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This thesis focuses upon the practice and realities of 19th century rural medical practitioners located throughout segments of southwestern Virginia. The study particularly examines the career of Montgomery County physician Robert T. Ellett, M.D. Despite opening a practice located far from his family home, Ellett's medical career gradually thrived despite operating within an arduous social and geographic environment. Initially Ellett's entrance into Montgomery County society depended solely upon his elite stature and adherence to their established "common interests." However, as time passed his identity became increasingly multidimensional. Ellett carefully crafted fruitful doctor/patient relationships by cautiously negotiating the domestic sphere. Patients and family members alike thought of Ellett as a healer and a "man of medicine." Meanwhile, Ellett sustained the financial growth needed to support his large family by holding numerous local patronage positions. Ironically, while Ellett's domestic relationships constructed his professional identity, that role was preserved by constantly manipulating positions gained through that trust. Therefore, country physicians depended upon much more than personal character in building their practices. Instead, successful practitioners in similar social environments achieved stability by balancing a multidimensional identity that ultimately subscribed to both local and personal interests. / Master of Arts

In America, certain attributes and behaviors become more publicly acceptable and more prominent in personalities as an individual matures in their chosen career path. The elite position in society of medical practitioners has been threatened during the 20th Century by new and increasing market pressures. The main hypotheses addressed in this project is the determination of the directional change of the attitudes that represent professionalism as a physician gains experience in the current medical environment and whether these attitudes change as a result of rural setting or specialization in medical practice. This project will also try to determine the reliability of a Likert scale survey instrument, designed and refined through principals of organization behavior theory in the late 1960s by Richard H. Hall. Using this tool, professional attitudes were measured in an original sample of randomly selected physicians drawn from the membership of a rural medical organization and differences were examined using bivariate analyses. The additional influences of medical tenure, organizational size and discipline specialization were also analyzed using bivariate analysis to determine if life experience (tenure, location and specialty choice) positively affects core attitudes of professionalism in medical practice. Results reflect the changing market environment and population demographic changes in rural medical practice, while also demonstrating a significant difference between physicians practicing solo without the support of a group structure. / Master of Science

The purpose of the study was to test a theoretical model explaining nurse practitioner judgments about the amount of interaction and participatory decision-making between nurse practitioners and physicians. The specific aims of the study included: (1) to examine the influence of nurse practitioner perceptions of care complexity and expected benefit-cost ratio of physician involvement on interaction and participatory decision-making; (2) to test a theory that integrates two alternative explanations of amount of interaction and participatory decision-making derived from social exchange theory and technology theory; and (3) to investigate the effect of practice rules on the relationships in the theoretical model. The study used a mathematical correlational design with a causal modeling methodology for model testing. A convenience sample of 38 nurse practitioners participated. Major concepts in the model were measured using a four scale magnitude estimation instrument developed for the study. The instrument consisted of operational definitions for each of the concepts and a set of 18 clinical situations scaled according to care complexity. Psychometric properties of the instrument including stability, internal consistency, content and construct validity were estimated. Matching of responses across two modalities was used to validate the production of ratio level data. Multiple regression techniques were used for theoretical model testing. In the test of the theoretical model, both care complexity and expected benefit-cost ratio had a significant impact on the nurse practitioners' judgments about amount of interaction and participatory decision-making. Predictions derived from social exchange theory and technology theory were supported. The effect of practice rules on the relationships in the model could not be determined since the index of practice rules did not achieve an acceptable level of stability. Nurse practitioner judgments about interaction and participatory decision-making were influenced by perceptions of care complexity and expectations of the benefits and costs of interaction with a specific physician. An understanding of the factors that affect nurse practitioner judgments about interaction and participatory decision-making may be used to guide interventions that enhance the fit between these structures and outcomes of care.

The patient's failure to cooperate effectively in the patient/physician (patient and physician) interaction has been shown to be a problem of significant magnitude. In the present study, an attempt was made to identify specific, patient behaviors which might be related to physician judgment of a good patient and progress of treatment. A checklist of 37 behaviors was compiled. A series of 100 patients was observed during their interaction with physicians and occurrences of behaviors from the checklist were noted by an experimenter. Physicians also indicated whether the patient was considered to be a good patient and whether treatment was progressing as expected. For every third patient, physicians noted the occurrence of behaviors from the checklist. An association was found between some behaviors from the checklist and the physicians' judgment. There was also shown to be a difference in the ability of the experimenter and the physicians involved to detect these behaviors.

This study examined to what extent the biological sex of the nurse-physician interactants affects the interpersonal communication satisfaction experienced by the nurse. Hypotheses One and Two predicted that communication satisfaction would differ significantly across various combinations of sex of nurse and sex of physician dyads. Hypothesis Three predicted that male nurses would experience higher levels of communication satisfaction than would female nurses. Interpersonal communication satisfaction was operationalized by two self-report instruments. The sample included 153 male and female nurses. Results indicated that same-sex interactions were more satisfying for female nurses, while mixed-sex interactions were more satisfying for male nurses. Nurses reported greater communication satisfaction when interacting with female physicians. Hypothesis three was not supported.

The expansion of health insurance through health care reform has reduced the number of uninsured. but access to providers has not been addressed. Understanding the relationship between practice choices and aptitude of health policy and delivery is essential to determine other factors or motivators that contribute to the development of health care access policies. This descriptive study explored the value-laden elements of health care reform, such as social constructions, to learn whether there are implicit ways to address the issue of access to health care in the United States. Schneider and Ingrams's conceptualization of policy making through social construction was used as the theoretical lens of this study. The research questions for the study examined the relationship between a provider's choices and their knowledge of health policy and delivery. This non-experimental, quantitative survey study used a convenience sample of 189 providers. The survey was a compilation of 4 existing instruments that were used to capture provider demographics and choices as well as scaled questions to assess knowledge. Data were analyzed through a series of chi-square tests. Significant relationships were found (p < .05) between the variables of specialty, medical licensure, and understanding of health policy and delivery concepts. This study contributes to social change by suggesting the need for health policy and delivery education programs geared towards providers. These changes could improve the level of provider engagement and be a catalyst for generating ideas of how the U.S. health care system could achieve the goal of providing efficient, high-quality care.

Background: With healthcare costs increasing faster than inflation in the United States. it is expected that fewer people will be able to afford health care in the future without changes to the healthcare system. It has been argued that much of the healthcare utilization presently observed is unnecessary and that a large portion of this wasteful spending can be attributed to the characteristics of local area physician supply and specialty mix. These arguments are based on observed positive correlations between local area health utilization and the local area supply of physicians and physician specialists. Commentators suggest that greater physician supply leads to the use of more physicians by patients resulting in diffuse, uncoordinated, and wasteful care. There have been calls for modifying the physician training system in the United States based on these correlations. However, we have found no studies demonstrating direct relationships between local area physician supply and the use of physicians by individual patients. Studies in physician-induced demand theory have examined the relationships between physician supply and healthcare utilization, whereas studies of physician referrals have only investigated the effects of local supply on referral rates not the number of physicians used by patients. Method: We isolated a set of patients with a consistent diagnosis and course of treatment (stage III colorectal cancer Medicare patients receiving surgery and chemotherapy but not radiation therapy) and investigated whether local area physician supply leads to the use of more physicians by these patients and more diffuse care across physicians during their first treatment course. Result: Our results show that not only the specialists' characteristics but also the market level variable as local physician supply affect the care dispersion in terms of numbers and specialty mix of physicians treating colorectal cancer patients with the same condition. Discussion: According to these findings, it is suggested that local physician supply has the causal relationship between the patterns of care dispersion. Supply of primary care physicians and oncology specialists tend to spur the physician utilization across four specialty groups which are more likely to have discretionary utilization.

A unique breed of nurses for the US market is emerging-the Physician-Nurses. They are foreign-educated physicians who have retrained as nurses. The purpose of this study was to generate a theory that can explain the development of their nursing identity. Specific aims were to discover barriers that participants perceived as problematic in their transition to nursing and catalysts that influenced how they addressed the central problematic issue they articulated. Grounded theory methodology guided by the philosophical foundations of symbolic interactionism was used. Twelve Physician-Nurses were interviewed. Transcribed interviews were imported to ATLAS.ti. Text data were analyzed by constant comparative method. Concept formation, development, modification and integration were accomplished through different levels of coding. Methods were employed to ensure trustworthiness of findings. Core categories were discovered and a central social psychological problem experiencing the burdens of a new beginning and a basic social psychological process combining the best of two worlds emerged. Further theorizing generated the substantive theory combining the best of two worlds and the beginnings of a formal theory. The substantive theory explained the three-dimensional central problem and the five-stage basic social psychological process. Dimensions of the central problem were (a) crossing cultures, (b) starting from zero, and (c) crossing professions. Stages of the basic process were (a) letting go of professional identity as physician, (b) experiencing growing pains, (c) seeing nursing as a saving grace, (d) gaining authority to practice as a nurse, and (e) engaging self to nursing and asserting "I am a nurse." The substantive theory is a springboard toward the development of a formal theory which may be able to further explicate the development of nursing identity in Physician-Nurses. This theory named, Theory of Transprofessionalism, was initially conceptualized as having five phases namely: (a) disengagement, (b) discouragement, (c) enlightenment, (d) encouragement, and (d) engagement. These stages correspond to the five stages of the substantive theory. The key concept nursing identity was operationalized by utilizing three statements published by the American Nurses Association that describe the professional registered nurse, the knowledge base for nursing practice, and the code of ethics for nurses.

<p>The two most controversial ends of life decisions are those in which physicians help patients take their lives and when the physician deliberately and directly intervenes to end the patients’ life upon his request. These are often referred to as voluntary euthanasia and physician assisted suicide. Voluntary euthanasia and physician assisted suicide have continued to be controversial public issues. This controversy has agitated the minds of great thinkers including ethicians, physicians, psychologists, moralists, philosophers even the patient himself. Hence the physician, patient, the public and policy makers have recently had to face several difficult questions.</p><p>Is it morally right to end the life of the patients? Is there any moral difference at all between Voluntary euthanasia and physician assisted suicide? Should a terminally ill patient be allowed to take his life and should the medical profession have the option of helping the patient die. Should voluntary euthanasia and physician assisted suicide be legalised at all? And what actually will be the legal and moral implications if they are allowed.</p><p>In a bid to find a lasting solution to these moral problems and questions has led to two different strong positions viz opponents and proponents of voluntary euthanasia and physician assisted suicide. The centre of my argument in this work is not to develop new general arguments for or against voluntary euthanasia and physician assisted suicide but to make a critical ethical comparative analysis of voluntary euthanasia and physician assisted suicide. This is the focus of my work. The sole aim of this work is neither to solely condemn nor to support voluntary euthanasia and physician assisted suicide but to critically analyze the two since we live in a world of pluralism.</p>