Female GPs Research Articles

How to reveal disguised paternalism

In a Swedish setting physicians are unlikely to give explicitly paternalistic reasons when asked about their attitudes towards patients' involvement in decision-making. There is considerable risk that they will disguise their paternalism by giving 'socially correct answers'. We suggest that disguised paternalism can be revealed with the help of indexes based on certain responses in postal questionnaires. The indexes were developed using material from a study examining attitudes of Swedish physicians to physician-assisted suicide (PAS). Apart from being asked about their attitudes, they were asked to prioritize between different arguments for and against PAS. One argument for PAS was: "PAS should be permitted out of respect for patients' autonomy". One argument against PAS was: "PAS should not be permitted since the non-maleficence principle in this case takes precedence over respecting patients' autonomy". Responses to the latter argument formed the cornerstone of a disguised-paternalism index, while an autonomy index was based on answers to the former argument. Applying our indexes to data from the PAS survey, we found that female GPs, surgeons, and older male physicians were least paternalistic. Among female physicians one finds both the most autonomy-respecting groups (female surgeons and GPs) and the least autonomy-respecting groups (female oncologists and psychiatrists); together with older male physicians in general, female GPs are the group displaying least disguised paternalism. We suggest that questionnaires exploring paternalism might be improved by including case-specific questions or statements by which to explore disguised paternalism. Here our indexes might be useful tools.

Variations in anxiolytic and hypnotic prescribing by GPs: a cross-sectional analysis using data from the UK Quality and Outcomes Framework

Wide variations in anxiolytic and hypnotic prescribing by GPs in England have been described, but are largely unexplained. To examine the relationships between the volume of anxiolytics and hypnotics prescribed by GPs and their practice characteristics, population demography, and performance indicators. Cross-sectional study. All general practices in England. A dataset was constructed for 8469 (98.8%) general practices including: standardised prescribing volume data for anxiolytics and hypnotics (average daily quantities per 1000 STAR-PUs [Specific Therapeutic group Age-sex weightings Related Prescribing Units]), practice descriptors, Index of Multiple Deprivation 2004, ethnicity data (2001 UK Census), and Quality and Outcomes Framework (QOF) data. The standardised volume of anxiolytics and hypnotics prescribed varied eightfold between practices on the 5th and 95th centiles. A regression model was constructed which explained 20.5% of the variation. Higher prescribing practices were located in more deprived areas (standardised beta 0.31), but also in areas with a lower proportion of ethnic minorities (black or black British = -0.22; Asian or Asian British = -0.12). Higher volumes were also prescribed by practices with lower QOF scores ('Clinical Care' domain = -0.12; 'Organisational' domain = -0.08). Other significant but weaker predictors were: lower proportions of female GPs, higher recorded prevalence of serious mental illness and non-training status. The proportion of GPs trained outside UK was not a predictor. Demographic factors were more powerful determinants of prescribing than characteristics of the practice itself. Nevertheless, the findings provide some support for the notion that high prescribing practices were less well developed, in that their QOF scores were lower and they were less likely to be training practices.

Decision Making Concerning the Acquisition and Use of Information and Communication Technology (ICT) in Medical Practices

A number of studies both within medical practices as well as the wider small business sector suggest that gender plays a role in both decision-making and the running of the business. Yet despite these apparent differences, the role of gender in the adoption of ICT in medical practices has remained largely ignored. This paper presents a study of 196 GPs (128 males, 68 females) who have adopted ICT in their practice. The results of this study show that the perception of drivers of ICT adoption and use in medical practices appear to differ depending on the gender of the GP. Where male GPs consider that there are 3 distinct underlying reasons for ICT adoption (medical/ business efficiency, external pressure, enhanced communication), female GPs couple enhanced communication with medical/business efficiency as the single most important driver for ICT adoption.

Factors influencing variation in prescribing of antidepressants by general practices in Scotland

The prescribing of antidepressants has been rising dramatically in developed countries. As part of an investigation into the reasons for the rise and variation in the prescribing of antidepressants, this study aimed to describe, and account for, the variation in an age-sex standardised rate of antidepressant prescribing between general practices. Cross-sectional study involving analyses of routinely available data. A total of 983 Scottish general practices. Age-sex standardised prescribing rates were calculated for each practice. Univariate and multivariate regression analyses were undertaken to examine how the variation in prescribing was related to population, GP, and practice characteristics at individual practice level. There was a 4.6-fold difference between the first and ninth deciles of antidepressant prescribing, standardised for registered patients' age and sex composition. The multivariate model explained 49.4% of the variation. Significantly higher prescribing than expected was associated with more limiting long-term illness (highly correlated with deprivation and the single most influential factor), urban location, and a greater proportion of female GPs in the practices. Significantly lower prescribing than expected was associated with single-handed practices, a higher than average list size, a greater proportion of GP partners born outside the UK, remote rural areas, a higher proportion of patients from minority ethnic groups, a higher mean GP age, and availability of psychology services. None of the quality-of-care indicators investigated was associated with prescribing levels. Almost half of the variation in the prescription of antidepressants can be explained using population, GP, and practice characteristics. Initiatives to reduce the prescribing of antidepressants should consider these factors to avoid denying appropriate treatment to patients in some practices.

General Practice in urban and rural New Zealand: Results of the 2007 RNZCGP membership survey

The provision of primary health care is an integral part of both a country's health system, and of the overall social and economic development of its communities. An adequate general practice and primary health care workforce is a prerequisite to the provision of good primary health care. Countries with stronger primary health care services have better health and much lower health costs. This paper reports the results of the RNZCGP's 2007 annual membership survey and discusses workforce development in urban and rural New Zealand (NZ). In 2007, the RNZCGP sent a survey form to all its financial members as part of the annual subscriptions mail-out to gather data about College members' current working patterns and help construct a longitudinal view of work preferences and hours worked per week. The response rate was 59% (1995 members/participants: 1098 males (55%) and 897 females). More female GPs (86%) worked in urban centres than male GPs (83%). NZ European GPs were overrepresented (67%) in the South Island when compared to their representation within the total population. Numbers of international medical graduates (IMGs) had increased in urban centres since 2005. All regions experienced a decrease in self-employed GPs. Rural GPs spend more hours per week in general practice than urban GPs. The GP workforce is an integral part of the NZ primary health care workforce, and is currently facing many challenges. Stakeholders need to ensure that NZ remains an attractive primary health care environment in order to retain NZ-trained GPs and attract IMGs.

Risk taking in general practice: GP out-of-hours referrals to hospital

Emergency admissions to hospital at night and weekends are distressing for patients and disruptive for hospitals. Many of these admissions result from referrals from GP out-of-hours (OOH) providers. To compare rates of referral to hospital for doctors working OOH before and after the new general medical services contract was introduced in Bristol in 2005; to explore the attitudes of GPs to referral to hospital OOH; and to develop an understanding of the factors that influence GPs when they refer patients to hospital. Cross-sectional comparison of admission rates; postal survey. Three OOH providers in south-west England. Referral rates were compared for 234 GPs working OOH, and questionnaires explored their attitudes to risk. There was no change in referral rates after the change in contract or in the greater than fourfold variation between those with the lowest and highest referral rates found previously. Female GPs made fewer home visits and had a higher referral rate for patients seen at home. One-hundred and fifty GPs responded to the survey. Logistic regression of three combined survey risk items, sex, and place of visit showed that GPs with low 'tolerance of risk' scores were more likely to be high referrers to hospital (P<0.001). GPs' threshold of risk is important for explaining variations in referral to hospital.

Preventing sexually transmissible infections in Australian general practice

The aims of the present study were to explore aspects of sexually transmissible infections (STI) prevention in general practice and to examine general practitioners' (GPs) perceived barriers to sexual-health promotion. The data from a postal survey of 409 GPs practising in New South Wales, Australia (response rate 45.4%) are analysed to explore the prevention of STI in general practice and to examine practitioners' perceived barriers to sexual-health promotion. About 49% of GPs reported having STI leaflets/pamphlets for patients in their clinic, while 21% had posters on STI displayed in their waiting room. Two-third (67%) of GPs provided STI-specific printed materials/leaflets to patients with STI. Female GPs were more likely to be proactive in STI prevention. Time and funding appear to be the major barriers to sexual-health promotion, followed by inadequate access to counselling. One-fifth (22%) of GPs felt that they had little influence in changing patients' risk behaviour, while about 28% emphasized the need for further preventive care training. The present study identifies inconsistencies in STI-prevention activities in general practice along with barriers to undertake sexual-health promotion. This area warrants further attention if GPs are to contribute fully to the control of STI.

Experience of prehospital emergency care among general practitioners in Ireland

Background:Although widely acknowledged, few data exist on the scope of general practice involvement in the management of prehospital emergencies. A study was undertaken to explore the frequency and types of...

Reporting of research data by GPs: a cautionary tale for primary care researchers

Given the importance of community-based research, there is a need to ensure the quality of data obtained from such studies. However, research has been considered a low priority for most GPs. To assess the quality of data reported by GPs in a large community-based study. Men were recruited as part of a population-based study on prostate-specific antigen (PSA) testing. Those with elevated initial PSA levels in the mid-1990s and no investigation in the intervening period were invited for repeat PSA testing. The GP of each included man was contacted and asked to report basic clinical information. Trained data extractors independently reviewed each man's GP medical notes and recorded data relating to prostate problems. Data provided by GPs were rematched with data extracted from medical notes. A total of 758 men with 379 GPs were included. In all, 366 (96.6%) GPs agreed to participate. Of 698 men suitable for follow-up, GP and note review data were available in 505 (72.3%) cases (287 GPs). Overall, 245 (85.4%) GPs provided completely accurate data. Male GPs, compared to female GPs, were found to have a higher level of inaccurate reporting (P = 0.008). We found that when GPs were asked to record basic clinical information, for the purposes of a primary care-based study, there was a significant level of inaccurate reporting. The results from our study confirm the importance of quality control in primary care research, especially in studies that involve GPs' reporting data.

New Zealand rural primary health care workforce in 2005: More than just a doctor shortage

To obtain a 2005 snapshot of New Zealand (NZ) rural primary health care workforce, specifically GPs, general practice nurses and community pharmacists. Postal questionnaires, November 2005. NZ-wide rural general practices and community pharmacies. Rural general practice managers, GPs, nurses, community pharmacy managers and pharmacists. Self-reported data: demographics, country of training, years in practice, business ownership, hours worked including on-call, intention to leave rural practice. General practices: response rate 95% (206/217); 70% GP-owned, practice size ranged from one GP/one nurse to 12 GPs/nine nurses. PHARMACIES: Response rate 90% (147/163). Majority had one (33%) or two (32%) pharmacists; <10% had more than three pharmacists. GPs: response rate 64% (358/559), 71% male, 73% aged >40, 61% full-time, 79% provide on-call, 57% overseas-trained, 78% male and 57% female GPs aged >40; more full-time male GPs (76%) than female (37%) . Nurses: response rate 65% (445/685), 97% female, 72% aged >40, 31% full-time, 28% provide on-call, 84% NZ-trained, 45% consulted independently in 'nurse-clinics' within practice setting. Pharmacists: response rate 96% (248/258), 52% male, 66% aged >40, 71% full-time, 33% provide on-call, 92% NZ-trained, 55% sole/partner pharmacy owners. Many intend to leave NZ rural practice within 5 years: GPs (34%), nurses (25%) and pharmacists (47%). This is the first NZ-wide rural workforce survey to include a range of rural primary health care providers (GPs, nurses and pharmacists). Ageing rural primary health care workforce and intentions to leave herald worsening workforce shortages.

Active listening in medical consultations: Development of the Active Listening Observation Scale (ALOS-global)

Objective Active listening is a prerequisite for a successful healthcare encounter, bearing potential therapeutic value especially in clinical situations that require no specific medical intervention. Although generally acknowledged as such, active listening has not been studied in depth. This paper describes the development of the Active Listening Observation Scale (ALOS-global), an observation instrument measuring active listening and its validation in a sample of general practice consultations for minor ailments. Methods Five hundred and twenty-four videotaped general practice consultations involving minor ailments were observed with the ALOS-global. Hypotheses were tested to determine validity, incorporating patients’ perception of GPs’ affective performance, GPs’ verbal attention, patients’ self-reported anxiety level and gender differences. Results The final 7-item ALOS-global had acceptable inter- and intra-observer agreement. Factor analysis revealed one homogeneous dimension. The scalescore was positively related to verbal attention measured by RIAS, to patients’ perception of GPs’ performance and to their pre-visit anxiety level. Female GPs received higher active listening scores. Conclusion The results of this study are promising concerning the psychometric properties of the ALOS-global. More research is needed to confirm these preliminary findings. Practice implications After establishing how active listening differentiates between health professionals, the ALOS-global may become a valuable tool in feedback and training aimed at increasing listening skills.

Gender shift in realisation of preferred type of gp practice: longitudinal survey over the last 25 years

BackgroundAn increasing number of newly trained Dutch GPs prefer to work in a group practice and as a non-principal rather than in a single-handed practice. In view of the greater number of female doctors, changing practice preferences, and discussions on future workforce problems, the question is whether male and female GPs were able to realise their initial preferences in the past and will be able to do so in the future.MethodsWe have conducted longitudinal cohort study of all GPs in the Netherlands seeking a practice between 1980 and 2004. The Netherlands Institute of Health Services Research (NIVEL) in Utrecht collected the data used in this study by means of a postal questionnaire. The overall mean response rate was 94%.ResultsOver the past 20 years, an increasing proportion of GPs, both male and female, were able to achieve their preference for working in a group practice and/or in a non-principal position. Relatively more women than men have settled in group practices, and more men than women in single-handed practices; however, the practice preference of men and women is beginning to converge. Dropout was highest among the GPs without any specific practice preference.ConclusionThe overwhelming preference of male and female GPs for working in group practices is apparently being met by the number of positions (principal or non-principal) available in group practices. The preference of male and female GPs regarding the type of practice and job conditions is expected to converge further in the near future.

Gold Coast general practitioners’ recommendations of health websites to their patients

To identify trends associated with health website recommendations by selected general practitioners to their patients. Quantitative data collection using a prepaid postal survey, consisting of 17 questions, mailed to 250 of 410 GPs (61%) on the Gold Coast, Queensland. The survey was conducted between 9 October and 11 December 2006. GPs' website recommendations to patients; associated GP demographic variables (age, sex and years of practice). 59% (64/108) of participating GPs recommend health websites to their patients during consultations. Male GPs (63%, 45/72), those aged 41-50 years (55%, 35/64), and those practising for < 10 years (60%, 12/20) are more inclined to recommend a health website to a patient. The majority of GPs (69%, 44/64) reported that they most often recommended websites to patients 26-45 years old. 53% of GPs (34/64) recommended websites to 1%-20% of their male patients, while 47% (30/64) recommended websites to 21%-40% of their female patients. A greater proportion of participating female GPs (47%, 17/36) do not recommend health websites, compared with male GPs (38%, 27/72). More than half the surveyed GPs actively recommend websites to their patients, with a GP's sex, age and years of experience influencing his or her recommendation decisions. Web-based continuing medical education courses or programs in medical schools may help doctors develop the skills necessary for the delivery of effective e-health care.

Education, training and support needs of Australian trained doctors and international medical graduates in rural Australia: a case of special needs?

Little attention has been paid to issues relating to the education, training and support needs of Australian medical graduates and international medical graduates (IMGs) in rural practices. The focus continues to be on recruiting to rural areas. The aim of this article was to document the education, training and support needs of rural GPs. Cross-sectional surveys were made of rural GPs working in rural north-west New South Wales, Australia. The main outcome measures were the key factors influencing rural GPs to stay in rural practice. Australian medical graduates and IMGs largely agree on key education, training and professional support needs. Continuing professional development, training opportunities, professional support and networking, as well as financial support are the doctors' shared top priority issues. Rural GPs satisfied with their current medical practice, intend to remain in rural practice for 40% longer than those who are not satisfied (11.5 years compared with 8.2 years). Rural GPs contented with their life as a rural doctor intend to remain in rural practice for 51% longer than those who are discontented (11.8 years compared with 7.8 years). While there is merit in delivering specially designed initiatives to target groups, such as male or female GPs, registrars or GPs, our results support the notion that IMGs should not so much be considered to have special needs, but rather an integral part of the region's medical workforce.

General practitioners' knowledge and practice of complementary/alternative medicine and its relationship with life-styles: a population-based survey in Italy

BackgroundThe growing popularity of CAM among the public is coupled with an ongoing debate on its effectiveness, safety, and its implications on the reimbursement system. This issue is critically important for GPs, who have a "gatekeeping" role with respect to health care expenditure. GPs must be aware of medications' uses, limitations and possible adverse effects. Our objective was to explore GPs' knowledge of CAM and patterns of recommendation and practice, as well as the relationship between such patterns and GPs' life-styles.MethodsA cross-sectional study was conducted in Tuscany, a region of central Italy. One hundred percent female GPs (498) and a 60% random sample of male GPs (1310) practising in the region were contacted through a self-administered postal questionnaire followed by a postal reminder and telephone interview.ResultsOverall response rate was 82.1%. Most respondents (58%) recommended CAM but a far smaller fraction (13%) practised it; yet 36% of CAM practitioners had no certificated training. Being female, younger age, practising in larger communities, having had some training in CAM as well as following a vegetarian or macrobiotic diet and doing physical activity were independent predictors of CAM recommendation and practice. However, 42% of GPs did not recommend CAM to patients mostly because of the insufficient evidence of its effectiveness.ConclusionCAM knowledge among GPs is not as widespread as the public demand seems to require, and the scarce evidence of CAM effectiveness hinders its professional use among a considerable number of GPs. Sound research on CAM effectiveness is needed to guide physicians' behaviour, to safeguard patients' safety, and to assist policy-makers in planning regulations for CAM usage.

Fewer medical graduates are choosing general practice: a comparison of four cohorts, 1980–1995

To compare general practice career choices of four cohorts of medical graduates. Retrospective longitudinal study of medical graduates. Data on employment since graduation, nature of current employment, and postgraduate qualifications were collected by postal survey in 2003. Four cohorts of Monash University Medical School graduates who completed their degrees in 1980, 1985, 1990 and 1995 (n = 386). Proportion of each cohort pursuing a general practice career. At 8 years after graduation, half of the graduates in the 1980 and 1985 cohorts were working in general practice, compared with 38% of 1990 graduates and 33% of 1995 graduates. Differences were mainly attributable to fewer female graduates working as GPs: female GPs comprised 62% of the 1980 cohort compared with 31% of the 1995 cohort. Graduates in more recent cohorts also entered the general practice workforce at a later stage than those in earlier cohorts. A rapidly declining proportion of new graduates from Monash University Medical School, particularly female graduates, are choosing general practice as a career. This will exacerbate future shortages in the general practice workforce.

The response of general practitioners to the threat of violence in their practices: results from a qualitative study

Violence directed towards GPs has been recognized as a significant problem in the UK. In Australian urban general practice, no study has previously examined this topic. The objective of this study was to investigate the responses of Australian urban GPs to experiences of violence and to perceptions of risk of violence. A qualitative study of data collected from two sources-focus group discussions and qualitative questionnaire responses. Focus group discussions were audiotaped and transcribed. Questionnaires offered the opportunity for respondents to make qualitative comments. The focus group transcripts and qualitative questionnaire responses were coded independently by members of the research team and subjected to thematic analysis. Three urban Divisions of General Practice in New South Wales, Australia. Focus groups were conducted with male and female GPs comprising a range of ages, socio-economic practice catchments and practice structures. Questionnaires were distributed to all GPs in the three divisions. The GPs in this study perceived themselves as being at significant risk of occupational violence. Despite responses to violence being largely ad hoc and uncoordinated, a coherent schema of GPs' responses to the threat of violence is apparent in the data. This has been characterized as encompassing primary, secondary and tertiary responses, and reflects a continuum of proactive to reactive responses. The findings will have implications for further research and for policy in the area.

Experiences of occupational violence in Australian urban general practice: a cross‐sectional study of GPs

To establish the prevalence and characteristics of occupational violence in Australian urban general practice, and examine practitioner correlates of violence. Cross-sectional questionnaire survey mailed to all members (n = 1085) of three urban divisions of general practice in New South Wales in August and September 2004. The three divisions were chosen to provide a range of socioeconomic status (SES) demographics. Occupational violence towards general practitioners during the previous 12 months. 528 GPs returned questionnaires (49% response rate). Of these, 63.7% had experienced violence in the previous year. The most common forms of violence were "low level" violence - verbal abuse (42.1%), property damage/theft (28.6%) and threats (23.1%). A smaller proportion of GPs had experienced "high level" violence, such as sexual harassment (9.3%) and physical abuse (2.7%). On univariate analysis, violence was significantly more likely towards female GPs (P < 0.001), less experienced GPs (P = 0.003) and GPs working in a lower SES status area (P < 0.001), and among practice populations encompassing greater social disadvantage (P = 0.006), mental health problems (P < 0.001), and drug- and alcohol-related problems (P < 0.001). Experience of violence was greater for younger GPs (P = 0.005) and those providing after-hours care (P = 0.033 for after-hours home visits). On multivariate analysis, a significant association persisted between high level violence and lower SES area (odds ratio [OR], 2.86), being female (OR, 5.87), having practice populations with more drug-related problems (OR, 5.77), and providing home visits during business hours (OR, 4.76). More experienced GPs encountered less violence (OR, 0.77) for every additional 5 years of practice. Occupational violence is a considerable problem in Australian urban general practice. Formal education programs in preventing and managing violence would be appropriate for GPs and doctors-in-training.

‘Heroes And Fairy Wrens’: The Changing Face Of Rural General Practice

Increasing numbers of women are entering the medical workforce in western industrialised countries. Many are calling for reform in the workplace by demanding more flexible hours to better balance the demands of work and home. This is particularly relevant in rural locations where limited childcare services are available. Ethnographic research in Western Australia with rural general practitioners examines whether greater numbers of female GPs entering medicine, and their demands for more flexibility in working hours, are altering traditional values and work practice in a rural setting.

Gender-related differences in general practice preferences: longitudinal evidence from the Netherlands 1982–2001

The proportion of female doctors is increasing. Yet, there is little evidence that demonstrates changing career preferences over a long period, nor do we know the long-term impact of changing male-female ratios in medicine. We explored this within the GP profession. By means of a longitudinal cohort study (postal questionnaires) among all graduated GPs in the Netherlands between 1982 and 2001 we explored trends in career preferences and investigated whether practice preferences of men and women differ over the years. Preference of becoming a GP has significantly decreased among men. GPs prefer group practice more than solo practice. Female doctors were more likely to prefer a small practice and to associate. Men prefer to take over an established practice. Main reasons to abstain from practicing as a GP for men were having found another job or not having found a practice according to their preferences. Main reasons for women were having decided for another job and family life. We conclude that male and female GPs select differently on practice setting. Preferences change through the years but tend to converge. Gender differences are likely due to the circumstance that career choices for men are more influenced by fluctuating labour markets, while female choices are more based on family circumstances. We expect that as more women will become a GP the demand for small group practices will increase. Also, as many female GPs abstain from practicing after having finished a vocational GP training program it will be essential to create work facilities to keep them available for the GP labour market.