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This Report examines the “paradox” of physician privacy: while physician privacy has been explicitly or implicitly invoked over the last century to defend physicians against greater transparency, proposals that might cause them economic harm, or interference by government or corporate entities, there has been little comprehensive work done to examine the substance and source of any privacy rights physicians may actually enjoy. This Report attempts to make three primary contributions with respect to physician privacy. First, the Report examines the current state of physician privacy and the legal framework that governs it. Second, the Report argues that physician “privacy” is not, and should not be considered, a unitary concept encompassing a singular meaning. Rather it is a broad umbrella term that encompasses not only a variety of legal protections for privacy, but guards against a variety of very different perceived harms. As a result, this Report argues that in evaluating policy initiatives, discussions about “privacy” implications can be counterproductive because the term obscures the real values, concerns, and policy judgments at play. To address this, the Report’s third aim is the proposal of an analytical framework that policymakers and others may use to consider the impact of various initiatives on the values and concerns that physician “privacy” actually protects: professional autonomy; economic considerations; personal dignity; and practical difficulties. / text

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The general purpose of this study was to ascertain how older adults want their physicians to communicate with them and behave toward them. The first objective was to develop an instrument to measure attitudes toward communication in the doctor-patient relationship, the Physician-Patient Communication Inventory (PPCI). The second objective was to investigate age differences among older adults in specific aspects of the doctor-patient relationship. Six forms were administered to 54 women and 6 men aged 60-91: Consent form, Subject Data Form, Known Doctor Behavior List (PPCI, Part I), Ideal Doctor Behavior List (PPCI, Part II), Rokeach Dogmatism Scale (short form), and an open-ended request for additional comments. Statistical analyses included varimax-rotated factor analyses, split-half reliabilities, divergent validity, frequency tabulations, Pearson product-moment correlations, and multiple analyses of variance. Results indicated that the PPCI is a reliable instrument containing nine factors which relate to the content and style of physician communication with patients. The particular importance for physicians to have medical knowledge and to be able to communicate is clear from both parts of the PPCI. Low correlations with the Rokeach Dogmatism Scale showed that the PPCI does not measure general authoritarianism and intolerance. Comparisons between subjects aged 60-74 and subjects 75-91 did not yield significant differences at the .05 level, although the results on the Known Doctor Behavior List Factor 3, Dissatisfaction with Doctors, indicated a slight preference in adults aged 60-74 for taking the active role of the consumer, rather than accepting an authoritarian physician (P < .09). Results reported on individual PPCI items indicated that the older adults did not want family involvement in diagnosis and treatment of their health problems. Responses to terminal illness issues were mixed, as were responses to physician responsibility in non-medical problems. Recommendations included (1) repeating this study using a larger sample size, extreme groups, groups varying on demographic variables, and groups of illness-alike subjects; (2) exploring reasons that lead to patient termination of the doctor-patient relationship; and (3) investigating preferences of older adults in family involvement, communication about terminal illness, and physician responsibility in non-medical problems.

BACKGROUND:Clinicians often encounter information about drug-drug interactions (DDIs) during clinical practice. This information is found within product information (hardcopy and electronic) and various electronic systems. Prescribers may receive medication-related communications in practice that are distributed by facsimile (fax), mail, or telephone from pharmacies and pharmacy benefit managers (PBMs). The purpose of this study was to determine if near-real time fax alerts for potential drug-drug interactions (PDDIs) would influence prescribing.METHODS:A prospective study, in cooperation with a pharmacy benefit manager (PBM), was conducted targeting 18 clinically important PDDIs. Fax alerts included an individualized letter to the prescriber with a list of the interacting drugs, PDDI evidence summaries with citations, and recommended clinical management strategies. Among the 18 PDDIs, 13 PDDIs could be assessed for prescription therapy changes using pharmacy claims data. A prospective cohort design was used to evaluate changes in prescription dispensing 90-days following a PDDI fax alert.RESULTS:A total of 8,075 fax alerts were sent to prescribers and there were 4,712 alerts for the 13 PDDIs that could be assessed for change using pharmacy claims data. There were 2,019 patients (interventions) for which fax alerts were sent to their prescribers who were matched with a control group consisting of patients with the same PDDIs but for whom no fax alert was sent. Overall, this study found 154 (7.6%) of patients in the fax alert group compared to 132 (6.5%) in the control group had changes in therapy (p=0.177).CONCLUSIONS:This fax alert intervention program observed no statistically significant differences in prescribing with a fax alert compared to the control group. If PBMs chose to send individualized, evidence-based information to clinicians regarding drug-drug interactions, this study suggests it may not be an effective intervention to mitigate harm.

Very little has been written about the physician-patient interaction from the perspectives of individuals with severe disabilities. It has been reported that satisfaction with the physician-patient relationship can affect continuity of care and compliance with therapeutic regimens. While it is feasible that these issues could be of less consequence to the health of patients who are non-disabled, discontinuity of care or noncompliance with treatment plans could result in critical, life-threatening situations for individuals with severe disabilities. This study explored factors of the physician-patient interaction that are important from the perspective of individuals with severe disabilities. Research questions addressed the nature of the interaction, similarity with factors considered fundamental by individuals without disabilities, and whether there were factors important to individuals with severe disabilities that previously had not been reported in the patient satisfaction literature. The six individuals selected to participate in the study represented a range of disabilities that met the Rehabilitation Services Administration (RSA) criteria to be considered severe: blind, cerebral palsy, deaf, post-polio, spinal cord injured, and systemic lupus erythematosus. These participants also met all criteria as "key informants" for the purpose of qualitative research. A qualitative design was selected, employing two in-depth ethnographic interviews with each participant to elicit responses to focused, open-ended questions about the physician-patient interaction. The questions were patterned after those used in the development of the Smith-Falvo Patient-Doctor Interaction Scale (PDIS). Permission from the senior author was granted for "fair use" of the PDIS, and the related findings were used as comparison measures to responses of participants in this study. Findings of this research indicate that the interactional dynamics (eye contact, greeting, familiarity and evidence of respect) of first impressions for each individual in the physician-patient dyad influence to a large degree whether a satisfactory relationship can be established. In addition, participants with severe disabilities need to be considered by their physicians as equal partners in the management of their health care.

Communication expectancy and reinforcement principles are systematically integrated to explain the effectiveness of communication strategies focused on improving initial and long-term medical adherence and patient satisfaction. Study 1 analyzed patients' evaluations of communication regard strategies and the effectiveness of these strategies in initial encounters. It was predicted that physician gender would play a major role in patients' communication evaluations. As predicted, negative regard influence strategies used by male physicians were perceived as more appropriate than negative regard influence strategies used by female physicians. Results did not indicate gender differences in perceptions of expectancies or relational concern as communicated by regard strategies. Study 1 also addressed the effectiveness of influence attempts in initial encounters with a physician. The study supports the predicted interaction for communication effectiveness in initial encounters. Specifically, the results support the claim that female physicians are limited to the use of positive regard strategies whereas male physicians are more effective persuaders using either positive or negative regard strategies. The results also indicate that the use of negative regard strategies by male physicians does not hinder patient satisfaction or physician perceptions, whereas the use of negative regard strategies by female physicians is negatively related to these outcome measures. The reinforcement expectancy framework tested in Study 2 argued that occasional use of nonrewarding communication would facilitate communication effectiveness for both male and female physician in ongoing physician-patient relationships. The results supported this assumption. Physician gender, however, did not mediate the effectiveness of certain strategy combinations as expected. Finally, the investigation found that previous exposure to any type of physician communications style, as opposed to never having seen the physician, facilitated a physician's influence attempts.

<p>Since the anecdotal assumption is that GPs do not effectively diagnose and manage problem drinking amongst their patients, this study investigated the role of GPs in addressing problem drinking in Cape Town as well as the prevalence of problem drinking amongst their patients.</p>

Over the past 50 years, the demographics of medical school graduates in the United States has changed dramatically with the number of women (47%) almost equaling the number of men in 2014 (AAMC, 2014). However, the Association of American Medical Colleges (2014) reports that orthopaedic surgery has the lowest proportion of female residents, instructors, assistants, associate, and full professors of all the sub-specialties and little has changed in the past several decades. Due to the healthcare reform and the changing needs of our society, it is importance to recruit, retain, and promote women into leadership positions. The purpose of this study is to ensure the success of women in orthopaedic surgery. A self-report survey was sent to all known women in orthopaedic surgery. The survey assessed perspectives of women in orthopaedic surgery in regards to organizational culture, leadership development, challenges, diversity, gender bias, recruitment, and retainment. An examination of the data provides insights into areas of improvement and implications for institutional practice. The results indicated that although institutions are making progress, more advocacy for gender equality, pro-family policies, and employee retention is needed.

MSc (Nursing), Faculty of Health Sciences, University of the Witwatersrand / Nurses working with critically ill patients in intensive care units (ICUs) have a unique role to play in health care. They spend 24 hours with patients and come into contact with all the disciplines which come to review these patients. Nurses therefore need to effectively collaborate with the multidisciplinary teams, especially physicians, in order to meet patients’ needs and maximise patient care outcomes. The purpose of this study was to identify and describe nurses’ perceptions towards nurse-physician collaboration in the intensive care units. A non experimental descriptive study design was utilised in this study. Data were collected using a questionnaire developed from the Jefferson Scale of Attitude toward Physician-Nurse Collaboration with additional two open-ended questions to cover the rest of the study objectives. Data were analysed using descriptive and inferential statistics as well as content analysis. Results showed that nurses working in Intensive Care units (ICUs) had positive attitude towards nurse-physician collaboration regardless of gender, years of working in the ICUs and whether registered intensive critical care nurse or not. The findings also showed that nurses perceive that the process of nurse-physician collaboration in Intensive Care Units provokes a number of challenges, such as superior-subordinate relationships which exist between nurses and physicians, workload and overlapping responsibilities hence, nurses feel inferior, undermined, mostly overwork and become frustrated. However, nurses suggested that promoting team-work; a focus on patient-centered care and staff motivation would assist in creating effective collaborative environment. collaborative environment