Individual Doctors Research Articles

Medical futility at the end of life: the first qualitative study of ethical decision-making methods among Turkish doctors

BackgroundThe swift advancement of intensive care medicine, coupled with technological possibilities, has prompted numerous ethical inquiries regarding decision-making processes concerning the withholding or withdrawal of treatment due to medical futility. This study seeks to delineate the decision-making approaches employed by intensive care physicians in Türkiye when faced with medical futility at the end of life, along with an ethical evaluation of these practices.MethodsGrounded theory, a qualitative analysis method was employed, conducting semi-structured, in-depth interviews with eleven intensive care physicians in Türkiye. The subsequent text analysis was carried out using MAXQDA software.ResultsParticipants assert that the decisions made by Turkish physicians determine whether treatment is futile, rely on medical consensus, and lack a standardized decision-making process. The decisions are influenced by legal and social pressures, resource constraints, and occasional conflicts of interest. The significance of professional hierarchy is notable, with limited consideration given to the opinions of nurses and other staff. The unstructured medical consensus processes are shaped by normative concepts such as benefit, age, justice, and conscience. Furthermore, it was observed that the conscientious opinions of physicians carry more weight than adherence to ethical principles and guidelines.ConclusionTo create optimal conditions for doctors to make ethically justifiable decisions, the dynamics within the treatment team should be improved, emphasizing the minimization of hierarchy, and ensuring the active participation of all team members in the decision-making process. Additionally, efforts should be directed toward narrowing the gap between the conscience of the individual doctor and established ethical principles. A potential solution lies in the nationwide implementation of clinical ethics committees and the establishing of clinical ethics guidelines, aiming to address, and overcome the identified challenges.

A Moderated Mediation Model on the Relationship Among Public Service Motivation (PSM), Self-Efficacy, Job Satisfaction, and Readiness for Change

Despite the pivotal role of employees in relation to organizational change, few studies have proposed an integrated influence mechanism that accounts for employee change readiness. By combining public service motivation (PSM), person–organization (P–O) fit, and expectancy–disconfirmation theories (EDT), we developed a moderated mediation model to explore individual-level impacts on organizational change. Based on questionnaire data collected from 512 doctors working in public hospitals in China, we found that individual doctors’ PSM positively contributed to their readiness for change but was moderated by self-efficacy and job satisfaction. Specifically, doctors with decreased job satisfaction resulting from realizing their limited capacity to influence policies from higher-ups tend to show a lack of willingness to actively prepare for change. In sum, this study not only contributes to a micro-level understanding of employees’ readiness for change but also proposes feasible suggestions to enable smoother and more successful organizational changes in public sector organizations. The research findings illuminate the crucial role that individual-level dynamics play in organizational change for scholars and practitioners.

Examination of cases in which senility was determined to be the cause of death in community medicine

In community medicine, there are many opportunities in which senility is noted as the cause of death. However, there are no clear criteria for diagnosing senility, and this decision is often left to the judgment of individual doctors. This study investigated the clinical characteristics of patients diagnosed with senility at our hospital. The subjects included 43 patients whose cause of death was listed as senility from among the death certificates of 282 patients prepared at our hospital. The survey items included age, sex, medical history, place of death, period from the day of explanation of the condition of senility to the date of death, BMI at the time of explanation, and blood sampling test. The mean age of patients who died due to senility was 92.2±6.5 years old. The male to female ratio was 15: 28. The most common medical history was dementia (76.7%), followed by hypertension and orthopedic disease (74.4%), respiratory disease (66.7%), and heart disease and gastrointestinal disease (60.5%). The places of death were nursing homes and private homes, and hospitals. The overall average time from presentation until death occurred was 110.2 days. There were also considerable differences depending on the case. The average BMI was 19.7±3.0, and the blood sampling results showed that total protein and serum albumin levels were lower than the reference values. Although the diagnosis of senility is vague and unclear, it is important to explain such a diagnosis to the family at an appropriate time and to cooperate with multiple professionals in the treatment process.

Rethinking continuity in primary care for people with mesothelioma.

Mesothelioma is a terminal disease that is linked to asbestos exposure. Continuity is difficult for GPs, and other healthcare professionals (HCPs), to provide within the current NHS primary care system, but is highly valued by people with mesothelioma. To understand the experiences of continuity in primary care among people with mesothelioma, their close persons, and their HCPs; how they achieve this (or not); and how it affects their healthcare service use. Realist case studies of patient journeys through the healthcare system (involving longitudinal interviews with people with mesothelioma, their close persons, and HCPs; and exploration of the organisational context). Data analysis allowed understanding of hidden mechanisms (resources and reasoning), triggered in certain contexts, leading to specific outcomes. Forty-eight interviews (involving 9 patients, 8 close persons, and 12 HCPs) were undertaken (totalling 30.8 hours/1848 minutes). Context-Mechanism-Outcome configurations related to: challenges unique to mesothelioma; capacity of patients/close persons/HCPs to facilitate continuity; multidisciplinary (MDT) approach differs from the family doctor model; and 'the NHS primary care system is broken'. Patients perceive their continuity needs to be unmet by the inflexible primary care system, which needs to adapt to a society in which people receive increasingly novel treatments and live longer with complex healthcare needs. A societal perspective shift is required to understand that an MDT now shares responsibility for care, rather than an individual family doctor. Policy documents continue to focus on access, and still do not advocate strongly enough for continuity, despite unequivocal evidence demonstrating its worth.

Spillovers and Training Effects on Mental Health Prescribing for Children

We use data on all prescriptions filled at U.S. retail pharmacies from 2006-2018 to examine deviations from best practice in the prescription of psychiatric medications to children. The results demonstrate the importance of spillovers from other doctors in the same area. However, individual doctor fixed effects remain extremely important. We also show that the practice styles of doctors who graduated in the same year from schools of the same rank evolve in a similar way across the country. Psychiatrists are less affected by area-level prescribing than general practitioners suggesting that specific training can reduce spillovers in questionable prescribing practices.

Effects of the Japanese medical office system on innovation creation among medical doctors: A survey of cardiologists in acute care settings

ABSTRACT In the Japanese medical office system, medical doctors are dispatched from university medical offices to affiliated hospitals. In the present study, the effects of Japan’s unique medical office system on innovation creation among medical doctors were examined. A questionnaire survey was administered to 150 cardiologists between 7 and 30 June 2023; results showed that 109 (73.0%) participants were affiliated with the medical office system and 41 (27.0%) were not. From the literature, the following categories of elements of creativity were extracted: personality, cognitive processes, competence/intelligence, motivation, work environment/management, social networks and entrepreneurial orientation. Analysis of these categories identified five types of factors influencing creativity: knowledge-seeking attitude, challenging work environment, intrinsic motivation promotion, diversity preference and self-help. Linear regression analysis showed that creativity increased with age (beta, 0.274 [95% confidence interval, 0.084–0.464]; p = 0.005) but was unaffected by all other factors. Thus, the study found that the medical office system did not have a negative impact on the creativity (i.e. innovation creation) of individual medical doctors; however, this system may delay the age at which these doctors can demonstrate their creativity.

G.G. Smith: A Urologist on the Western Front

Objectives World War I (WWI) left a devastating impact on Europe. Urologist George Gilbert (GG) Smith served with a Harvard-associated group of surgeons and nurses stationed at the western front from 1915-1916. First-hand accounts and medical observations from the front are rare, so Smith’s wartime diary is a valuable source to gain further insight into what was once termed the ‘War to End All Wars’. Our objective was to study Smith’s diaries from WWI to better understand the personal and professional experiences and sacrifices of those who fought and served Methods The GG Smith diaries were obtained courtesy of the Smith family. Archives were consulted from the American Urological Association (AUA) William P. Didusch library (Linthicum, MD), Center for the History of Medicine at Countway Library (Cambridge, MA), the British Red Cross, the American Hospital of Paris, and cited secondary sources. Results Smith graduated from Harvard medical school in 1908 after training at Massachusetts General Hospital (MGH). He joined the growing urology faculty at Harvard under the leadership of Hugh Cabot. Following the start of WWI and before the United States’ formal involvement in the war, the Harvard Surgical Unit (HSU) was one of a number of ‘neutral’ medical corps from America’s elite hospitals, composed of individual doctors and nurses who were deployed wherever they were needed for a 3-month tour of duty. As a member of the HSU, Smith was stationed by the warfront, braving air attacks and bombs to care for hundreds of wounded, combatting infections, trauma, and fractious personalities.. The skill in leadership he developed served him well as President of the AUA from 1935-1936, Chair of Urology at MGH from 1938-1945, and President of the Massachusetts Society of Social Hygiene from 1937-1945 Conclusions Smith’s war time diary is testimony to the great philanthropic efforts of America’s institutions during WWI, to the remarkable progress in medical and surgical care that was motivated by the devastation of that war, and to the diversity of people whose pragmatic heroism contributed to the Allied victory.

Non-invasive medical imaging technology for the diagnosis of burn depth.

Currently, the clinical diagnosis of burn depth primarily relies on physicians' judgements based on patients' symptoms and physical signs, particularly the morphological characteristics of the wound. This method highly depends on individual doctors' clinical experience, proving challenging for less experienced or primary care physicians, with results often varying from one practitioner to another. Therefore, scholars have been exploring an objective and quantitative auxiliary examination technique to enhance the accuracy and consistency of burn depth diagnosis. Non-invasive medical imaging technology, with its significant advantages in examining tissue surface morphology, blood flow in deep and changes in structure and composition, has become a hot topic in burn diagnostic technology research in recent years. This paper reviews various non-invasive medical imaging technologies that have shown potential in burn depth diagnosis. These technologies are summarized and synthesized in terms of imaging principles, current research status, advantages and limitations, aiming to provide a reference for clinical application or research for burn specialists.

Patient Health Services at Individual Practice Doctors in Muna District

Introduction: The phenomenon that occurs in the field shows that now many practicing doctors are opening practices like the BPJS program which opens family doctor services. In general, one district has 4,7 and 10 practicing doctors and each practicing doctor has BPJS patients. However, there is a discrepancy in the field, namely that there are still general practitioners who have many BPJS patients and some of them have few patients. In terms of science or competence and facilities, it shows that for general practitioners to have the same knowledge the reality in the field is that there are still many practicing doctors who are a few times their patients. Therefore I feel interested in finding out if it is the doctor who has the problem, the patient, or the facility.
 Methods: The type of research in this study is a qualitative method, which is a study aimed at describing and analyzing phenomena, events, activities, social, attitudes, beliefs, and perceptions of people individually and in groups.
 Result: Research results show that Based on the informant's statement, it can be seen that patients who come for treatment at the clinic of an individual practice doctor get good service and the officers are very friendly so patients do not have the desire to move to another primary facility.
 Conclusion: In general, health services at individual pre-training doctors (DPP) contribute greatly to improving patient satisfaction in Muna Regency.

필수의료의 위기와 의학전문직업성

There are deep concerns about Korean medical care. It is becoming difficult to find doctor who save life in emergency rooms, operating rooms, intensive care units, and rural hospitals. The so-called ‘critical care’ is shaking in its roots. In the meantime, medical professionalism has lost its way. It does not seem appropriate to attribute the cause of the problem to individual doctors. It is not reprehensible for individuals, who are people before doctors, to choose quality of life over a sense of duty. Not only medical staff on site, but also patients, civic groups, media, and politicians began to recognize the seriousness of the problem. This article examines Korean medical care for serious illnesses by dividing them into ‘symptom and sign’, ‘pathophysiology and diagnosis’, and treatment stages. It was diagnosed that the crisis in Korean medical care was due to the irrationality of philosophyless health care policies, doctors choosing work-life balance over a sense of duty, the collapse of the medical delivery system due to the expansion of large hospitals, and the moral hazard of patients and doctors due to private medical insurance. As a prescription to save Korean medicine, it was proposed to break away from the short-sighted discussion of ‘cost vs capacity’ and build a system that takes into account the restoration of trust between patients and doctors, the enhancement of professionalism, and the transition from normative ethics to positive ethics.

Initial Treatment for Cerebral Infarction

The treatment protocol for ischemic stroke has changed drastically in the past 20 years. In particular, the indications for recombinant tissue plasminogen activator(rt-PA)and thrombectomy have expanded. Using rt-PA or thrombectomy may be selected smoothly by receiving a call from the emergency team and efficiently collecting patient information, computed tomography scans, and blood samples. The total time required to prepare the equipment and devices should be reduced. To save as many patients as possible, a system should be established. A multidisciplinary approach is necessary from delivery to treatment to overcome the limitations of an individual doctor. Herein, we present our hospital's innovations to help other hospitals develop such systems.

‘We were treated like we are nobody’: a mixed-methods study of medical doctors’ internship experiences in Kenya and Uganda

ObjectiveMedical interns are an important workforce providing first-line healthcare services in hospitals. The internship year is important for doctors as they transition from theoretical learning with minimal hands-on work under...

Automatic Robust Crackle Detection and Localization Approach Using AR-Based Spectral Estimation and Support Vector Machine

Auscultation primarily relies upon the acoustic expertise of individual doctors in identifying, through the use of a stethoscope, the presence of abnormal sounds such as crackles because the recognition of these sound patterns has critical importance in the context of early detection and diagnosis of respiratory pathologies. In this paper, we propose a novel method combining autoregressive (AR)-based spectral features and a support vector machine (SVM) classifier to detect the presence of crackle events and their temporal location within the input signal. A preprocessing stage is performed to discard information out of the band of interest and define the segments for short-time signal analysis. The AR parameters are estimated for each segment to be classified by means of support vector machine (SVM) classifier into crackles and normal lung sounds using a set of synthetic crackle waveforms that have been modeled to train the classifier. A dataset composed of simulated and real coarse and fine crackles sound signals was created with several signal-to-noise (SNR) ratios to evaluate the robustness of the proposed method. Each simulated and real signal was mixed with noise that shows the same spectral energy distribution as typically found in breath noise from a healthy subject. This study makes a significant contribution by achieving competitive results. The proposed method yields values ranging from 80% in the lowest signal-to-noise ratio scenario to a perfect 100% in the highest signal-to-noise ratio scenario. Notably, these results surpass those of other methods presented by a margin of at least 15%. The combination of an autoregressive (AR) model with a support vector machine (SVM) classifier offers an effective solution for detecting the presented events. This approach exhibits enhanced robustness against variations in the signal-to-noise ratio that the input signals may encounter.

Doctors Fact-Check, Journalists Get Fact-Checked: Comparing Public Trust in Journalism and Healthcare

Public trust in journalism has fallen disconcertingly low. This study sets out to understand the news industry’s credibility crisis by comparing public perceptions of journalism with public perceptions of another institution facing similar trust challenges: healthcare. Drawing on in-depth interviews with 31 US adults, we find that although both healthcare and journalism face public distrust, members of the public generally tend to feel more trusting of individual doctors than they do of individual journalists. This is because people (a) perceive doctors to be experts in their field and (b) engage more frequently with doctors than they do with journalists. Consequently, our interviewees described treating their doctors as “fact-checkers” when it comes to health information they find online, demonstrating trust in their physicians despite their lack of trust in healthcare more broadly. Meanwhile, the opposite unfolds in journalism: Instead of using legitimate news sources to fact-check potential misinformation, people feel compelled to “fact-check” legitimate news by seeking alternative sources of corroboration. We conclude that, to improve their credibility among the public, journalists must strike the right balance between persuading the public to perceive them as experts while also pursuing opportunities to engage with the public as peers.

The use of locum doctors in the NHS – results of a national survey of NHS Trusts in England

BackgroundLocum working in healthcare organisations has benefits for individual doctors and organisations but there are concerns about the impact of locum working on continuity of care, patient safety, team function and cost. We conducted a national survey of NHS Trusts in England to explore locum work, and better understand why and where locum doctors were needed; how locum doctors were engaged, supported, perceived and managed; and any changes being made in the way locums are used.MethodsAn online survey was sent to 191 NHS Trusts and 98 were returned (51%) including 66 (67%) acute hospitals, 26 (27%) mental health and six (6%) community health providers. Data was analysed using frequency tables, t-tests and correlations. Free-text responses were analysed using thematic analysis.ResultsMost NHS Trusts use locums frequently and for varying lengths of time. Trusts prefer to use locums from internal locum banks but frequently rely on locum agencies. The benefits of using locums included maintaining workforce capacity and flexibility. Importantly, care provided by locums was generally viewed as the same or somewhat worse when compared to care provided by permanent doctors. The main disadvantages of using locum agencies included cost, lack of familiarity and impact on organisational development. Some respondents felt that locums could be unreliable and less likely to be invested in quality improvement. NHS Trusts were broadly unfamiliar with the national guidance from NHS England for supporting locums and there was a focus on processes like compliance checks and induction, with less focus on providing feedback and support for appraisal.ConclusionsLocum doctors provide a necessary service within NHS Trusts to maintain workforce capacity and provide patient care. There are potential issues related to the way that locums are perceived, utilised, and supported which might impact the quality of the care that they provide. Future research should consider the arrangements for locum working and the performance of locums and permanent doctors, investigating the organisation of locums in order to achieve safe and high-quality care for patients.

Developing and evaluating a professional development plan pilot for doctors in unaccredited posts: A pilot study

Purpose In Australia, doctors from their third-year post graduation who are not on specialist training pathways frequently work in unaccredited posts with varying amounts of education and support. In 2019, the New South Wales Ministry of Health (NSW Health) and the Health Education and Training Institute (HETI) agreed on a pilot process for these doctors to develop a professional development plan (PDP). The pilot aimed to implement the process and evaluate its feasibility and acceptability. Methodology/approach The process was piloted at four sites in 2021. The evaluation methodology was informed by the non-adoption, abandonment and challenges to scale-up, spread and sustainability (NASSS) framework with data derived from site meetings, interviews with doctors in unaccredited positions and PDP supervisors, and analysis of PDPs and time required. Findings A total of 42 doctors undertook the PDP process, of whom 25 were interviewed. Of the 28 supervisors recruited, 13 were interviewed. Three sites reported successful implementation, with most doctors having a PDP in progress. Despite challenges associated with the diversity of the workforce and workplaces, all sites were supportive of the process being rolled out with appropriate resourcing. Research implications The research findings indicated that embedding a PDP process more widely across the state will be complex due to the diversity of the workforce and clinical workplaces. Practical implications The PDP process, while acceptable and feasible, needs to adapt to local circumstances, including the workforce, supervisory capacity and experience, individual doctor needs and available resources. Originality The evaluation supports the need for a supported PDP process for doctors in unaccredited positions. Limitations The findings may not be transferable to all NSW Health facilities or to other states or territories. Doctors who consented to be interviewed were more likely to be positive about the process than those who did not. The study did not include a cost evaluation or explore cost-effectiveness due to the short time frame.

Adolescents’ self-reported health status, behaviours and health issues addressed during routine school doctor consultations in Switzerland: an observational study

We aimed to investigate the self-reported health status and behaviours of 7th-grade adolescents, associations with gender and educational track, as well as health issues addressed during routine school doctor consultations in Switzerland. Data on health status and behaviours, specifically general well-being, stimulant and addictive substance use, bullying/violence, exercise, nutrition and health protection, and puberty/sexuality, were drawn from routinely collected self-assessment questionnaires from 1076 (of a total of 1126) students from 14 schools in the Swiss canton of Zug in 2020. Data on health issues addressed in school doctor consultations were collected by nine school doctors (for 595 individual consultations). Multilevel logistic regression analyses were used to investigate the association of gender and educational track with unfavourable health status or behaviours. Although 92% (n = 989) of the students reported being happy or satisfied overall, 21% (n = 215) often or almost always felt sad, and 5-10% had repeatedly been seriously physically hurt (n = 67), sexually harassed with words (n = 88) or experienced uncomfortable physical contact (n = 60). Female gender and a lower educational track were associated with unfavourable health status. In 90% (n = 533) of the school doctor consultations, at least one topic of disease prevention or health promotion was addressed, whereby the topics addressed depended strongly on the individual school doctors. Our findings revealed that unfavourable health status and behaviours were prevalent among adolescents but the health topics addressed in school doctor consultations were not tailored to students' self-reported health issues. A school-based approach that strengthens adolescents' health literacy and provides opportunities for patient-centred counselling has the potential to improve the current and future health of adolescents and, ultimately, adults. To realise this potential, it is essential for school doctors to be sensitised and trained to address students' health concerns. Emphasis should be placed on the importance of patient-centred counselling, the high prevalence of bullying, and gender and educational differences.

A Study of Factors Influencing the Volume of Responses to Posts in Physician Online Community.

Today's diverse health needs place greater demands on physicians. However, individual doctors have limited capabilities and may encounter many unsolvable medical problems. The physician online community provides a platform for physicians to communicate with each other and help each other. Physicians can post for help about problems they encounter at work. The number of responses to physicians' posts is critical to whether or not the problem is resolved. This study collected information on 13,226 posts from a well-known physician online community in China to analyze the factors that influence the number of post replies. In the analysis of the post content of the physician online community, this study innovatively introduces word usage features in the medical field. TextMind was used to extract the rate of several types of words in posts that frequently appear when describing medical information. Ultimately, we found that the rate of time words, visual words, auditory words, and physiological process words used in posts had a positive and significant effect on the number of post responses. A series of new post features has been found to have an impact on the number of post replies in physician online communities. This finding is beneficial for physicians to quickly obtain peer assistance through online platforms, increasing the likelihood of solving workplace challenges and improving physician care, as well as the success of physician online communities.

Dietitians' and nutritionists' knowledge and views on aspects of health claims regulation in the UK: Do we inadvertently shoot the messenger?

Article 12(c) of the Nutrition and Health Claims Regulation (NHCR) prohibits authorised health claims in consumer-facing commercial communications which make reference to the recommendations of individual doctors or health professionals. However, this has been controversial amongst dietitians and nutritionists who work in commercial settings. Given the lack of empirical data, a survey was conducted amongst UK-based nutrition professionals to assess their knowledge of, and attitudes to, Article 12(c). The findings revealed confusion about the scope of the regulation and how it applies to working practices, with a considerable proportion of respondents being unable to recognise examples of commercial communications or health claims, indicating a need for additional training. There was also a broad interpretation of what nutrition professionals could, and could not, say about a hypothetical food product. This paper explores current guidance in Great Britain and debates the proportionality and fairness of Article 12(c), which, at present, does not regulate authorised health claims made by influencers or celebrities in commercial communications to consumers. It could be argued that consumers are better protected by the articulation of health claims by nutrition professionals who are guided by codes of practice rather than by unqualified, unregulated individuals. Hence, it is essential to level the regulatory playing field either by revising the NHCR to amend Article 12(c) or by updating the guidance to apply an interpretation of the Article's intention which enables a broader role for nutrition professionals in commercial communications. Such action would also be consistent with the UK's better regulation agenda to ensure evidence-based, proportionate regulation for industry.

Personal drug education to learn evidence-based medicine

A variety of new methods are being tried in education of pharmacology for medical students, to make pharmacology be directly oriented to practical medical treatment. Among them, thinking that the method of "selection of personal drug (P-drug)" is suitable for learning "evidence-based medicine (EBM)", I have been engaged in "P-drug education" in Kyushu university for many years. If doctors carefully select medicines that are indispensable for their medical treatment based on clinical evidence, are made familiar with how to use them, and in principle perform daily medical treatment using only those medicines, EBM can be really practiced. And moreover, it may also lead to the suppression of medical errors and adverse drug reactions. Such essential medicines for an individual doctor are called P-drug. Since 2003, I have adopted "P-drug selection" in the education of pharmacology for upper grade medical students. After more than 15 years of trial and error, I have been able to create an educational model using "P-drug selection" that I think could be easily adopted at any medical school. At this symposium, I talked about the relationship between "P-drug selection" and EBM and demonstrate the "P-drug education" model.