The aim of this project was to use patient scenarios (clinical/case vignettes) to explore three aspects of General Practitioners' (GPs') clinical decision-making: how difficult decisions are perceived to be, the time taken to make decisions, and the appropriateness of decisions relative to evidence-based clinical guideline recommendations. A systematic review synthesised the results of published scenario studies. A secondary analysis of scenario studies which investigated antibiotic prescribing for upper respiratory tract infection (URTI) and x-ray referral for low back pain was performed. Relationships between the three aspects of decision-making were investigated, and scenario and GP characteristics associated with these aspects were identified. An online scenario study further refined these relationships for two specific URTI types: sore throat and otitis media. Cognitive processes involved in clinical decision-making were investigated in a Think-Aloud interview study, where GPs verbalised their thoughts while making prescribing decisions for URTI scenarios. There was some evidence that inappropriate antibiotic prescribing for URTI was associated with greater decision difficulty and longer decision time. Decisions made using a more effortful cognitive process may therefore be less likely to be appropriate. Illness durations of four or more days and, in otitis media, unilateral ear examination findings were related to inappropriate prescribing. Based on these results, suggestions have been made for informing the design of interventions to support GPs in making appropriate decisions. A secondary aim was to provide an overview of the methodology and reporting of scenario studies. The systematic review indicated a lack of consistency in methodologies, while reporting is often inadequate. Formats less similar to real consultations (e.g. written scenarios) are commonly used: the results of studies using these formats may be less likely to reflect real practice decision-making than studies using more realistic formats (e.g. videos). Based on these findings, methodological recommendations for scenario studies have been developed.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of MSc (Med) in Bioethics & Health Law Johannesburg, May 2017 / Spiraling health care costs have posed a threat to access to health care for scheme members, as more has to be done with even less. Managed care programmes were introduced to control the health care costs by reducing medical doctors autonomy. My aim was to ascertain the extent to which the managed care processes impede medical doctors’ autonomy. Principled conditions were identified where the limitation of doctors’ autonomy as a result of managed care could be morally justified which include where implementation would result in a just distribution of resources and a limitation of medically futile treatment. However principled conditions where these managed care tools would not ethically be justified included where they would result in adverse patient outcomes, where they result in a loss of medical doctors morale or where they result in reduced trust in the patient doctor relationship. / MT2017

This research sought to identify the reasons physicians attributed for practicing in Oregon, the reasons for relocating out of Oregon, and the reasons for failures in recruiting physicians to Oregon. A random sample survey of 494 Oregon physicians identified the presence of economic and non-economic factors related to the recruitment and retention of physicians in Oregon. The research indicated that non-economic factors are overwhelmingly selected by physicians as reasons for locating their practices in Oregon, while economic factors are strongly selected as reasons for relocating out of Oregon, and as reasons for candidates not accepting positions. The data and research design do not provide the information needed to explain these divergent findings. The non-economic factor of Oregon lifestyle would appear to be a substantial recruitment asset as 93% of respondents selected "Oregon lifestyle" as an influential reason for locating their practice in Oregon. 86% of influential reasons to locate a practice in Oregon were non-economic factors. Economic factors were identified in 16% of respondents who reported planning to relocate out of Oregon within five years. The OHSU (2002) Workforce Assessment obtained a figure of 4% for this variable. This suggests future recruitment needs may be larger than anticipated. Physicians commonly contend with recruitment activities as 80% of respondents reported attempting to recruit physicians in the last five years. Of respondents reporting recruitment attempts, 69% reported at least one recruitment failure. Most of these failures were due to economic factors. While non-economic factors dominated the findings for reasons to locate in Oregon, economic factors dominated the findings for reasons to relocate and for recruitment failures. A full range of economic factors such as salary, reimbursement, liability premium costs, Oregon's economy were considered influential. Non-economic factors including lifestyle, collegiality, and family living in Oregon were influential factors identified in this survey. Much of recruitment theory is 'low-level', which appears as the ordinary organizing constructs for recruitment practices. As recruitment is largely an applied endeavor, recruitment theory is little developed and examined and is fertile ground for development and testing. / Graduation date: 2005

Thesis (Ed. D.)--West Virginia University, 2004. / Title from document title page. Document formatted into pages; contains xi, 236 p. : ill. Includes abstract. Includes bibliographical references (p. 196-209).

This study evaluates the hypothesis that medical reasoning in real clinical situations involves multiple cognitive tasks whose complex interactions are coordinated in an opportunistic manner. A problem-solving architecture originating from research in artificial intelligence, the blackboard model, is proposed as an integrative framework for representing these characteristics of situated medical reasoning and for reconciling different theoretical perspectives about medical reasoning. A naturalistic clinical situation, involving the manipulation of the patient record by an internist while managing a case, provides the empirical data for this in depth qualitative case study. The video recording of the subject's record manipulation behavior allows the cueing of retrospective think-aloud verbalizations and the preservation of the real-time aspects of problem solving. The association of theory-driven task analysis using the blackboard model with data-driven propositional analysis confirm that medical reasoning in this situation indeed comprises a variety of cognitive tasks, which are described. Also, the opportunistic character of control knowledge and the complex interactions between control strategies and cognitive tasks are confirmed and described. The blackboard model allows the principled representation of these characteristics of situated medical reasoning, thus supporting its integrative character. However, certain aspects of the data, mostly related to the ambivalence of several concepts that are used by the subject during the course of problem-solving, are not explained in the most parsimonious manner by the blackboard model, nor by symbolic cognitive architectures in general. A connectionist alternative is proposed which seems to better account for these phenomena. Finally, a tentative neurophysiological interpretation of the blackboard framework is offered for integrating the symbolic and connectionist perspectives. This study has additional implications con

In today's society, there exists an ever-growing concern over the serious deficit in the primary physician services. With the high cost of health care consistently rising, increased demands are being made for better health care practices. The problems now facing the medical profession emphasize the lack of supply, distribution, organization, utilization, and financing of physician services.The problems of helath care are not mutually exclusive of one another; but rather, they are interrelated and dependent. The problems have manifest themselves in overburdened physicians, rapidly rising medical costs, lack of appropriate use of equipment and facilities, lack of any medical care and services in many rural areas, maldistribution of physicians in urban areas, and delays in seeking medical care by the population.During this time when medical schools are re-examining the objectives and potentialities of their programs, schools of allied health professions are developing and expanding their "non-physician" programs. One of these allied health professions receiving a great deal of attention is the physician assistant. The physician assistant, however, has not been readily accepted into established medical practice. Questions concerning minimum educational standards, licensing, legal responsibility, professional roles, and future professional goals have been raised.The present investigation was undertaken in order to determine the impressions of practicing, licensed physicians in the state of Indiana concerning the utilization, roles, and acceptance of the physician assistant concept. More specifically, this study was designed to determine what, if any, relationship between descriptive aspects of the physician and his practice and his impressions concerning the utilization of the physician assistant in medical practice. The descriptive aspects of the physician population included: medical specialty, age of physician, number of years in practice, type of practice, size of practice, the location of the practice, military experience, distance to urban areas, distance to nearest hospitals, and number of new patients seen each day.The population for this study consisted of a 10 per cent random sample of physicians practicing in Indiana during 1972. The questionnaire utilized was constructed and items selected on the basis of job descriptions, tasks, and functions presented or proposed, in some form, in clinical settings, physician assistant training programs, and to physician assistants throughout the country.The practice of quality medicine mandates that physicians be a conservative group and not take extreme positions. If confronted with a "rating-scale" type of answer, responses might tend to fall in the middle ranks. For this reason, a forced choice (yes or no) type of questionnaire was developed. Each item was designed to measure the impressions and opinions of the physician toward some aspect of the role concept for the physician assistant.A questionnaire was mailed to each of the sample members. Included with each questionnaire was: 1) an explanatory letter introducing the study, 2) an addressed, stamped envelope to be used in returning the survey form. At three week intervals, a follow-up survey form was sent to those sample members who had not returned the form. This was done for two follow-up periods to ensure maximum return.The data was handled in two ways. Initially, the data was handled in a descriptive manner; that is, a simple frequency count was done to see how physicians as a group answered each question or statement. Next, the physician population was categorized and each of the variables was measured. The statistical method used for this study was the chi square (x2) method.The mailing questionnaire was chosen as the method of data collection because it was inexpensive, successful with individuals of higher socioeconomic groups, larger sample size, and bias of the researcher minimum to results.The sample for this study consisted of a ten per cent random sample. The study was initiated in April, 1973, and terminated in September, 1973. A total of 451 questionnaires were mailed to the population sample. Of these, 225 were returned, accounting for a 51.3% questionnaire return.Of the physicians surveyed, 38.8% practiced general medicine. Genreal surgery accounted for 11.0% of the sample. The remainder was made up of various specialties. It was also observed that 32.0% of the physician sample were in the age range of 41-50 years and 28.4 were in the age range of 51-60 years. Only 2.7% of the physicians were under 30 years and 3.1% over 70 years.Of the physicians sampled, 34.4% had been practicing medicine for over 30 years and 53.9% of the physicians practiced alone. Only 1.4% of the physicians were retired.Of the physician sample, 49.8% saw from 26-50 patients each day and over 42% practiced in urban areas greater than 100,000 population. Only 8.1% of the physicians were practicing in areas of 5,000 or less population.With respect to military experience, 77.1% practiced medicine in the military.With a breakdown in regards to distance to nearest urbanarea (100,000 population), 45.4% were within 10 miles and 15.5% were located in areas greater than 50 miles from urban areas. Furthermore, 90.6% of the physicians were located within 10 miles of a hospital.It was observed that 72.1% of the physicians saw from 0-5 new patients each day; 6% saw more than 25 new patients each day.An analysis of the data revealed that physicians as a group agree with the philosophy of the physician assistant concept. The majority of physicians felt that the physician assistant should be trained through approved academic programs which were under the direction of recognized medical schools. In conjunction with this, the physicians felt that standardization in terms of quality and program content was desirable. It was interesting to note that only 79.7% of the physicians felt that standardization was necessary.Many felt they would rather train the physician assistant themselves for the specific needs of their own practice. Some physicians felt that the training programs could be offered through local hospital training schools and not only through medical schools.The next area of interest dealt with legal responsibility. Only 25% of the physicians responding felt that the physician assistant should be legally responsible for his performance.Almost 66 percent of the physicians said that the physician assistant should be permitted to write certain prescriptions. Also 41% said that the physician assistant should be able to write patient orders in the hospital.The majority of physicians felt that the physician assistant should be able to detect abnormal signs and symptoms and make preliminary diagnoses based on the results of such examinations and report these on patients' permanent records or charts. Nearly 52% of the physicians said that their patients would accept the physician assistant to take care of them when they were sick.Approximately 75% felt that the role of the physician assistant overlaps that of the registered nurse.Most of the sample did not feel that the widespread use of the physician assistant would reduce the present quality of health care. Related to this, almost 79% of the physician sample felt that present health care delivery services need to be restructured.The most quoted salary range for the physician assistant was in the 8 to 10 thousand dollar range.Most physicians stated that if they were to employ a physician assistant, they would devote more time to existing patients.Approximately 16% of the Indiana physicians, at present, employ a physician assistant and nearly 64% said they would consider employing a physician assistant in the future.On the basis of the data collected from this survey of physicians concerning the utilization of the physician assistant in Indiana, the following conclusions are made:(1) The majority of physicians feel that the physician assistant should be trained in approved programs.(2) Only 25% of the physicians feel that the physician assistant should be legally responsible for his performance.(3) The majority of physicians feel that the physician assistant should be permitted to write certain prescriptions.(4) The majority of physicians feel that the physician assistant would be accepted by their patients.(5) Nearly three-fourths of the physicians feel that the role of the physician assistant overlaps that of the registered nurse.(6) Nearly 70% of the physicians felt that health care delivery needs to be restructured in order to better meet patient needs.(7) Most physicians would utilize more time to existing patients if they were to employ a physician assistant.(8) The vast majority of physicians feel that the physician assistant is a valuable member of the health care team and will improve the quality of patient care.Ball State UniversityMuncie, IN 47306

No description available.

Thesis (M. P. H.)--University of Hong Kong, 2007.

Thesis (M. P. H.)--University of Hong Kong, 2007.

Thesis (M. P. H.)--University of Hong Kong, 2007.