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Objective: To describe relationships between primary physician and patient characteristics and the approach to prevention and quitting of smoking., Methods: A questionnaire composed of descriptions of cases and clinic activities was given to primary physicians., Results: Fewer smoking physicians use written materials, yet former smokers more often recommend smoking cessation groups. Greatest efforts are invested in high-risk patients. However, former smokers invest greater efforts among youth and pregnant women. Workload and patient's main complaint exert great influence on raising the subject., Conclusions: The various attitudes of physicians emphasize the importance of physician education that should be according to their smoking habits.

Objectives: To examine how family physicians identify and document obesity., Study Design: Prospective cross-sectional study of 289 patients in 7 family practice clinics of Clalit Health Services in Israel., Methods: Two hundred eighty-nine patients from 7 family practice clinics had their body mass index (BMI [calculated as weight in kilograms divided by height in meters squared]) determined by the study staff and subsequently compared with the data retrieved from the family practices' database regarding physicians' BMI documentation and obesity diagnosis. Demographic variables, comorbidities, and medication use were also extracted. Multivariate odds ratios (ORs) and 95% confidence intervals (CIs) were obtained to determine the predictors of BMI documentation., Results: Seventy-eight of 289 patients (27.0%) were obese (BMI, > or =30.0), and 126 (43.6%) were overweight (BMI range, 25.0 to < or =29.9). Body mass index was documented in 39 of 78 obese patients (50.0%) and in 49 of 126 overweight patients (38.9%) (P <.001). Diagnosis of obesity was recorded in 19 of 78 obese patients (24.4%). Older patients (OR, 2.77; 95% CI, 1.39-5.49) and obese patients (OR, 2.04; 95% CI, 1.04-3.99) were more likely to have their weight and height measured and BMI calculated by their physician. Patients with comorbid conditions such as diabetes mellitus (OR, 4.35; 95% CI, 2.20-8.62) and hypertension (OR, 3.20; 95% CI, 1.71-5.99) and patients taking chronic medications (OR, 3.44; 95% CI, 1.20-9.83) were also more likely to have their BMI documented., Conclusions: Family physicians failed to identify most obese and overweight patients, as seen by lack of BMI documentation and concordant diagnoses in the medical problem list. Determination of BMI by physicians in family practice is of utmost importance, and its incorporation into medical care should be optimized.

Background: The influenza vaccination rates in high risk populations decreased in 2006, in part, perhaps, as a reaction to a cluster of deaths that were initially attributed to the vaccine. We postulated that this event affected family physicians who usually recommend vaccination, and caused a change in their prescribing behavior., Objectives: To survey family physicians as to their recommendation of the influenza vaccine in 2006 as opposed to the previous year., Methods: After the 2006 influenza vaccination season an anonymous questionnaire was distributed in various settings to family physicians. The questions related to prescribing behavior in various target populations and whether they vaccinate themselves and their families., Results: A total of 122 physicians responded; 74.5% thought that there was minimal or no connection between the vaccine and the deaths, 75.8% also denied any change in their recommendation behavior. However, there was a significant decrease in the recommendation strength as seen in the percentage of physicians who reported very strong recommendations to the elderly (57.4% vs. 32.3%, p < 0.05) and chronically ill patients (64.8% vs. 39%, p < 0.05). No difference was seen in their reported personal vaccination behavior. A multivariate regression model did not find any correlations between characteristics of the responding physicians and their attitudes or changes in attitudes to the influenza vaccine., Conclusions: The family physicians were more hesitant in recommending the influenza vaccine in 2006, and this may have affected vaccination rates. Improved availability of information and guidance to family physicians after the cluster of deaths may have prevented this.

The use of the Internet is growing rapidly. Up to 70% of American Internet surfers use the Web for some kind of medical purpose. Only a few studies characterized the consulting population and their inquiries. The objective of this study was to define the content of queries and the characteristics of the consulting population in an open access 'Ask the family physician' non-commercial open forum. Data had been collected from the family medicine forum in www.doctors.co.il. This site has 10 - 15 new queries daily, and a physician reply is given on most occasions within 24 h. We analysed demographic characteristics and the content of the queries. In addition, we sent detailed questionnaires to 200 randomly selected consulters. We analysed 1,002 consecutive queries. The average age of the consulters was 31.8 years, 63.4% women. Women applied more often for someone else, compared to men (13.7 versus 8%p = 0.01). 82.2% applied to the forum for a first opinion on the subject matter. The most frequent subjects were: infectious diseases (7.3%), deciphering blood chemical analysis results (3.2%), vitamin B(12) (3.2%), deciphering blood count analysis results (2.9%), Epstein - Barr virus and Cytomegalovirus (2.8%), and hypertension (2.4%). Only 10% (20/200) replied to our e-mail questionnaire. We described the characteristics of inquiries to a Web-based question answering service. Its consumers are mainly younger females who consult the virtual physician prior to consulting their own family physician. They mainly seek medical knowledge especially in interpreting laboratory tests and information about various medical conditions.

Objectives: Many women in Western countries fail to breastfeed long enough. The aim of this study was to examine the attitudes and knowledge of Israeli family physicians (FPs), gynaecologists and paediatricians towards breastfeeding., Design and Participants: A questionnaire examined Physicians' attitudes towards breastfeeding and their role in encouraging it, their sources of information and adequacy of knowledge., Results: Four hundred and seventy-eight physicians responded to the survey: 123 FPs, 134 gynaecologists and 221 paediatricians. Ninety to -hundred per cent of physicians agreed that breastfeeding is the best feeding method for infants and agree that physicians should encourage it. Less than 20% of physicians discuss breastfeeding with pregnant women, and less than 30% discuss it with women 3 months or more postnatally. On average, physicians correctly answered 3.5 +/- 1.7 out of seven questions examining knowledge. Physicians state their main sources of information as their own experience and reading. One hundred and ninety physicians specified how they encourage breastfeeding--of those, 75.3% speak only of the advantages of breastfeeding., Conclusion: Physicians have a positive disposition towards breastfeeding but their knowledge is somewhat low. It seems awareness is lacking to the importance of continuous support and practical guidance beginning before birth and continuing until 3 months or more postnatal.

Some physicians confuse seriousness with professionalism, therefore avoiding the expression of humor in daily practice. This review aims to exemplify the use of humor in everyday practice in the primary care setting, illustrating the benefits of its use. Physicians can change their attitude and "bring a smile" and joy to their practice. "Teaching to smile", as well as having a positive attitude towards life, can be part of the educational tasks of the family physician.

Background: The use of laboratory tests by family physicians has increased in recent years., Aims: To evaluate the relationship between family physicians' characteristics and the number and type of laboratory tests requested, taking into account chronic diseases., Design of Study: Retrospective, cross-sectional study., Setting: One hundred and sixty-two physicians treating 230 123 patients in one district of a health management organisation in Israel., Method: Physicians' use of 16 common types of laboratory tests was assessed in relation to physicians' demographic, professional, and clinic characteristics. The utilisation rate over 1 year was divided into quintiles for each laboratory test, and each physician was given a global laboratory score (for each test the physician got a score from 1 (utilisation in the lower quintile) to 5 (higher quintile). The global score was the sum of scores of the individual tests., Results: On logistic regression analysis, four background characteristics were associated with the global score for the utilisation of laboratory tests. The highest hazard ratios were for being a female doctor (3.2, 95% confidence interval [CI] = 1.5 to 6.5), working in an urban clinic (3.2, 95% CI = 1.1 to 9.8), and having a greater workload than doctors in rural clinics (1.4, 95% CI = 1.1 to 1.8). Being a graduate of a Western country or Israel had a negative association with the global score (0.4, 95% CI = 0.1 to 0.99)., Conclusion: Female sex and working in a urban clinic were major factors in the use of laboratory tests in clinical practice. As more women enter the medical profession, an improved understanding of the sex differences in ordering medical tests is important.

In recent years there is a steady increase in requests for laboratory tests by primary care physicians. This increase does not necessarily have a diagnostic and therapeutic yield. There is a relationship between background characteristics of the family physicians and their utilization of laboratory tests. Various studies have been conducted in order to understand the physician's motives for ordering laboratory tests in attempts to reduce their number. Interventions to reduce laboratory test utilization yield different and sometimes opposing results. We reviewed the literature dealing with laboratory test utilization and interventions to reduce it.

Background: There are many patient dependent factors that determine health care costs. However, it is not clear if the family physicians' background and training affects health care costs., Aim: To investigate if the family physicians background and training affect their costs., Methods: Included in the study were all the family physicians of Clalit Health Services, Central District according to the following criteria: at least two years work on the same patient list of at least 450 patients, doctors either with specialization in family medicine or with no specialization. The annual costs for treating 1,000 normalized patients (NP) were calculated for each doctor. The doctors' socio-demographic backgrounds were recorded including the country in which they graduated from medical studies, seniority, place of work and managerial position., Results: A total of 137 doctors treating 268,453 NP were investigated. The average age of the doctors was 47.4 +/- 8.0 years and on average they had 22.7 +/- 8.2 years of work experience as doctors. Most had graduated in the former USSR (57%), or Israel (20%). Forty percent were specialists in family medicine. We found an 8.7% reduction in health care costs for 1,000 NP over a year when comparing specialists in family medicine to non-specialists (p < 0.01). In multiple regression, the following factors were associated with lower costs: a country practice and specialization in family medicine., Conclusion: The health care costs are reduced by specialists in family medicine when compared to non-specialists. It also appears that costs are lower in non-urban practices. These findings should affect decision makers in the health system in encouraging specialization in family medicine.

Background: The threat of bioterrorism consequent to the September 11, 2001 attack in the USA generated suggestions for improved medical response mainly through hospital preparedness., Objectives: The aim of the present study was to investigate the impact of this period of tension on patients' first choice for care and for receiving relevant information, and on primary care doctors' feelings of responsibility in the eventuality of an anthrax attack., Methods: During October 11-31, 2001, 500 patients from 30 clinics throughout Israel were asked to complete a questionnaire on their awareness of the anthrax threat, measures taken to prepare for it, and preferred sources of care and information. Their 30 physicians, and an additional 20, completed a questionnaire on knowledge about anthrax and anthrax-related patient behaviours and clinic visits., Results: The outstanding finding was the low rate (30%) of patients who chose the hospital emergency department as their first choice for care or information if they were worried about an anthrax attack or the media communicated that an attack was in progress. The other two-thirds preferred their family doctor or the health authorities. Most of the physicians (89%) felt it was their responsibility to treat anthrax-infected patients and that they should therefore be supplied with appropriate guidelines., Conclusion: This study suggests that in Israel, a country with a high degree of awareness of civil defence aspects, both patients and primary care doctors believe that family physicians should have a major role in the case of bioterrorist attacks. This must be seriously considered during formulation of relevant health services programmes.

Background: The common feature of the different varieties of non-conventional medicine (NCM) is the lack of recognition, complete or partial, given to them by the institutions of conventional medicine. Treating all varieties in the same way can cause confusion., Aim: To investigate the knowledge and attitudes of family practitioners (FP) in the methods of NCM that are most commonly practiced in Israel., Methods: Anonymous questionnaires were used that tested knowledge and probed attitudes about FP about acupuncture, homeopathy, shiatsu and reflexology., Results: 130 FP participated in the study (response rate 91%). In-depth training of any one of the NCM methods was rare (3-7%). Overall, a very minimal level of knowledge of all four methods was found--58% did not manage to answer even one knowledge question correctly, and the best result was five correct answers out of eight. Most of the doctors recognized NCM as legitimate, and thought that conventional and non-conventional medicine should co-exist side by side. Over 30% saw the possibility of integrating all four NCM methods within the institutions of conventional medicine. No significant difference was found in the doctors' attitudes towards the different methods. Better knowledge was associated with more positive attitudes towards NCM (p < 0.05), and a greater likelihood of referring patients (p < 0.1)., Conclusion: Since attitudes towards NCM seem to be shaped by knowledge to a certain extent, educators should consider teaching more about these treatments both in medical schools and as part of CME.

Objectives: To document and assess Israeli family physicians' (FPs) knowledge, attitudes and practices regarding the management of overweight and obesity., Methods: Anonymous questionnaires were completed by 510 family physicians (82% compliance rate). The questionnaires were distributed in various continuous medical education sites of FPs in Israel. The measures included attitudes to and resources of knowledge on weight management, views regarding the prescription of drugs, approaches to and strategies recommended for weight loss., Results: In all, 73% of FPs viewed weight management as important and reported that they often treated cases of overweight and obesity, including for patients without concomitant risk factors. The medical advice most frequently offered is: increase physical activity, decrease number of total calories (eat less) and consultation with a dietitian (95, 81 and 58% respectively). However, most responders (72%) believed that they had limited efficacy in treating obesity and considered themselves not well prepared by medical school to treat overweight patients. Some 60% reported feeling that they have insufficient knowledge regarding nutritional issues. Regarding pharmacotherapy for treating obesity, only 66% knew the drugs' prescription indications. However, the vast majority (87%) knew about the gradual increase of weight after stopping drug treatment., Conclusions: Knowledge gaps and ambivalent attitudes toward obesity management were found. More education focusing on obesity, from medical school to post-graduate learning, seems warranted based on these findings.

Background: The consultation is the pivot of clinical teaching in ambulatory care. It is therefore essential that students observe the consultation. The students' presence itself influences the consultation and also requires the patients' consent. Moreover the introduction in Israel of the "Patients' Rights Act" in 1996 has made us more acutely aware of the place of the patient in teaching especially with regard to the consent to be part of the teaching process., Aim: This study was undertaken in order to investigate how tutors in family medicine perceive changes in the consultation caused by the presence of students., Methods: An anonymous physician questionnaire was distributed on the first day of the 6th year clinical clerkship in family medicine. The questions pertained to perceived influence on length and content of the consultation. In addition physician and patient background information was gathered; and the physicians were asked to estimate the patients' willingness to be part of the teaching process., Results: 46 tutors in family medicine participated, 70% of whom were female. Sixty four percent of the doctors thought that the student's presence had an influence on the consultation. Ninety one percent thought that it increased consultation length, especially of the physical part (93%). More than half thought that the student's presence might interfere with asking intimate questions. The majority held the opinion that the patient's gender and socioeconomic background were inconsequential. Ninety two percent of physicians estimated that 5% or less of the patients would refuse the presence of a student., In Conclusion: Tutors in family medicine think that the presence of a student affects the consultation. Those involved in and responsible for teaching should take this into account. Further research of these changes with objective measurements is needed.

Clinical guidelines are systematically developed statements designed to help practitioners and patients make decisions about appropriate health care for specific clinical states. Attitudes of family physicians to clinical guidelines for treating diabetes and guidelines in general were evaluated from anonymous questionnaires answered by physicians participating in continuous medical education throughout the country (May-June 1998). The questionnaire dealt with attitudes to the recently published specific guidelines for treating the diabetic patient and overall perception of the efficacy of clinical guidelines. 293 family physicians, aged 40.2 +/- 7.0 responded (83%). 93.5% appreciated the guidelines and thought them applicable. Most (83.7%) reported the guidelines to be of help in their daily work; 31.4% said they were oversimplified; a quarter said they aimed mainly at containing costs. Most respondents preferred written guidelines of up to 5 pages. In view of our results, attention can now be turned to developing ways to implement the guidelines. To improve adherence, they need to be short and the rate of publication of new clinical guidelines should be slowed.

The content of all consultations of a family physician during the first 2 months in a new practice and again in the same 2 months, 2 years later were analyzed. The workload did not change between the 2 periods, but in the first period there were relatively more men over the age of 60 years, and a more marked predominance of women in the 45-59 year age-group. There were more follow-ups of pre-existing conditions during the first period, but in both periods the main reason for visits was an acute condition; a quarter of visits required only simple counseling without further investigation or prescribing of medication. During the first period 9% of visits were for the explicit purpose of getting to know the new physician, usually by women. Thus the initial period in a new practice is not excessively burdensome, but involves seeing a number of patients who come either simply to get to know the new doctor, or to present non-chronic problems without expectation of further investigation.