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Purpose: This paper aims to characterize the use of demographic data in multiple-choice questions from a commercial preclinical question bank and determine if there is appropriate use of different distractors., Background: Multiple-choice questions for medical students often include vignettes describing a patient's presentation to help guide students to a diagnosis, but overall patterns of usage between different types of nonmedical patient information in question stems have yet to be determined., Methods: Three hundred eighty of 453 randomly selected questions were included for analysis after determining they contained a clinical vignette and required a diagnosis. The vignettes and following explanations were then examined for the presence/absence of 11 types of demographic information, including age, sex/gender, and socioeconomic status. We compared both the usage frequency and relevance between the 11 information types., Results: Most information types were present in less than 10% of clinical vignettes, but age and sex/gender were present in over 95% of question stems. Over 50% of questions included irrelevant information about age and sex/gender, but 75% of questions did not include any irrelevant information of other types. Patient weight and environmental exposures were significantly more likely to be relevant than age or sex/gender., Discussion: Students using the questions in this study will frequently gain practice incorporating age and sex/gender into their clinical reasoning while receiving little exposure to other demographic information. Based on our findings, we posit that questions could include more irrelevant information, outside age and sex/gender, to better approximate real clinical scenarios and ensure students do not overvalue certain demographic data., Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-023-01778-z., Competing Interests: Conflict of InterestThe authors declare no competing interests., (© The Author(s) under exclusive licence to International Association of Medical Science Educators 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Background: This community-based intervention study examined the effects of 2 different message strategies for presenting information about the prostate specific antigen (PSA) test., Methods: A quasi-experimental longitudinal design with 2 intervention and 1 control group., Results: Knowledge increased significantly among participants who received either version of the intervention message and remained elevated at 12 months. Presenting information in the context of other men's health issues was associated with greater increases in knowledge relative to PSA only., Conclusions: Community-based interventions can increase knowledge about prostate cancer screening. Clinicians need to take careful account of what their patients understand and correct misperceptions.

Background: Chronic pain is a frequent cause of suffering and disability that negatively affects patients' quality of life. There is growing evidence that disparities in the treatment of pain occur because of differences in race., Objective: To determine whether race plays a role in treatment decisions involving patients with chronic nonmalignant pain in a primary care population., Design, Setting, and Participants: A cross-sectional survey was administered to patients with chronic nonmalignant pain and their treating physicians at 12 academic medical centers. We enrolled 463 patients with nonmalignant pain persisting for more than 3 consecutive months and the primary care physicians participating in their care., Results: Analysis of the 397 black and white patients showed that blacks had significantly higher pain scores (6.7 on a scale of 0 to 10, 95% confidence interval (CI) 6.4 to 7.0) compared with whites (5.6, 95% CI 5.3 to 5.9); however, white patients were more likely to be taking opioid analgesics compared with blacks (45.7% vs 32.2%, P<.006). Even after controlling for potentially confounding variables, white patients were significantly more likely (odds ratio (OR) 2.67, 95% CI 1.71 to 4.15) to be taking opioid analgesics than black patients. There were no differences by race in the use of other treatment modalities such as physical therapy and nonsteroidal anti-inflammatories or in the use of specialty referral., Conclusion: Equal treatment by race occurs in nonopioid-related therapies, but white patients are more likely than black patients to be treated with opioids. Further studies are needed to better explain this racial difference and define its effect on patient outcomes.

Objective: To determine patient preferences for addressing religion and spirituality in the medical encounter., Design: Multicenter survey verbally administered by trained research assistants. Survey items included questions on demographics, health status, health care utilization, functional status, spiritual well-being, and patient preference for religious/spiritual involvement in their own medical encounters and in hypothetical medical situations., Setting: Primary care clinics of 6 academic medical centers in 3 states (NC, Fla, Vt)., Patients/participants: Patients 18 years of age and older who were systematically selected from the waiting rooms of their primary care physicians., Measurements and Main Results: Four hundred fifty-six patients participated in the study. One third of patients wanted to be asked about their religious beliefs during a routine office visit. Two thirds felt that physicians should be aware of their religious or spiritual beliefs. Patient agreement with physician spiritual interaction increased strongly with the severity of the illness setting, with 19% patient agreement with physician prayer in a routine office visit, 29% agreement in a hospitalized setting, and 50% agreement in a near-death scenario (P <.001). Patient interest in religious or spiritual interaction decreased when the intensity of the interaction moved from a simple discussion of spiritual issues (33% agree) to physician silent prayer (28% agree) to physician prayer with a patient (19% agree; P <.001). Ten percent of patients were willing to give up time spent on medical issues in an office visit setting to discuss religious/spiritual issues with their physician. After controlling for age, gender, marital status, education, spirituality score, and health care utilization, African-American subjects were more likely to accept this time trade-off (odds ratio, 4.9; confidence interval, 2.1 to 11.7)., Conclusion: Physicians should be aware that a substantial minority of patients desire spiritual interaction in routine office visits. When asked about specific prayer behaviors across a range of clinical scenarios, patient desire for spiritual interaction increased with increasing severity of illness setting and decreased when referring to more-intense spiritual interactions. For most patients, the routine office visit may not be the optimal setting for a physician-patient spiritual dialog.

The role of the telephone in medical practice is important, but often problematic. Mistakes in telephone diagnosis and triage can have severe consequences. An effective office system can reduce liability risks, and in some cases telephone contact can substitute for office visits. Internists feel unprepared to provide telephone care. Therefore, residency education needs to focus on documentation, consultant availability, and performance feedback. Research should focus on improving outcomes, reimbursement issues, and technologic advances. This article describes internists' telephone interactions with ambulatory patients, preparation for telephone medicine, and aspects of office telephone systems and makes comparisons with other primary care fields.

Objective: To determine health utility scores for specific debilitated health states and to identify whether race or other demographic differences predict significant variation in these utility scores., Design: Utility analysis., Setting: A community hospital general internal medicine clinic, a private internal medicine practice, and a private pulmonary medicine practice., Participants: Sixty-four consecutive patients aged 50 to 75 years awaiting appointments. In order to participate, patients at the pulmonary clinic had to meet prespecified criteria of breathing impairment., Measurements: Individuals' strength of preference concerning specific states of limited physical function as measured by the standard gamble technique., Main Results: Mean utility scores used to quantitate limitations in physical function were extremely low. Using a scale for which 0 represented death and 1.0 represented normal health, limitation in activities of daily living was rated 0. 19 (95% confidence interval [CI] 0.13, 0.25), tolerance of only bed-to-chair ambulation 0.17 (95% CI 0.11, 0.23), and permanent nursing home placement 0.16 (95% CI 0.10, 0.22). Bivariate analysis identified female gender and African-American race as predictors of higher utility scores ( p

Given the explosive expansion of capitated reimbursement for the services of primary care physicians, we conducted a national survey of a random sample of these practitioners to measure attitudes toward capitated payment and identify predictors of important attitudes. Descriptive, factor analytic, and regression techniques were used. The response rate was 54%. As measured by scales derived from factor analysis, perceptions were strong that capitation was costly to professional and patient relationships. Patients' access to care was perceived as slightly reduced. Actual participation in capitation attenuated feelings of lack of access but not those of capitation's costly effects. Physicians' attitudes toward capitation remain negative, but participants perceive their patients' access to appropriate care as reasonable.

The roles of reimbursement and other predictors that affect physicians' willingness to accept publicly insured continuing care patients were examined in a national survey. The response rate was 47%. Eighty-eight percent of the respondents were accepting new patients. Forty-two percent of these physicians were willing to accept new continuing care patients insured by Medicaid, 70% reported accepting those paying by Medicare assignment, and 85% said they accept patients covered by Medicare plus balance-billing payments. Low reimbursement was the strongest predictor for lack of acceptance. The results suggest that systems of multitiered reimbursement are associated with diminished access for patients insured in the lower tiers.