Good Physician Research Articles

A Little Hurts a Lot: Exploring the Impact of Microaggressions in Pediatric Medical Education.

> You have such a difficult name. > You speak English so well! > Do you really eat bats? When Faiza, an adolescent patient, is told by her doctor that her name is difficult to pronounce, she hears, “You are different, and you don’t belong.” When a patient tells Christopher, a resident, that he speaks English really well, he wonders what assumptions they have made regarding his ability to be a good physician. When Kimberly, a medical student of Chinese heritage, is asked by her patient if she eats “strange foods” during the current coronavirus disease 2019 pandemic, she feels the sting of heightened xenophobia. Although possibly seeming benign, these incidents are the definition of microaggressions, like “death by a thousand cuts.” Microaggressions, as suggested by the prefix, are not overt or grandiose displays of discrimination.1 They are inherently nuanced discriminatory remarks or behaviors stemming from unconscious bias, often unintentional on the part of the aggressor. Although we focus on racist microaggressions in this article, many groups may experience them, including differently abled individuals, sexual and gender minorities, and religious minorities.2 The subtle … Address correspondence to Shazeen Suleman, MSc, MD, MPH, FRCPC, Women and Children’s Health, Unity Health Toronto, St. Michael’s Hospital, 30 Bond St, 15 Cardinal Carter - Room 014, Toronto, ON, Canada M5B 1W8. E-mail: shazeen.suleman{at}unityhealth.to

Impact of the Price of Gifts From Patients on Physicians' Service Quality in Online Consultations: Empirical Study Based on Social Exchange Theory.

BackgroundGift giving from patients to physicians, which is prohibited in traditional clinical settings in China, has been found to occur in online health communities. However, there is debate on the validity of online gifts since physicians gain an economic benefit. Moreover, the potential impact of these gifts, particularly with respect to the financial value of the gift, on the online consultation service quality remains unexplored.ObjectiveThe aim of this study was to explore the impact of gift price on the quality of physicians’ online consultation service. Insight into this impact is expected to help resolve existing debate on the appropriateness of the gift-giving practice in online consultations.MethodsA dataset of 141 physicians and 4249 physician-patient interactions was collected from the Good Physician Online website, which is the largest online consultation platform in China. Based on social exchange theory, we investigated how gift price affects the quality of physicians’ online consultation service and how this impact changes according to the physician’s service price and number of all gifts received. Manual annotation was used to identify the information support paragraphs and emotional support paragraphs in the answers of physicians. The quality of the information support paragraphs, rather than the complete answer, was used to test the robustness of our model.ResultsGift price had a positive impact on the quality of physicians’ online consultation service (β=4.941, P<.01). This impact was negatively mediated by both the physician’s service price (β=–9.245, P<.001) and the total number of gifts they received (β=–5.080, P<.001).ConclusionsGift price has a positive impact on physicians’ online behavior, although the impact varies among physicians.

Patients’ expectations with regard to the quality of orthopedic medical care

Objective: To assess, through the Surgical and Medical Experience Questionnaire translated and adapted into Portuguese, the opinions and expectations of patients with regard to the treatment protocols and medical training of the foot and ankle orthopedic specialist. Methods: This cross-sectional observational study assessed, through the application of a questionnaire, the opinions and expectations of patients with regard to orthopedic protocols adopted by the foot and ankle specialist. Results: One hundred and thirty patients were selected. Among the participants, 33.8% were male and 66.2% female. The predominant characteristics of a good physician were good outcomes, according to 31% of the participants, followed by quality of care according to 28.6%, and qualities of a good surgeon, chosen by 27.6%. Approximately 89% of patients do not conduct any research on their physician. Correlation was found between the study level and the choice of physician. Conclusion: The demand for physicians with highly specialized skills has increased over the years. It is evident that in the case of better educated patients, a physician’s resume is much more important, unlike less educated patients. It is possible to observe that, for patients, there are still multiple barriers and variables. Level of Evidence V, Therapeutic Study; Expert Opinion.

Pitfalls of judgment during the COVID-19 pandemic

Pitfalls of judgment during the COVID-19 pandemic

Working on Health Optimization: A Major Goal for Health Maintenance

Some years ago – let’s say, for sure, some decades ago – a “good physician” was considered the one who would request a few laboratory tests to some patient and they would come out all altered. – Yes – one would say – he got it right to the point, disease concerning. However, in the 21st century, when we have moved the focus of preventive care from prevention of diseases to health maintenance, we believe that the “good physician” may be considered the one that aims at keeping all the test results basically normal. Actually, more than that: optimal. In fact, keeping the eyes on optimal test results is a major goal for Age Management practitioners. For that, even if we still have the established reference ranges, we’ve got to have our own interpretation of the tests we are used to from a different, more detailed standpoint than in the general practice. Some normal results must be seen as subnormal, which are, indeed, still different from abnormal. Some results may also be considered critical – that is, those ones which demand some urgent and immediate action.

Good Physician Adherence to Guideline-Directed Medical Therapy Associated with Lower Patient Mortality and Hospitalisation Rates Across The World

While the guidelines for the managements of heart diseases have been well-developed and updated periodically, they do not guarantee to reduce the number of heart disease morbidity and mortality. Since the holistic approach is not carefully applied, this morbidity rate may not be significantly reduced. The holistic approach to managing heart disease has broad aspects, but the most important aspect is regarding physician adherence to Guideline-Directed Medical Therapy (GDMT). This paper aimed to discuss the physician adherence to GDMT, and its role in reducing morbidity and in-hospitalization in heart disease patients. Several large scale studies have revealed that good adherence to heart failure treatment guidelines among physicians improved not only quality of life but also resulted in a better prognosis. On other hands, because the main target of physicians adherence to GDMT is to achieve maximally tolerated dose, it is also important that the understanding when and how to add, switch, and titrate all therapies to maximally tolerated doses and ideally target doses is important to reduce the morbidity and mortality of heart disease patients. However, in some points, this principle might not be applied properly due to several limitations. In this case, physicians may have to consider the balance between patients preferences, healthcare resources, and the risk of adverse outcomes. In conclusion, it should be noted that physician adherence to GDMT has an important role to reduce morbidity and mortality of heart disease patients.

Two multinational, observational surveys investigating perceptions of beauty and attitudes and experiences relating to aesthetic medical procedures.

BackgroundData on opinions and experiences of aesthetic medical procedures outside the United States and Western Europe are scarce.AimsThis study aimed to survey users and non‐users of aesthetic procedures in countries where this information is less readily available, to understand attitudes and perceptions relating to beauty.Patients/MethodsTwo independent internet‐based observational surveys were conducted. Survey 1: individuals from Colombia, Lebanon, Malaysia, Russia and Turkey who were ‘users’ or ‘non‐users’ of aesthetic medical procedures. Survey 2: individuals from Colombia, Russia, Thailand, Turkey and the United Arab Emirates who were ‘users’ of non‐surgical aesthetic treatments.ResultsSurveys 1 and 2 were completed by 300 and 160 individuals, respectively, most of whom were female (94.0% and 99%). Overall, respondents rated the eyes and smile as the most pleasing male and female facial features. Most participants (mean 82.6%; range 75%‐100%) believed maintaining a healthy lifestyle was important for ageing gracefully, and over one‐third (36.0%; 28%‐47%) believed men age more gracefully than women. The emphasis respondents placed on the importance of physical attributes vs inner feelings, internal beauty and self‐confidence varied between countries. Users were often more positive about aesthetic medical procedure outcomes than non‐users. Adequate information, good physician communication (including managing treatment expectations), treatment recommendations based on patient need and good aftercare improved treatment satisfaction.ConclusionsThe eyes and smile were key features of attractiveness, but maintaining a healthy lifestyle was consistently considered an important factor for ageing gracefully. Ensuring patients are well informed was a major determinant of treatment satisfaction.

Quality Management in Otolaryngology - An Assessment of the Current Situation - On Current View, how is the State of Quality Standards in German Hospitals and Practices, esp. in Otolaryngology? An Appraisal with.

To deal with medical malpractice, apart from sanctions an ethical code has been developed since ancient times which shapes our present expectation of a good physician. A century ago, industrialization and standardization initiated medical quality management in the USA. In the 1950s, the Japanese concept of total quality management arose, winning huge influence also in medicine. Every recent system of certification or accreditation originates from these roots.In the last 15 years in Germany, minimum standards in health care have been enforced by law with increasing sophistication. Additionally, self-governed institutions of physicians have been clearly contributing to the quality of care.Quality management has become an integral part of the German healthcare system, most notably in risk management and patient orientation. There are also a multitude of voluntary physician-driven initiatives to improve the quality of care, among others the guidelines of the medical societies.A survey was conducted by the author to evaluate the implementation of quality management in otolaryngological departments and practices. The degree of implementation was predominately higher than for the national peers.Currently there are substantial challenges to the health care system which impact the quality of care. Lack of funding, shortage of qualified staff, societal changes and effects of rapid scientific progress are a few to name.To achieve a broad implementation of quality management in the future, wise political decisions and proper funding are crucial - the concept as such has long been accepted.

Nietzsche's The Gay Science: An Introduction by Michael Ure

Reviewed by: Nietzsche's The Gay Science: An Introductionby Michael Ure Jordan Rodgers Michael Ure. Nietzsche's The Gay Science: An Introduction. Cambridge Introductions to Key Philosophical Texts. Cambridge: Cambridge University Press, 2019. Pp. viii + 273. Paper, $28.99. The works of Nietzsche's middle period tend to be neglected by Nietzsche scholars. Already, Michael Ure's first book, Nietzsche's Therapy(Lexington Books, 2008) was a welcome exception, and he continues his exploration in this new book, a study of the work Nietzsche called his most personal, The Gay Science(hereafter, GS). Nietzsche is right to call GSpersonal, and Ure is right to emphasize it. Its preface explains that Nietzsche wrote the text while recovering from long illness, and many of the first edition's 342 aphorisms allude to his personal experiences. Calling it a "philosophical autobiography" (1), as Ure does, is perhaps an overstatement. Nietzsche wrote one of those— Ecce Homo—and wild as that book is, it did at least attempt to narrate Nietzsche's life and works, which cannot be said of GS. "Self-portrait," another of Ure's metaphors for GS(163), is better, especially since successful self-portraits can be selective and impressionistic, even formless. Though personal experience clearly informs GSdeeply, its form is indeed difficult to discern. Ure tackles that problem by proposing two big interpretive strategies: first, that Nietzsche is a proponent of a metaphilosophical claim, familiar from the Stoics and Epicureans, that philosophy is an "art of living" (8); second, that Nietzsche puts distinctive emphasis on that word "art»it refers not just to techniques, but to an aesthetic account of the overall goal of the process. That goal, to appeal to one of GS's most famous aphorisms, is to "'give style' to one's character" ( GS290). GS's "fundamental significance for modern philosophy and culture lies in its claim that the consequences of the death of God extend into the very fabric of our lives" (21). Thus, Nietzsche's goal in the book, on Ure's reading, is to diagnose like a good physician what ails late modernity, and what techniques of life are to be prescribed in response. Like the Hellenistic philosophers, he conceives of himself as a kind of physician, and like them his aim is the health and flourishing of his subjects. But Nietzsche's prescription is different: he rejects the Hellenistic ideal of passionless ataraxiaand avoidance of suffering, placing in its stead an "ethics of self-cultivation" (154) that involves the embrace of passion and suffering as necessary parts of a flourishing life. More obviously, he rejects their universalism: "if Stoics are necessarily uniform and unvaried, Nietzscheans must be irregular and varied" (200). That is because the goal of the process is not conformity to some set of rules, but appreciation and development of one's own singular self. The thought of eternal recurrence, put forward first in GS341, is meant to help this process along, because "only a life that bears the monogram of our own existence… is worthy of repetition" (198). Ure conceives of this thought in terms of the Hadotian conception of "spiritual exercises": it is not a doctrine, but a practice in directed meditation. Just as Epictetus invites you, with regard to every impression, to ask whether it is under your control or not, Nietzsche invites you to ask whether your life thus far is one whose eternal recurrence would be desirable. I am skeptical of how much the analogy with the Hellenistic philosophers helps. GSclearly aims to be a call to action, but, as Ure himself notes, what Nietzsche gives us is "a [End Page 624]series of notes sketching his personal wishes, habits and quirks" (163). Not only that, but he seems not to be a realist about the flourishing that is apparently the goal of his ethics of self-cultivation (see GS301). And so one naturally wonders what the success conditions are, and what value the goal is supposed to possess. Ure says that the success of the process lies "in creating a life that we wish to repeat eternally" (202), but that "we" is just each individual "I," whose...

Virtuous Physician: Indonesian Perspective

Physicians are virtuous profession because they deal with life and death and especially with vulnerable persons. It is a humanity profession. To be good physicians need to have high standard of compassion and care (virtue). Medical virtues have to be taught in the faculty of medicine so that the alumni have virtuous character. In their lives as physician, there are many regulations to maintain the application of virtue in their services. Unfortunately, now the erosion of virtues becomes more apparent. Some physicians are more profit-oriented rather than humanity-oriented.

Designing bowel preparation patient instructions to improve colon cancer detection

Abstract Medical personnel usually write and design documents that inform physicians or patients about procedures or therapies. Document design, however, requires skills that are not normally applied, resulting in information that is often not used properly. This article describes a project developed by the Alberta Colorectal Cancer Screening Program. The goal was to help patients better prepare for their colonoscopies. The process started with an analysis of the existing documents, and the development of performance specifications based on the literature on legibility, reading comprehension, memorization and use of information, plain language, visual perception, page layout, and image use. The project included an iterative process of prototyping and testing that resulted in 23 design criteria. Each iteration was tested with users to ensure ease of use, completeness of information, and accuracy and clarity to facilitate adoption. The project helped reduce practice variation regarding bowel preparation in the province of Alberta, Canada. This project illustrates how information design can help healthcare organizations provide patient-centred care. Information design helps patients engage in their own caring process, by providing information that people can use, understand and apply. After 15 months of use, the document has been downloaded more than 48,000 times, suggesting a good physician reception.

A Successful Strategy against the Expected Shortage of Physicians in Rural Areas

The expected shortage of physicians in rural areas of Germany calls for strategies to prevent an under-supply of care for patients living in such areas. The innovative care project "Good Physicians are needed for the Countryside" is a multi-modal concept comprising 29 components implemented in an economically deprived area, aiming to attract young physicians to work in rural areas on a long-term basis. 5 physicians in training were hired during the project phase, and a further 3 after the project had ended. 2 of these now own and run one of the cooperating practices. Project components facilitating learning across generations was considered especially important;13 of 29 project components (45%) were judged to be very important by participants. It is possible to motivate medical doctors and their families to work in the countryside by providing targeted individual professional and personal counselling, which requires limited organizational capacity but considerable commitment of staff time.

QOLP-14. CAREGIVER PERCEPTIONS OF END OF LIFE CARE IN PATIENTS WITH HIGH GRADE GLIOMA

Abstract INTRODUCTION Patients dying from high-grade gliomas (HGG) often suffer from a high symptom burden in the end-of-life (EoL) phase. Since patients with HGG typically do not follow up with providers in the EoL phase, information about quality of life and symptom management is sparse. Family caregivers are most informed about the patient’s symptoms and disease course. The aim of this study is to assess the quality of EoL care of HGG patients from the caregiver perspective. METHODS Caregivers participated in the Toolkit After-Death Bereaved Family Member Interview (TIME survey). This validated survey assesses EoL care by calculating “domain scores” (DS) in five different areas: 1) physical comfort and emotional support, 2) advance care planning, 3) focus on the individual, 4) attention to family, and 5) coordination of care. Caregivers also rated aspects of care using a 10 point Likert scale. RESULTS In a prospective study, 40 of 55 enrolled family caregivers completed the interview a median of 26 days after death. 68% of caregivers were female. DS indicate the quality of care. (0 = no opportunity to improve care, 1 = care was always sub-optimal). Caregivers perceived high satisfaction with information and decision-making (0.18), advance care planning (0.19), focus on the individual (0.16) and coordination of care (0.11). Attention to family (0.25) was not as well rated. Caregivers rated the overall care 8.90 ±1.36/10 on a 0–10 scale. CONCLUSIONS Caregivers reported a high overall satisfaction with EoL care provided, though attention to family could be improved. While previous research suggests the importance of good physician communication in allowing patients to die with dignity, more focus should be on the caregiver in the EoL phase to improve end of life care, caregiver burnout and bereavement.

Why Won't My Patient Act Like a Jerk?

I'm avoiding Mr. G's room. I shouldn't have read the emergency room notes from the other hospital, where this middle-aged man raised a stink about the wait. What type of person calls the triage nurse a bitch? From the timestamps on the electronic medical record notes, he stormed from that ER and drove his abdominal pain, vomiting, diarrhea, and discontent directly across town to us. I'm reminded of this oft-quoted aphorism from Sir William Osler: "The good physician treats the disease; the great physician treats the patient who has the disease." It's cited by medical educators as an invocation to never forget the humanistic heart at the center of clinical care. But what if the patient is a jerk? That I haven't met Mr. G, only read briefly about him, doesn't stop these ugly feelings from surfacing.

A Doctor and a Scholar

Too often critics ignore the philosophic significance of Eryximachus, the physician from Plato’s Symposium, and mistakenly dismiss Eryximachus’ presence in the text. However, this paper argues that a review of the role of medicine in the Platonic dialogues, coupled with a close reading of the Symposium’s structure and language reveals how the physician’s emphasis on love as a harmonizing force is analogous to Socrates’ emphasis on balance and harmony throughout the dialogues. Also, the description of the good physician is reflective of the way a good philosopher operates. By employing the medical trope, Eryximachus’ speech allows the reader greater insight into Platonic philosophy.

Specialty and Lifestyle Preference Changes during Medical School

Medical student specialty choices have significant downstream effects on the availability of physicians and, ultimately, the effectiveness of health systems. This study investigated how medical student specialty preferences change over time in relation to their demographics and lifestyle preferences. Students from ten medical schools were surveyed at matriculation (2012) and graduation (2016). The two surveys included questions about specialty and lifestyle preferences, demographics, educational background, and indebtedness. Student data from 2012 to 2016 were paired together and grouped into those whose specialty preferences remained constant or switched. Response rates in 2012 and 2016 were 65% (997/1530) and 50% (788/1575), respectively. Fourth-year students ranked "enjoying the type of work I am doing" as less important to a good physician lifestyle than did first-year students (from 59.6 to 39.7%). The lifestyle factors "having control of work schedule" and "having enough time off work" were ranked as more important to fourth-year students than first-year students (from 15.6 to 18.2% and 14.8 to 31.9%, respectively). The paired dataset included 19% of eligible students (237/1226). Demographic and lifestyle factors were not significantly associated with specialty preference switching. Additionally, no significant association existed between changing lifestyle preferences and switching specialty preference (p =0.85). During the course of medical school, lifestyle preferences became more focused on day-to-day factors and less on deeper motivational factors. Neither demographics nor lifestyle preferences appear to relate to a student's decision to switch specialty preference during medical school. These findings represent an important step in uncovering causes of specialty preference trends.

Recent Advances and Changing Face of Anatomy Teaching and Learning in Medical Education

Abstract Background A sound knowledge of human anatomy is a major requirement for being a good physician or a practicing surgeon. Despite digitalization and modernization of education sector, traditional cadaveric dissection still occupies the leadership of anatomy education. It is becoming an untold truth that no modern technologies such as virtual dissection or 3D model printing could replace cadaveric dissection in its way of teaching students. Methods Recent research studies on modern anatomical teaching methods for medical and non-medical students and their influences are reviewed. Results Despite new technologies, traditional cadaveric dissection helps students to acquire more practical knowledge and still occupies prior position on its way.

Bleary Image.

Pastel and oil paint on wood are used to investigate the importance and challenge of self-preservation during processes of medical training and professionalization. This image considers whether, why, and how self-sacrifice is necessary to become a good physician and investigates this set of themes from ethical and aesthetic perspectives.

The experience of spousal caregivers of patients recently diagnosed with cancer in Taiwan

BackgroundMost qualitative studies on caregivers of cancer patients have explored the experiences of family members and friends in Western or European countries. Little is known about the experience of spousal caregivers of patients recently diagnosed with cancer in a Chinese population. AimThe aim of this study was to explore the lived experience of spouses of patients recently diagnosed with cancer in Taiwan. MethodsThis qualitative study analysed focus groups interview data using thematic analysis. Participants were purposively sampled from a medical hospital in central Taiwan. Four focus group interviews were conducted; 15 spousal caregivers participated. FindingsResearch findings from the spouses, seven husbands and eight wives, included four main themes: handling emotions to make decisions quickly, experiencing meaningful support from a right and good physician, struggling with changes in daily life, and placing a peaceful mindset at the centre of life. DiscussionChinese collectivistic culture expects family members to make medical decisions and filter information a patient receives. Spousal caregivers informed patients about their cancer in order to avoid or reduce the amount of psychological harm. Spouses’ strong commitments to caregiving provided them with power and motivation to continue caregiving. A peaceful mindset, influenced by the traditional Chinese philosophy of Buddhism, was considered critical for prolonging the patient’s life and maintaining the caregiver’s emotional health. ConclusionsIt is important for healthcare professionals to understand Chinese cultural influences and concerns of spousal caregivers when caring for Chinese patients to manage patients and caregivers effectively.

The Perceptions of Patients and Their Families About a Good Physician: A Qualitative Content Analysis

The Perceptions of Patients and Their Families About a Good Physician: A Qualitative Content Analysis