 23.4%), tailored patient information resources (13, 20.3%), treatment visualization tools (17, 26.6%) and communication training platforms (19, 29.7%). Overall, these technologies enhance risk communication and SDM, despite heterogeneity in evaluation methods. However, improvements in the usability and versatility of these interventions are needed.Conclusions: There is emerging literature regarding applications of AI and VR to facilitate doctor-patient surgical risk communication.Practice Implications: AI and VR hold the potential to personalize doctor-patient surgical risk communication to individual patients and healthcare contexts. [ABSTRACT FROM AUTHOR]

Against Medical Advice (AMA) discharges pose significant challenges to the healthcare system, straining patient-clinician relationships while contributing to avoidable morbidity and mortality. Furthermore, though these discharges culminate in patients' departure from hospitals, their effects reverberate long after, propagated by clinician notes stored in patients' medical records. These notes capture exceptionally fraught interactions between patients and providers, describing the circumstances surrounding breakdowns in clinical relationships. Additionally, they represent just one side of complex, contentious social interactions, for in describing AMA discharges, clinician notewriters quite literally have the last word. For these reasons, notes documenting AMA discharges provide insight into the ways in which clinicians conceptualize, characterize, and propagate power differentials in the contemporary healthcare system. Here, we present a qualitative thematic analysis of 185 notes documenting AMA discharges from a large urban US medical center, interpreting note dynamics through three sociological models of power analysis: (i) the distributive model of power promulgated by Max Weber, (ii) the collectivist power model characterized by Talcott Parsons and Hannah Arendt, and (iii) structural interpretations of power developed by Michel Foucault. We argue that in documenting AMA discharges, clinicians appear to conceive of their relationship with patients in almost exclusively distributive terms, which in turn contributes to an adversarial dynamic whereby both patients and clinicians ultimately suffer disempowerment. We furthermore argue that by facilitating clinicians' recognition of power's collectivist and structural dimensions, we may help transform breakdowns in patient-clinician relationships into opportunities for collaboration. • Against Medical Advice (AMA) discharges pose key challenges during hospitalizations. • Sociologists have posited alternative, collectivist and structural, models of power. • Notes documenting AMA discharges reveal clinicians' conceptualization of power. • Clinicians conceive of power almost exclusively in distributive terms. • Applying alternative power models to clinical practice may promote humanistic care. [ABSTRACT FROM AUTHOR]

Risk communication is a key legal and ethical component of shared decision-making. Decisions about total knee replacement, a common surgery, must contend with the fact that a minority of cases result in unintended outcomes, some of which have devastating effects. To understand how risks are communicated during decision-making, we audio-recorded and analysed 62 consultations between surgeons and patients. Various communication methods were evident, including listing risks without elaboration, discussing them in a conversational manner, abrogating discussion of risk, or using decision-tools. Discussion of risks was often brief in nature, and risk communication was sometimes curtailed or deferred by both patients and surgeons. Risks could also be observed to play a part in reinforcing policy norms of the doctor-patient relationship that highlighted patient responsibility. Nevertheless, patients and surgeons in the observed consultations appeared more interested in developing trusting relationships than in discussing risks. Because patients had sometimes experienced considerable deterioration in their knee function before their consultation, were in pain and struggled with mobility, the realities of clinical practice clashed with the policy norms of choice and patient responsibility. Rather, decisions could appear coerced by the disease process rather than being clear-cut examples of self-determination. While policy norms putatively use risk disclosure to frame communication between patients and clinicians as a transaction between customer and technician, the lack of conformity to these norms in the consultations may indicate resistance to this framing. A greater emphasis on determining positive roles for trust and care would help policy to present a nuanced understanding of decision-making. Risk communication could be seen as a factor in the formation of trusting relationships, improving its role in decision-making processes while recognising its inherent tensions with practice. • Risk communication is a key legal and ethical component of shared decision-making. • Neutral lists of risks had limited effects on the observed decision-making process. • Risk communication was sometimes abandoned by both patients and surgeons. • Participants appeared more interested in developing trust than conforming to policy. [ABSTRACT FROM AUTHOR]

Perceiving empathy from healthcare professionals contributes to clinical benefits. Yet, for methodological and ethical reasons, the factors affecting perceived empathy, such as how the nonverbal behaviors of professionals interact, are less understood than those influencing the actual act of empathizing. Two online studies examined how the perception of empathy in a medical context of pain was influenced by factors related to digital healthcare professionals (DHPs) and participants acting as suffering patients. In Study 1 (n = 123), participants watched videos of DHPs showing variations in gaze direction, posture, and facial expression to rate perceived empathy from a visual patient perspective. They perceived more empathy from the face expressing pain, regardless of gaze, posture, and gender of the DHPs. The sex of participants also modulated perceived empathy. Study 2 (n = 116) expanded Study 1 by adding faces expressing pain and sadness of varying intensities, along with perspective-taking instructions, to determine whether higher perceived empathy for the face expressing pain stems from its congruence with the medical pain context. Participants perceived more empathy in faces expressing sadness than pain. Sadness and pain interacted differently with the effects of intensity, posture, and gaze direction. This work challenges the idea that exact congruence with the patient's affective state is necessary and further contributes to investigating nonverbal behaviors of empathy. • Sad faces of digital healthcare professionals are perceived as more empathic than pain faces in a medical context. • Facial expression modulates the effects of gaze, posture, and gender on perceived empathy. • Women's perception of empathy is less variable than men's. [ABSTRACT FROM AUTHOR]

Video recordings of oncology interviews reveal how doctors rely on worry to establish medical expertise, facilitate treatment decision-making, and construct worry parameters to help patients understand whether there is a reasonable need for worry or not. Doctors express worry as frequently as cancer patients during oncology interviews, but they face a dilemma: how to provide care for cancer patients without directly stating they are worried about them? Plausible explanations are offered for why doctors do not state personal worries. Conversation analytic methods were employed to identify how doctors rely on worry to achieve distinct social actions. Four worry formulations are examined: (1) variations of "we worry" (and at times, non-specific and second person "you"), (2) hypothetical worry scenarios, (3) dismissing worry and offering assurance, and (4) doctors claiming they are not worried, bothered, or alarmed. Doctors align with and speak for the professionals and institutions they represent, expressing collective worries and claiming the legitimate right to worry (or not). Doctors also avoid abandoning patients to their own decision-making, yet do not formulate worry to coerce deference or dictate patients' choices. In all cases patients agreed and displayed minimal resistance to doctors' worry formulations. These findings contribute to ongoing work across institutional settings where participants have been shown to construct objective, legitimate claims meriting worries about diverse problems. Work is underway to examine when and how patients explicitly raise and doctors respond to cancer worries. Clinical implications are raised for how doctors can use worry to legitimize best treatment options, help patients minimize their worries, rely on hypothetical scenarios allowing patients to compare how other patients managed their cancer, and not dismiss the importance of minimizing the need to worry as a resource for offering reassurance. • Conversation Analytic methods were employed to analyze video recorded interviews. • Doctors' worry formulations are examined including "we worry" and "you". • Doctors do not express personal worry but speak on behalf of fellow professionals. • A 'view from nowhere' is evident as doctors claim objectivity and medical authority. • Worry formulations facilitate patients' choices and shared decision-making. [ABSTRACT FROM AUTHOR]

Detection of medical insurance fraud is of significant research importance. Currently, most methods focus on supervised data, but identifying gang fraud requires exploring relationships among gang members, for which labeled data cannot be obtained in advance, this makes unsupervised models more suitable. In this paper, we propose an unsupervised model based on knowledge graph and the Louvain algorithm for identifying medical insurance gang fraud. Firstly, a knowledge graph is constructed based on medical records using the NetworkX algorithm to establish a knowledge graph of anti-gang fraud in medical insurance, facilitating the summarization of risk rules after community division. Then, the Louvain algorithm is applied to the patient–doctor relationship network to discover communities, and then we divide the entire knowledge graph into four levels of communities with high, medium, low, and no apparent risk, respectively. Different measures are proposed for communities with different risk levels for supervision. To demonstrate the superiority of the proposed model, it is compared with other unsupervised models on multiple datasets for gang fraud identification. By comparing the correct partition rate, the superiority of the proposed model in the research of medical insurance gang fraud identification is demonstrated, providing an effective unsupervised learning method for identifying medical insurance gang fraud, facilitating the proposal of prevention and control measures, and preventing fraudulent incidents. • The problem of fraudulent medical insurance funds with group crime is very serious. • Medical insurance gang fraud detect by an unsupervised model based on knowledge graph. • Build a knowledge graph and find the community using NetworkX and Louvain algorithm. • The risk score of communities are calculated by the summarized risk rules to divide into four levels. • It can be used to provide prevention and control suggestions and prevent fraud cases. [ABSTRACT FROM AUTHOR]