Internal Medicine Physicians Research Articles

Universal hepatitis B vaccination in adults aged 19–59 years: Updated recommendations of the advisory committee on immunization practices—United States, 2022

Universal hepatitis B vaccination in adults aged 19–59 years: Updated recommendations of the advisory committee on immunization practices—United States, 2022

Perceived effectiveness of cancer screening among family medicine and internal medicine physicians in the United States

Family and internal medicine physicians play an important role in cancer screening, yet there are limited data on their beliefs regarding effectiveness of screening tests, which may affect physicians’ likelihood to recommend such tests. The study purpose was to assess current beliefs among family medicine and internal medicine physicians regarding effectiveness of various types of cancer screening. A national sample of 582 physicians from the American Medical Association’s Physician Masterfile were surveyed. Participants were asked about their perceived effectiveness of screening for colon, lung, breast, prostate, and cervical cancer among average, healthy individuals. Chi-square tests were conducted to assess relationships between perceiving screening tests to be ‘very effective in reducing cancer-related mortality’ and demographic characteristics. A substantial majority of physicians perceived colonoscopy (83.8%) and Pap smear (82.9%) to be very effective. Perceiving low-dose computed tomography (LDCT), Pap smear, and prostate-specific antigen (PSA) as ‘very effective’ differed by gender, with females less likely to endorse LDCT and Pap smear but more likely to endorse PSA. Perceiving PSA as ‘very effective’ differed by age and graduation year, with younger or more recently graduated physicians being less likely to perceive PSA as ‘very effective’. Non-Hispanic Black/African-American physicians were more likely to perceive mammography as ‘very effective’ than other groups. Physicians’ perceived effectiveness about cancer screening tests varies widely and may influence their recommendations or usage of these tests. Understanding physicians’ beliefs can help in improving uptake of evidence-based screening tests by providers and patients to promote early detection and successful treatment.

A national study of moral distress among U.S. internal medicine physicians during the COVID-19 pandemic.

BackgroundThere have been no studies to date of moral distress during the COVID-19 pandemic in national samples of U.S. health workers. The purpose of this study was to determine, in a national sample of internal medicine physicians (internists) in the U.S.: 1) the intensity of moral distress; 2) the predictors of moral distress; 3) the outcomes of moral distress.MethodsWe conducted a national survey with an online panel of internists, representative of the membership of the American College of Physicians, the largest specialty organization of physicians in the United States, between September 21 and October 8, 2020. Moral distress was measured with the Moral Distress Thermometer, a one-item scale with a range of 0 (“none”) to 10 (“worst possible”). Outcomes were measured with short screening scales.ResultsThe response rate was 37.8% (N = 810). Moral distress intensity was low (mean score = 2.4, 95% CI, 2.2–2.6); however, 13.3% (95% CI, 12.1% - 14.5%) had a moral distress score greater than or equal to 6 (“distressing”). In multiple linear regression models, perceived risk of death if infected with COVID-19 was the strongest predictor of higher moral distress (β (standardized regression coefficient) = 0.26, p < .001), and higher perceived organizational support (respondent belief that their health organization valued them) was most strongly associated with lower moral distress (β = -0.22, p < .001). Controlling for other factors, high levels of moral distress, but not low levels, were strongly associated (adjusted odds ratios 3.0 to 11.5) with screening positive for anxiety, depression, posttraumatic stress disorder, burnout, and intention to leave patient care.ConclusionsThe intensity of moral distress among U.S. internists was low overall. However, the 13% with high levels of moral distress had very high odds of adverse mental health outcomes. Organizational support may lower moral distress and thereby prevent adverse mental health outcomes.

Prevalence of and factors associated with inappropriate Clostridioides difficile testing in a teaching hospital in Korea

BackgroundGiven the increasing incidence of Clostridioides difficile infections in Korea, there has been an increase in inappropriate testing for C. difficile, which has rendered overdiagnosis of asymptomatic colonisers common. We aimed to investigate the appropriateness of C. difficile testing and the related factors.MethodsWe retrospectively reviewed the medical records of patients who were admitted to a 1300-bed tertiary-care teaching hospital in Korea and were tested for C. difficile infection from September 2019 to November 2019. We performed logistic regression analysis to investigate factors related to inappropriate testing. Further, a survey was conducted on physicians to assess the knowledge and ordering patterns of C. difficile testing.ResultsWe included 715 tests from 520 patients in the analysis. Testing was classified as hospital-onset and community-onset and subclassified as appropriate and inappropriate following an algorithmic method. Among the 715 tests, 576 (80.6%) and 139 (19.6%) tests were classified as hospital-onset and community-onset, respectively. Among the hospital-onset tests, 297 (52%) were considered inappropriate. The risk of inappropriate testing increased when C. difficile tests were conducted in the emergency room (OR 24.96; 95% CI 3.12–199.98) but decreased in intensive care units (OR 0.36, 95% CI 0.19–0.67). The survey was conducted on 61 physicians. Internal medicine physicians had significantly higher scores than non-internal medicine physicians (7.1 vs. 5.7, p = 0.001). The most frequently ordered combination of tests was toxin + glutamate dehydrogenase (47.5%), which was consistent with the ordered tests.ConclusionAlmost half of the C. difficile tests were performed inappropriately. The patient being located in the emergency room and intensive care unit increased and decreased the risk of inappropriate testing, respectively. In a questionnaire survey, we showed that internal medicine physicians were more knowledgeable about C. difficile testing than non-internal medicine physicians. There is a need to implement the diagnostic stewardship for C. difficile, especially through educational interventions for emergency room and non-internal medicine physicians.

Physician prices and low-value services: evidence from general internal medicine.

To assess the cross-sectional relationship between prices paid to physicians by commercial insurers and the provision of low-value services. Observational study design using Health Care Cost Institute claims representing 3 large national commercial insurers. The main outcome was count of 19 potential low-value services in 2014. The secondary outcome was total spending on the low-value services. Independent variables of interest were price quintiles based on each physician's mean geographically adjusted price of a mid-level office visit, the most commonly billed service by general internal medicine (GIM) physicians. We estimated the association between physician price quintile and provision of low-value services via negative binomial or generalized linear models with adjustments for measure, region, and patient and physician characteristics. This study included 750,452 commercially insured patients attributed to 28,951 GIM physicians. In 2014, the mean geographically adjusted price for physicians in the highest price quintile was $122.6 vs $54.7 for physicians in the lowest quintile ($67.9 difference; 95% CI, $67.5-$68.3). Relative to patients attributed to the lowest-priced physicians, those attributed to the highest-priced physicians received 3.6, or 22.9%, fewer low-value services per 100 patients (95% CI, 2.7-4.7 services per 100 patients). Spending on low-value services attributed to the highest-priced physicians was 10.9% higher ($520 difference per 100 patients; 95% CI, $167-$872). Commercially insured patients of high-priced physicians received fewer low-value services, although spending on low-value services was higher. More research is needed to understand why high-priced providers deliver fewer low-value services and whether physician prices are correlated with other measures of quality.

The problems related to internal medicine consultations in the emergency department

Objectives: Overcrowding in the Emergency Department (ED) is a serious and growing problem during recent years and one of the main causes of it is dysfunctional consultation system. We aimed to determine the problems related to patients who were admitted to the ED and requested consultations from internal medicine (IM) physicians and to contribute to the gap in the literature regarding this isssue. Methods: In a period of one year, 3601 patients, who were admitted to the ED of a university hospital and were consulted by IM physicians were included in this prospective cross-sectional study. The epidemiological characteristics of patients, length of ED stay and consultation-related problems were investigated. Results: The most common problems related to consultations were delayed completion of the consultation procedures for 88 (2.4%) patients, and unnecessary consultation requests for 66 (1.8%) patients, and patient referrals with inappropriate indications from IM outpatient clinics to the ED for 53 (1.5%) patients. There were differences of opinion among IM physicians and emergency medicine specialists regarding the need for consultation for 36 (1%) patients. The most important difference was in the various infections seen in patients with histories of hematologic or solid organ malignancies (n = 9). Conclusions: According to these findings, good collaboration must be established among ED physicians and consultant physicians. Furthermore, physicians must avoid inappropriate referral patients from outpatient clinics to the ED. Additionally, unnecessary consultation requests from the ED must be avoided, and consultation requests must be addressed quickly.

Performance of infectious diseases specialists, hospitalists, and other internal medicine physicians in antimicrobial case-based scenarios: Potential impact of antimicrobial stewardship programs at 16 Veterans' Affairs medical centers.

As part of a project to implement antimicrobial dashboards at select facilities, we assessed physician attitudes and knowledge regarding antibiotic prescribing. An online survey explored attitudes toward antimicrobial use and assessed respondents' management of four clinical scenarios: cellulitis, community-acquired pneumonia, non-catheter-associated asymptomatic bacteriuria, and catheter-associated asymptomatic bacteriuria. This study was conducted across 16 Veterans' Affairs (VA) medical centers in 2017. Physicians working in inpatient settings specializing in infectious diseases (ID), hospital medicine, and non-ID/hospitalist internal medicine. Scenario responses were scored by assigning +1 for answers most consistent with guidelines, 0 for less guideline-concordant but acceptable answers and -1 for guideline-discordant answers. Scores were normalized to 100% guideline concordant to 100% guideline discordant across all questions within a scenario, and mean scores were calculated across respondents by specialty. Differences in mean score per scenario were tested using analysis of variance (ANOVA). Overall, 139 physicians completed the survey (19 ID physicians, 62 hospitalists, and 58 other internists). Attitudes were similar across the 3 groups. We detected a significant difference in cellulitis scenario scores (concordance: ID physicians, 76%; hospitalists, 58%; other internists, 52%; P = .0087). Scores were numerically but not significantly different across groups for community-acquired pneumonia (concordance: ID physicians, 75%; hospitalists, 60%; other internists, 56%; P = .0914), for non-catheter-associated asymptomatic bacteriuria (concordance: ID physicians, 65%; hospitalists, 55%; other internists, 40%; P = .322), and for catheter-associated asymptomatic bacteriuria (concordance: ID physicians, 27% concordant; hospitalists, 8% discordant; other internists 13% discordant; P = .12). Significant differences in performance regarding management of cellulitis and low overall performance regarding asymptomatic bacteriuria point to these conditions as being potentially high-yield targets for stewardship interventions.

Challenges in the transition from resident to attending physician in general internal medicine: a multicenter qualitative study

BackgroundThe attending physician in general internal medicine (GIM) guarantees comprehensive care for persons with complex and/or multiple diseases. Attendings from other medical specialties often report that transitioning from resident to attending is burdensome and stressful. We set out to identify the specific challenges of newly appointed attendings in GIM and identify measures that help residents better prepare to meet these challenges.MethodsWe explored the perceptions of 35 residents, attendings, and department heads in GIM through focus group discussions and semi-structured interviews. We took a thematic approach to qualitatively analyze this data.ResultsOur analysis revealed four key challenges: 1) Embracing a holistic, patient centered perspective in a multidisciplinary environment; 2) Decision making under conditions of uncertainty; 3) Balancing the need for patient safety with the need to foster a learning environment for residents; and 4) Taking on a leader’s role and orchestrating an interprofessional team of health care professionals. Newly appointed attendings required extensive practical experience to adapt to their new roles. Most attendings did not receive regular, structured, professional coaching during their transition, but those who did found it very helpful.ConclusionsNewly appointed attending physician in GIM face a number of critical challenges that are in part specific to the field of GIM. Further studies should investigate whether the availability of a mentor as well as conscious assignment of a series of increasingly complex tasks during residency by clinical supervisors will facilitate the transition from resident to attending.

Discussion Guide for the May Article.

Discussion Guide for the May Article.

Effects of Healthcare Organization Actions and Policies Related to COVID-19 on Perceived Organizational Support Among U.S. Internists: A National Study.

Perceived organizational support (POS) may promote healthcare worker mental health, but organizational factors that foster POS during the COVID-19 pandemic are unknown. The goals of this study were to identify actions and policies regarding COVID-19 that healthcare organizations can implement to promote POS and to evaluate the impact of POS on physicians' mental health, burnout, and intention to leave patient care. We conducted a cross-sectional national survey with an online panel of internal medicine physicians from the American College of Physicians in September and October of 2020. POS was measured with a 4-item scale, based on items from Eisenberger's Perceived Organizational Support Scale that were adapted for the pandemic. Mental health outcomes and burnout were measured with short screening scales. The response rate was 37.8% (N = 810). Three healthcare organization actions and policies were independently associated with higher levels of POS in a multiple linear regression model that included all actions and policies as well as potential confounding factors: opportunities to discuss ethical issues related to COVID-19 (β (regression coefficient) = 0.74, p = .001), adequate access to personal protective equipment (β = 1.00, p = .005), and leadership that listens to healthcare worker concerns regarding COVID-19 (β = 3.58, p < .001). Sanctioning workers who speak out on COVID-19 safety issues or refuse pandemic deployment was associated with lower POS (β = -2.06, p < .001). In multivariable logistic regression models, high POS was associated with approximately half the odds of screening positive for generalized anxiety, depression, post-traumatic stress disorder, burnout, and intention to leave patient care within 5 years. Our results suggest that healthcare organizations may be able to increase POS among physicians during the COVID-19 pandemic by guaranteeing adequate personal protective equipment, making sure that leaders listen to concerns about COVID-19, and offering opportunities to discuss ethical concerns related to caring for patients with COVID-19. Other policies and actions such as rapid COVID-19 tests may be implemented for the safety of staff and patients, but the policies and actions associated with POS in multivariable models in this study are likely to have the largest positive impact on POS. Warning or sanctioning workers who refuse pandemic deployment or speak up about worker and patient safety is associated with lower POS and should be avoided. We also found that high degrees of POS are associated with lower rates of adverse outcomes. So, by implementing the tangible support policies positively associated with POS and avoiding punitive ones, healthcare organizations may be able to reduce adverse mental health outcomes and attrition among their physicians.

Interrater agreement of the HEART score history component: A chart review study.

Study objectivesThis study investigated the interrater reliability of the history component of the HEART (history, electrocardiogram, age, risk, troponin) score between physicians in emergency medicine (EM) and internal medicine (IM) at 1 tertiary‐care center.MethodsWe conducted a retrospective, secondary analysis of 60 encounters selected randomly from a database of 417 patients with chest pain presenting from January to June 2016 to an urban tertiary‐care center. A total of 4 raters (1 EM attending, 1 EM resident, 1 IM attending, and 1 IM resident) scored the previously abstracted history data from these encounters.The primary outcome was the interrater agreement of HEART score history components, as measured by kappa coefficient, between EM and IM attending physicians. Secondary outcomes included the agreement between attending and resident physicians, overall agreement, pairwise percent agreement, and differences in scores assigned.ResultsThe kappa value for the EM attending physician and IM attending physician was 0.33 with 55% agreement. Interrater agreement of the other pairs was substantial between EM attending and resident but was otherwise fair to moderate. Percent agreement between the other pairs ranged from 48.3% to 80%. There was a significant difference in scores assigned and the subgroup in which there was disagreement between the raters demonstrated significantly higher scores by the EM attending and resident when compared to the IM attending.ConclusionThis study demonstrates fair agreement between EM and IM attending physicians in the history component of the HEART score with significantly higher scores by the EM attending physician in cases of disagreement at 1 tertiary‐care center.

Lung Cancer Screening Knowledge and Perceived Barriers Among Physicians in the United States

IntroductionLung cancer remains the leading cause of cancer death in the United States and has historically been detected late in its course. Low-dose computed tomography scan (LDCT) reduces lung cancer mortality by 20% and is currently recommended by clinical practice guidelines. However, compared with other cancer screening modalities, LDCT utilization remains low. This study surveyed office-based primary care physicians across the United States to better understand LDCT utilization. MethodsA total of 1500 family and internal medicine physicians selected from the American Medical Association’s physician master file were surveyed between April and July 2019 regarding LDCT practices, eligibility, clinical scenarios, and perceived barriers. ResultsThe American Association for Public Opinion Research response rate 3 was 59% (652 respondents); 599 completed supplemental questions regarding lung cancer screening. A total of 88% of respondents discussed LDCT in the previous year, and 78% had ordered at least one LDCT. Most (59%) knew the tobacco exposure criteria for LDCT and correctly identified appropriate clinical scenarios (49%–86% responded correctly). Less than half of respondents correctly identified the age eligibility criteria (44%–45% responded correctly). In general, male physicians, those who graduated after 1990, and family medicine physicians were more likely to report accurate knowledge regarding LDCT eligibility. The top perceived barriers to LDCT were cost to the patient (48% identified as a major barrier), insurance not covering screening (46% major), and patients being unaware of lung cancer screening (40% major). ConclusionKnowledge and practices about lung cancer screening are improving, though remain suboptimal. The most common barriers remain cost or insurance-based and suggest the need for a systems-based response to increase awareness and reduce the underutilization of LDCT.

Addressing Health Concerns Interrupted by the COVID-19 Pandemic

Addressing Health Concerns Interrupted by the COVID-19 Pandemic

Burnout and Resilience of Internal Medicine Physician Trainees in a Tertiary Government Hospital in the Philippines during the COVID-19 Pandemic: A Mixed-method Study

Objectives. Internal Medicine physician trainees faced unique challenges as the primary frontline physicians at a tertiary COVID-19 government referral center during the COVID-19 pandemic. This study examined the prevalence of burnout and resilience of these physician trainees during the early period of the pandemic, the determinants of burnout, and their sources of anxiety and coping mechanisms.&#x0D; Methods. Using a mixed-methods approach, we conducted an online cross-sectional survey to measure burnout and resilience among 196 Internal Medicine physician trainees using the Maslach Burnout Index Human Services Survey for Medical Personnel and the Connor-Davidson Resiliency questionnaires, respectively. We then conducted virtual focus group discussions and in-depth key informant interviews to explore the trainees’ sources of anxiety and coping mechanisms until thematic saturation was satisfied.&#x0D; Results. Out of 146 respondents (from 196 eligible participants, 74% response rate), four percent of physician trainees fit the frank burnout profile, 40% were engaged, while the majority had intermediate profiles (23% ineffective, 28% overextended, and 4% disengaged). The mean resilience score was 72.9 (SD 12.4). Resilience was a significant negative predictor for burnout (Beta Coefficient = -0.73, p&lt;0.001). Its protective effect decreases in those with more exposure to patient deaths (Beta Coefficient = 6.767, p&lt;0.05). Significant sources of anxiety included changes in the practice of medicine (changes in workflow, working in full personal protective equipment, telemedicine and zoom fatigue, constant threat of acquiring the infection) and having competing demands between service and training. Coping mechanisms included preserving a haven, maintaining social relationships, and self-care.&#x0D; Conclusion. In the largest government hospital in the Philippines, four percent of Internal Medicine physician trainees had burnout, 40% were engaged, and the majority were at-risk for burnout a few months into the COVID-19 pandemic in 2020. Resilience reduces the risk for burnout. However, its protective effect decreased with exposure to a higher number of patient deaths per week.

Development and preliminary validation of a scale to assess physicians' emotional distress intolerance in end-of-life care communication.

End-of-life care (EOLC) communication is beneficial but underutilized, particularly in conditions with a variable course such as chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF). Physicians' emotional distress intolerance has been identified as a barrier to EOLC communication. However, studies of emotional distress intolerance in EOLC have largely relied on anecdotal reports, qualitative data, or observational studies of physician-patient communication. A free-standing measure of multiple dimensions of distress tolerance is warranted to enable the identification of individuals experiencing distress intolerance and to facilitate the effective targeting of interventions to improve distress tolerance. This study provides preliminary data on the reliability and validity of the Physician Distress Intolerance (PDI) scale. We examine potential subdimensions of emotional distress intolerance. Family medicine and internal medicine physicians completed the PDI, read vignettes describing patients with COPD or CHF, and indicated whether they initiated or delayed EOLC communication with their patients with similar conditions. Exploratory and confirmatory factor analyses were performed on separate samples. Confirmatory factor analysis confirmed that a three-factor solution was superior to a two- or one-factor solution. Three subscales were created: Anticipating Negative Emotions, Intolerance of Uncertainty, and Iatrogenic Harm. The full scale and subscales had adequate internal consistency and demonstrated evidence of validity. Higher scores on the PDI, indicating greater distress intolerance, were negatively associated with initiation and positively associated with delay of EOLC communication. Subscales provided unique information. The PDI can contribute to research investigating and addressing emotional barriers to EOLC communication.

Jugular Venous Pressure Measurement Is Accurate When Performed By Attending Physicians On Internal Medicine Wards

<h3>Introduction</h3> Jugular venous pressure (JVP) is a widely used estimate of central venous pressure (CVP). It is unclear how accurate JVP measurement is by physicians in different stages of clinical practice. We investigated the accuracy of JVP measurement across different levels of medical training by comparing JVP measurements to the peripheral venous pressure (PVP) measurement, which has been shown to have a high degree of correlation to CVP measurements. <h3>Hypothesis</h3> JVP will be better correlated with CVP when measured by physicians of higher level of clinical training. <h3>Methods</h3> A prospective, cross-sectional study in which 82 participants (13 third or fourth-year medical students, 26 interns, 21 residents, and 22 attending internal medicine physicians) measured JVP in patients admitted for acute decompensated heart failure (ADHF) to the general medicine ward. JVP measurements were compared to the PVP measured from a peripheral intravenous catheter by standard technique. <h3>Results</h3> Forty-five patients were enrolled with a mean age of 69±14 years, mean body mass index (BMI) of 31±9 kg/m², mean ejection fraction (EF) of 47±20%, and mean B-type natriuretic peptide (BNP) of 1242±1161 pg/ml. Mean JVP was 8.6 (4-18) cmH₂O for medical students, 8.7 (4-16) cmH₂O for interns, 9.1 (5-20) cmH₂O for residents, and 9.2 (4-15) cmH₂O for attending physicians. Mean PVP was 8.7 (1-20) mmHg. The JVP and CVP were found to have a moderate correlation (r=0.42, p=0.005) for attending physicians and a low correlation for medical students or residents. High-degree correlation among attending physicians was noted in patients with EF < 50% (r=0.60, p=0.009), BMI < 30 (r=0.55, p=0.008) and BNP > 1000 (r=0.56, p=0.01). <h3>Conclusions</h3> JVP is a reliable estimation of volume status in those admitted with ADHF when examined by an attending-level internal medicine physician, specifically in patients with a low BMI, low EF, and a high BNP.

Women's health for a primary care workforce.

Primary care training should include competencies to provide reproductive health services. In the United Sates, primary care is often provided by general internal medicine physicians. Longitudinal training experiences for internal medicine residents in women's health increase knowledge, skills and retention in careers in women's health, but very little literature describes their implementation. The purpose of this paper is to describe the implementation and evaluation of a 2-year women's health training pathway in Internal Medicine. Using the Context, Input, Process, Product (CIPP) model, we describe the salient features of a complex, longitudinal educational intervention at the development, planning and evaluation stages within a large academic medical centre. In 2019, we conducted interviews with the pathway participants (N = 6) in the first 3years of the programme and used the CIPP framework and Kirkpatrick's Model as an a priori codebook for analysis. Participants reported high fidelity and that the training was relevant and appropriate to meet their needs. Practicing clinicians similarly reported that training was relevant and useful and met desired goals for knowledge and integrated approaches to care. Trainees reported unexpected benefits of identity formation and a community of practice. These results suggest that longitudinal training pathways are an effective way to train Internal Medicine residents to provide comprehensive care to women. This study has broader applications for health professions education, providing a model for implementation and evaluation of complex educational interventions in large organisations. Future research should focus on dissemination to train a workforce prepared to offer evidence-based care to women throughout their lifespan.

The COVID-19 Healthcare Coalition Telehealth Impact Study

Obtain a detailed perspective from the principal investigator of this landmark telehealth study paving the way for understanding gaps and to allow telehealth best practices to emerge, creating a more effective and resilient system of care delivery in the U.S. The COVID-19 Telehealth Impact Study was designed to describe the natural experiment of telehealth adoption during the pandemic. Using a large claims data stream and surveys of providers and patients, studying all 50 states to inform healthcare leaders. Biography Francis “FX” Campion serves as Principal Lead for Digital Health at MITRE with work focused on AI for healthcare, FHIR interoperability and the use of synthetic data for clinical modelling. He is a co-principal investigator for the COVID-19 Telehealth Impact Study. He serves as clinical consultant to the U.S. Government for the Federal COVID Response for Therapeutics. He is a practicing internal medicine physician at Atrius Health in Boston. Prior to work at MITRE he served as Senior Clinical Informaticist at IBM Watson Health where his team built machine learning and natural language processing applications for care of patients with diabetes and heart failure. Prior to that he served as the Chief Medical Officer for Ayasdi providing AI solutions for providers and payers. There he co-authored the book, “Machine Intelligence for Healthcare.”

Cityscapes.

Philip Alexander, MD, is a native Texan, retired physician, and accomplished musician and artist. After 41 years as an internal medicine physician, Dr. Phil retired from his practice in College Station in 2016. A lifelong musician and former music professor, he often performs as an oboe soloist for the Brazos Valley Symphony Orchestra. He began exploring visual art in 1980, evolving from pencil sketches—including an official White House portrait of President Ronald Reagan—to the computer-generated drawings featured in this journal. His images, which first appeared in this journal in the spring of 2012, are his own original creations.If you would like to see your art published in the Methodist DeBakey Cardiovascular Journal, submit your creation online at journal.houstonmethodist.org as a “Humanities” entry.

Physicians, emotion, and the clinical encounter: A survey of physicians’ experiences

ObjectivesTraining in emotion management is not a standard part of medical education. This study’s objective was to understand physicians’ challenges navigating emotion (their own and their patients’) and identify areas for intervention to support physician wellness and enhance patient care. MethodsIn 2019, we surveyed 103 physicians in emergency medicine, internal medicine, family medicine, and neurology. Participants quantitatively reported emotion training, emotions that were challenging, and barriers to addressing emotion. They provided qualitative examples of emotion challenges and successes that we analyzed using an inductive thematic analysis. ResultsThere were no significant differences in responses by specialty. Only 10% reported receiving emotion management training, with no evidence that more recently trained physicians received more. Those who had received training on emotion reported greater comfort in dealing with patients’ emotions and were more likely to engage in teaching on emotion. There were gender and career stage differences regarding which emotions physicians found most challenging. The authors identified central themes of emotion-related challenges and successes. ConclusionsTargeted educational initiatives are needed to advance physicians’ ability to navigate emotion in clinical encounters. Practice implicationsDeveloping strategies for managing patients’ emotions may better prepare physicians for navigating the emotional demands of practicing medicine.