The current maxim concerning diagnosis and treatment of mood and anxiety disorders is that family physicians fail to appropriately respond to patients with anxiety and depression. This estimate is based upon a collection of studies that have found that accurate recognition in general practice occurred in 9% to 75% of patients with depression, and 34% to 50% of patients with anxiety. However, most studies have found that more than half of physicians accurately detected depression and anxiety in their patients.<p> This dissertation examined physicians responses (detection, treatment, and follow-up) to clinical scenarios of patients presenting with symptoms of either depression or anxiety. Furthermore, this study evaluated the associations between physicians responses and physician attributes (personal and professional), organizational setting, information/resource use, and barriers to care.<p> A cross-sectional study of Saskatchewan family physicians yielded a response rate of 49.7% (N=331/666). The results of this study revealed that most physicians provided appropriate depression and anxiety care with respect to recognition of disorders and follow-up care. Specifically, 85.4% of physicians provided an accurate tentative diagnosis of depression, and 86.3% provided an accurate tentative diagnosis of anxiety; 82.5% of physicians suggested adequate follow-up depression care while 79.4% offered adequate follow-up anxiety care. However, a notable proportion of physicians did not provide effective treatment; 65.6% of physicians recommended effective (immediate) anxiety treatment, and 55.6% recommended effective (immediate) depression treatment.<p> This study found that physicians provision of care to patients with anxiety and depression was more likely to be associated with their personal attributes, organizational setting, and information/resource use than with their professional attributes. First, neither tentative diagnosis of depression nor tentative diagnosis of anxiety was significiantly associated with any of the tested measures. Second, ineffective treatment of depression was significantly more likely among physicians who were female, educated at the undergraduate level in Canada (versus elsewhere), scored lower on anxiety attitude factor 1 (social context view of anxiety amenable to intervention), had a low patient load (< 100 patients/week), and used medical textbooks to make specific clinical decisions; ineffective treatment of anxiety was significantly more likely among physicians who had completed their undergraduate and postgraduate medical training in Canada (versus elsewhere), had a low patient load ( <100 patients/week), did not practice in a private office/clinic, and used colleagues within as well as outside their main patient care setting to update their general medical knowledge. Third, physicians were significantly more likely to provide inadequate follow-up care to the depressed patient if they were in solo practice and used drug manuals to update their general medical knowledge, and significantly more likely to provide inadequate follow-up care to the anxious patient if they (the physician) were female and did not use mental health professionals to update their general medical knowledge.<p> Results indicated that after controlling for the effects of other factors, physicians with low patient loads were three times more likely to provide ineffective treatment of depression than physicians with high patient loads. Furthermore, when holding the effects of all other factors constant, physicians who had completed postgraduate training in Canada were approximately five times more likely to provide ineffective treatment of the anxious patient than physicians who had completed their postgraduate training outside of Canada.

Moderne Technikgeschichte deutet den menschlichen Körper als etwas Gemachtes, als „Biofakt“: Der Radsportler erscheint als eine Art Hybridwesen. Nicht nur das Sportgerät, sondern auch der Athlet wurde auf den Prüfstand gestellt und in Funktionseinheiten zerlegt. Das Spektrum des medizinischen Interesses am Sportlerkörper verschob sich im 20. Jahrhundert von physiologischen Studien über die spezielle Traumatologie und Therapie im Sport hin zum Design des Sportlerkörpers. Medizinisches Wissen wurde dabei zu einem konstituierenden Element des Hochleistungssports schlechthin. / Contemporary history of technology interprets the human body as a man-made “biofact”: The racing cyclist, especially, seems to be a hybrid. Not only the sports equipment, but also athletes have been examined and stripped down into functional units. In the 20th century, the interest of sports physicians shifted from physiological studies, via special treatments and therapies for athletes, to the design of their bodies. Medical knowledge became an important element of top-class sports.

This project was aimed at defining, quantifying and analyzing the value of uncompensated care provided by physicians as part of the Yale Medical Group for the 2008 fiscal year. Using an opportunity cost model, uncompensated care was calculated for each department as a total of bad debt and free care and then compared to existing estimates of such care. Another aim of this study was to conduct an interdepartmental comparison of the value of such care as a percentage of departmental earnings. To undertake this study, a literature search was performed to determine previous estimates and models of uncompensated care by physicians. Primary financial data (including charges, payments and write-offs for Bad Debt and Free Care) from the Yale Medical Group for fiscal year 2008 was then collected, fed into the opportunity cost model and compared to published estimates. The results of this study showed that, as a whole, physicians at the Yale Medical Group provided $6,510,373.65 of Uncompensated Care (or 2.75% of Total Payments) with a departmental range of 0.57%-15.29% of Total payments. These results show that Faculty physicians at Yale provided a larger amount of Uncompensated care than the published estimates obtained from random sampling of almost 4000 physicians. The results also reveal large differences in levels of uncompensated care between departments at Yale.

Thesis (Ph.D.)--University of Nebraska-Lincoln, 2008. / Title from title screen (site viewed Sept. 18, 2008). PDF text: ix, 185 p. : ill. ; 1 Mb. UMI publication number: AAT 3304202. Includes bibliographical references. Also available in microfilm and microfiche formats.

Thesis (M.A.)--Boise State University, 2009. / Includes bibliographical references (leaves 75-79).

Thesis (Ph. D.)--University of Texas at Austin, 2000. / Vita. Includes bibliographical references (leaves 223-238). Available also in a digital version from Dissertation Abstracts.

Abstract Physicians in the emergency department (ED) are facing a number of unique challenges in the currently changing healthcare and economic climates. Dramatic increases in ED patient volumes have been noted nationwide with visits related to prescription opioid abuse and misuse alone having increased by 111% between 2004 and 2008. Ironically, several challenges ED physicians are facing arise from regulatory and economic initiatives which were originally designed for the protection of patients. Regulatory requirements to address pain as the fifth vital sign, along with entities utilizing patient satisfaction based reimbursement, have inadvertently created an environment conducive to exploitation by the prescription opioid abuser. A literature review revealed an informational gap with regard to the impact economic and regulatory factors exert on the management of patients, exhibiting drug seeking behavior, by ED physicians. The lack of available information is the basis for this original research. A descriptive, cross-sectional, non-experimental study was conducted over a two month period (October - November, 2013) to elicit opinions of ED physicians regarding the management of opioid seeking patients. Respondents were asked to include opinions on factors perceived to impact treatment of this patient population. Of the ED physicians surveyed, 71% reported a perceived pressure to prescribe opioids to avoid administrative and regulatory criticism and 98% perceive patient satisfaction scores as being too highly emphasized by reimbursement entities as a means of evaluating healthcare quality. Rising patient volumes and changes in the healthcare climate were also cited as factors impacting management practices when treating patients exhibiting drug seeking behavior. Emergency department physicians have a unique role in providing unrestricted access of care for the public. This role, in conjunction with the aforementioned concerns, has served to create an environment conducive to the potentiation of prescription opioid misuse and abuse.

Introduction: Shortage of doctors and nurses is a global problem. How to retain them in the public sector is one of the most important issues that needs to tackle at the administrative level. There are numerous number of studies focusing on the factors that medical staff considered to be significant in enhancing their job satisfaction so as to make them stay in their existing job. However, there are relatively fewer studies on the intervention that are effective to increase the job satisfaction. In this project, literatures are reviewed on the effectiveness of different management measures in enhancing job satisfaction of the medical staff. Method: Literature search on the effect of different management measures on job satisfaction of medical staff. The review will also cover the combination of various measures in order to maximize their effects in enhancement of job satisfaction. Results: It is suggested that by improving the working environment, which includes unit re-organization, workload re-allocation and new technology adoption, is the most common and effective way to improve job satisfaction among medical staff. Indirectly, by allowing more autonomy and provision of training as well as learning opportunities to the staff can lead to an increase in self-esteem and respect from patients and colleagues. These will in turn improve job satisfaction. However, due to the use of different evaluation methodologies by different investigators, direct comparison of the management measurements is difficult. Conclusion: The management measures like improving the working environment, allowing more autonomy and providing trainings are found to be effective in enhancing job satisfaction of medical staff. Using standardized evaluation tools will allow a more valid comparison between different interventions. / published_or_final_version / Public Health / Master / Master of Public Health

The changes in the health care system have been remarkable over the past decades, along with the rapid economic development of China. The overall living standard of rural residents has generally improved; however, health expenses still make up a large part of their annual expenditure. During the new reform period, the importance of the village doctor has been emphasized by many scholars, and yet there are few studies conducted from the perspective of interactions between health administration, village doctor and rural resident to discover the invisible factors that influence the delivery of the health care service. Thus, this study aims to explore the street-level bureaucracy within the rural health care sector and its impact on rural residents. Guided by the Street-level Bureaucracy Theory and its application in public agency research, this study explores street-level bureaucracy in the grassroots health care sector in terms of health care regulation and provision before and after the recent series of health care reforms, and evaluates its impact on rural residents by analyzing health equity in terms of health care access, and the actual working and living conditions of the village doctor were identified. Apart from the official statistical data from document analysis and internet resources, the voices and advice of village doctors and rural residents in Jiangsu Province were also obtained from in-depth interviews, which provided the qualitative information for this study. There are four findings. First, as a typical street-level bureaucrat in the grassroots sector, the working condition of the village doctor has become more stable and their discretionary control has been enhanced greatly after the reforms, due to the implementation of specific rules and regulations and the changes in payment methods; Second, despite the fact that many regulations have been put into effect, compared to the supervision of the health administration, the payment method plays a significant role in the promotion of service equity; Third, village doctors regard their social reputation as important as their income, for they live in a small community network. Although the role of village doctor has been emphasized in the new reform, improvements in health equity are still not obvious and have had limited effect; Fourth, the function of the village doctor is not fully utilized, even though the coverage of current health insurance in rural areas has been tremendously expanded in the past decade. Accordingly, policy implications regarding the understanding of the work and social environment of village doctors in rural areas, especially on the future exploration of their function related to further reforms, are identified in the final chapter. Additionally, the theoretical and practical significances of this study have also been presented. / published_or_final_version / Social Work and Social Administration / Master / Master of Philosophy

A study was conducted to measure the effects of misanthropic attitudes towards physicians on the avoidance of health care for both treatment and preventive purposes. Demographic and other attitudinal and behavioral variables were also measured. Results indicated that income, age, health status, cancer preventing and detection beliefs and health care misanthropy were all related to subjects' health care avoidance for treatment-oriented purposes. Age, sex, use of blood pressure screening tests, and objective health status were significantly associated with avoidance of health care for preventing purposes. As well, those who rated high on misanthropy measures were more likely to patronize non-traditional health care providers than traditional medical doctors. A discussion of communication theories which may provide some explanation for health care avoidance is also given.