Involvement In Direct Patient Care Research Articles

COVID-19 and mental distress among health professionals in eight European countries during the third wave: a cross-sectional survey.

Even during the third wave of the COVID-19 pandemic health professionals were facing mental health challenges. The aim of this study was to examine the mental health of doctors, nurses and other professional groups in Europe and to identify differences between the professional groups. We conducted a cross-sectional online survey in 8 European countries. We asked for demographic data, whether the participants were exposed to COVID-19 at work, for main information sources about the pandemic, the Depression Anxiety Stress Scales (DASS-21), and major stressors. A MANCOVA was carried out to find predictors of mental health among health care professionals. The sample (N = 1398) consisted of 237 physicians, 459 nurses, and 351 other healthcare professionals and 351 non-medical professionals with no direct involvement in patient care. The mean mental health of all groups was affected to a mild degree. Major predictors for depression and anxiety weretheprofession groupwith higher scores especially in the group of the nurses and working directly with COVID-patients. In the third wave of the COVID-19 pandemic, the psychological burden on health professionals has remained high, with being nurse and working directly with COVID19 patients being particular risk factors for mental distress. We found as a main result that nurses scored significantly higher on depression and anxiety than practitioners.

Clinical Pharmacy Faculty Provision of Direct Patient Care, Challenges, and Opportunities.

The quadripartite mission of clinical track faculty members involves research, teaching, services, and direct patient care. However, the extent of faculty involvement in direct patient care remains a challenge. Thus, the study's objective is to evaluate the effort spent on direct patient care by clinical faculty of pharmacy schools in Saudi Arabia (S.A.) and identify factors that hinder or facilitate providing direct patient care services. This multi-institutional, cross-sectional questionnaire study conducted between July 2021 and March 2022 involved several pharmacy schools' clinical pharmacy faculty members in S.A. The primary outcome was the percentage of time/effort spent on patient care services and other academic responsibilities. The secondary outcomes were the factors affecting the effort spent on direct patient care and the barriers preventing the provision of clinical services. A total of 44 faculty members took the survey. The percentage of effort spent on clinical education was highest at a median (IQR) of 37.5 (30, 50), followed by that spent on patient care [19 (10, 28.75)]. The percentages of effort spent on education and the length of academic experience were negatively associated with efforts spent on direct patient care. The most commonly reported barrier affecting fulfilling patient care duties was the lack of a clear practice policy (68%). Although most clinical pharmacy faculty members were involved in direct patient care, half of them devoted only 20% or less of their time to it. An effective effort allocation for clinical faculty duties will require the development of a clinical faculty workload model that sets realistic expectations about the time spent on clinical and non-clinical duties.

Core Roles and Responsibilities of Physicians in Hospice Care: A Statement by and for U.S. Hospice and Palliative Care Physicians.

Physicians are integral members of hospice interdisciplinary teams (IDTs). This statement delineates the core roles and responsibilities of hospice medical directors (HMDs) and hospice physicians who are designated by the hospice program to fulfill core HMD responsibilities. In addition, we describe the basic elements of hospice programs' structure and function required for hospice physicians to fulfill their roles and responsibilities. Finally, we call attention to hospice program characteristics and circumstances of the work environment that should raise a hospice physician's concerns that hospice patients and families are at risk of receiving low-quality care. Such factors include lack of a functioning IDT, minimal physician involvement in direct patient care and clinical IDT meetings, inadequate responses to symptom emergencies in patients' homes, and no or limited access to general inpatient and continuous home hospice care. We write as individual physicians who are concerned about troubling variability in access to and quality of U.S. hospice care. This statement arises from the need to protect the safety and well-being of vulnerable seriously ill people with their families from low-quality hospice care. This statement is primarily intended to be a resource to hospice physicians in negotiating employment agreements and justifying staffing and programmatic resources necessary to perform their jobs well. This statement may also serve as a resource and reference for patient advocacy groups, hospice industry leaders, health services oversight organizations, accountability agencies, and legislatures in efforts to ensure the safety, quality, and reliability of hospice care in the United States.

SG-APSIC1121: Family caregivers in the patient room: Exploring the family involvement in care provision across hospital settings from an infection prevention and control (IPC) perspective

Objectives: Across many Asian countries, family caregivers provide a wide range of patient care activities while staying in the patient’s room. This unique care arrangement has been reported as a factor contributing to the spread of outbreaks including Middle East respiratory syndrome and coronavirus disease 2019 (COVID-19) in many Asian countries. We sought to understand the context in which direct patient care activities are provided by family caregivers and/or private caregivers in hospitals across Bangladesh, Indonesia, and South Korea from the infection prevention and control (IPC) perspective. Methods: We used a multimethod design with both quantitative and qualitative approaches. In total, 432 patients were surveyed from 5 tertiary-care hospitals across 3 selected countries, and 64 participants from 2 groups were interviewed: group A comprised patients, family caregivers and private caregivers and group B comprised healthcare workers. Survey data were analyzed descriptively, and the interview data were analyzed using thematic analysis. Results: The study findings highlight the different landscapes of care provision in the selected countries. Both the interviews and surveys highlighted 2 aspects of family caregiving. (1) Family caregivers inhabit in the patient zone for long periods, resulting in overcrowding, and (2) they provide a wide ranges of physically associated care activities, including those associated with the risk of healthcare-associated infections (HAIs). Despite the high number of family caregivers and their in-depth involvement in direct patient care, education and support provided to family caregivers around IPC/HAI were insufficient and varied. Also, challenges related to maintaining adequate hygiene in the environment for minimum IPC were reported. Conclusions: This study has elucidated the current landscape of family involvement in inpatient care provision and acknowledges their contribution to high risks of HAI, as well as their current lack of IPC knowledge and practice. These findings reveal that future updates in IPC strategy should acknowledge this arrangement with family caregivers and should address this role with IPC measures.

Evaluation of Web-Based Information on Spine Tuberculosis.

Objective: To evaluate and assess the information about spine tuberculosis available on the internet to the general public for its quality, adequacy, and authenticity.Introduction: Tuberculosis is a bacteriological disease that has been associated with humankind since early human civilization. Spinal tuberculosis is an affection of the spine by the tubercle bacilli and can cause major complications, such as neurological dysfunction and spine deformities. Since the revolution in information technology, information about the disease is widely available on the internet.Material and methods: A total of 68 websites were selected on Google, Yahoo, and MSN search engines for the information available about the disease. Scientific journals, books, and any other research materials were excluded from this study. The information was documented and evaluated for its validity, sufficiency, and authorship.Results: The public education websites (PEdWebs: Those websites which did not have direct involvement in patient care) were the major source of the information with 58.82% (40) of it coming from them. In all, there were 69% (47) physicians and 30.9% (21) non-physicians. Among the physicians, 89.4% reviewed the information through commercial websites. “Inadequate” information about spine tuberculosis was provided by 11.8% (8), “Moderate information” by 51.5% (35), and “Sufficient information” by 36.8 % (25) of the websites. Among the websites, 13.2% (9) did not mention any specific presentation of the disease. Sufficient information on that aspect was provided by only 45.58% (31) of the websites. Only 39% emphasized the importance of early diagnosis and subsequent disease management. The majority, i.e., 79.4% (54), did not mention the preventive measures.Conclusion: The internet has a lot of information regarding spine tuberculosis. The majority of this information comes from physicians. However, not every website has complete and essential information regarding the disease.

Differences in Attitudes of Front-Line Clinicians, Healthcare Workers, and Non-Healthcare Workers Toward COVID-19 Safety Protocols

BackgroundThe advent of the coronavirus disease 2019 (COVID-19) has generated varying opinions toward adhering to safety protocols among public health experts. With decreasing restrictions on public gatherings, lax protective behaviors, distortion of facts, and increasing availability of COVID-19 vaccines, response to public health guidelines vary greatly. Personal experiences with COVID-19, education, and work environment may influence decisions on safety recommendations and vaccination protocols among the public and healthcare professionals alike. To better understand how individuals process and make decisions regarding COVID-19 safety measures, this study investigated the attitudes among clinical and non-clinical healthcare workers and non-healthcare workers toward COVID-19 safety protocols.MethodologyCross-sectional data were collected from Florida residents using an online, 20-item anonymous questionnaire. Participants were recruited using the Florida Department of Health database for physician emails, social media, and snowball sampling strategies. The survey consisted of demographic items and questions regarding patient attitudes toward safety protocols for COVID-19 (e.g., likeliness to wear a mask in public despite state regulations being lifted, maintaining a distance of at least 6 feet between close friends and family, dining at restaurants/bars, gathering in groups larger than 10 people, getting a COVID-19 vaccine if one becomes available). Data were analyzed using one-way analysis of variance and chi-square test using SPSS version 27 (IBM Corp., Armonk, NY, USA).ResultsOf the 373 participants who completed the survey, 183 (49.1%) worked in the healthcare field, with 100 (28.6%) providing direct patient care. The rest (n = 190; 50.9%) reported that they do not work in the healthcare industry. Findings suggest that those working in healthcare with direct involvement in patient care were more likely to get the COVID-19 vaccine than those not working in healthcare. Additionally, those working in healthcare and providing direct patient care were more likely to think that masks were effective in reducing the spread of COVID-19 compared to those who worked in healthcare but did not provide direct patient care.ConclusionsThis study provides new insights into the attitudes of front-line clinicians, non-clinical healthcare workers, and the general population. Increasing health promotion efforts and debunking myths about COVID-19 may prove useful in mitigating the spread of the disease.

Averting Burnout in Pediatricians: Understanding the Intersection of Workload and Meaning of Work.

Averting Burnout in Pediatricians: Understanding the Intersection of Workload and Meaning of Work.

Implementation and evaluation of a virtual learning advanced pharmacy practice experience

Background and purposeThe novel severe acute respiratory syndrome coronavirus 2 restricted student involvement in direct patient care. Virtual learning is an effective education strategy in pharmacy curriculums. This study aimed to evaluate student perceptions of virtual learning advanced pharmacy practice experiences (APPE) utilizing an electronic 12-question survey. Educational activity and settingVirtual learning was developed and implemented, and students were surveyed at the end of the APPE. The survey was comprised of one open-ended and 11 Likert scale questions. It assessed implementation and use of virtual learning in place of a standard on-site APPE. FindingsResponses were attained from 19 students. Questions regarding resources provided and virtual learning enabling autonomous, independent learning had the highest percent of strong agreement. No responses indicated strong disagreement. Three questions solicited >10% response rate of somewhat disagree, 16% associated with virtual learning helping the student become a better member of the healthcare team after graduation. Open-ended responses acknowledged appreciation of the virtual APPE and presented material. One in six students commented on the ability to apply the learned information to direct patient care. Feedback was delivered on consideration for increased utility of patient care-orientated applications to facilitate simulation of real-life patient cases. SummaryStudents who completed the virtual APPE were satisfied overall. Virtual teaching modalities may be incorporated into APPEs, particularly when direct patient care access is limited, but should not be used to completely replace the experience gained during direct patient care.

Physician-scientist or basic scientist? Exploring the nature of clinicians' research engagement.

Theoretical understanding of what motivates clinician researchers has met with some success in launching research careers, but it does not account for professional identification as a factor determining sustained research engagement over the long-term. Deeper understanding of clinicians' research-related motivation may better foster their sustained research engagement post-training and, by extension, the advancement of medicine and health outcomes. This study used an integrated theoretical framework (Social Cognitive Career Theory and Professional Identity Formation) and appreciative inquiry to explore the interplay of professional identification and research context in shaping post-training research success narratives. To foreground professional identification, 19 research-active clinicians and 17 basic scientists served as interviewees. A multi-institutional, multi-national design was used to explore how contextual factors shape external valuation of research success. The findings suggest that research-active clinicians do not identify as the career scientists implied by the modern physician-scientist construct and the goal of many clinician research-training programs. Their primary identification as care providers shapes their definition of research success around extending their clinical impact; institutional expectations and prevailing healthcare concerns that value this aim facilitate their sustained research engagement. Integrated developmental and organizational interventions adaptive to research context and conducive to a wider range of medical inquiry may better leverage clinicians' direct involvement in patient care and advance progress toward human health and well-being.

It is time to rethink theall‐Pharm.D. educational system: Multiple tiered degrees would better serve the diverse nature of pharmacy practice

AbstractAs of the year 2000, schools of pharmacy stopped offering the option of a 5‐year baccalaureate degree. The 6‐year Doctor of Pharmacy (Pharm.D.) is now the sole entry‐level pharmacy degree. Proponents of an all‐Pharm.D. educational system envisioned that universal doctoral training would raise the level of pharmacy practice by clinically preparing all graduates for greater involvement in direct patient care. Opponents of the change were concerned that some students would be over‐trained and under‐utilized for the distributive practices that awaited them on graduation. Others disputed the rationale of attempting to train all students to be clinical practitioners because societal preferences and the nature of pharmacy practice provided contradictory evidence of such a need. The purpose of this report is to review, from a historical perspective, how the all‐Pharm.D. decision evolved and explore whether the profession might be better served by a different educational system moving forward. It is difficult to find a compelling reason for having eliminated the tiered degree system that existed prior to the all‐Pharm.D. The 5‐year Bachelor of Science (B.S.) in Pharmacy and the 2‐year post‐B.S. Pharm.D. degrees served useful academic purposes and proved to be beneficial for students in each respective program. Some pharmacy schools currently lack sufficient resources to provide advanced clinical training and may be better suited to offering a baccalaureate degree. The nursing model of tiered degrees culminates with the terminal Doctor of Nursing Practice (DNP), which, in large part, justifies the prescribing privileges and provider status afforded to nurse practitioners. A single entry‐level degree system over‐trains many students and undermines the potential of pharmacists to earn prescribing privileges and provider status in recognition of the clinical expertise they possess. A tiered degree system seems better suited to the diverse nature of pharmacy practice. Successfully executing such academic reform would require unity of purpose and collaboration across the profession.

Creation of an Interactive Virtual Surgical Rotation for Undergraduate Medical Education During the COVID-19 Pandemic

ObjectiveDuring the coronavirus 2019 pandemic, medical student involvement in direct patient care has been severely limited. Rotations mandatory not only for core curricula but also for informing decisions regarding specialty choice have been postponed during a critical window in the application cycle. Existing virtual rotations are largely observational or lack patient-facing components.SettingA virtual Otolaryngology - Head and Neck Surgery rotation at the University of Pennsylvania (Philadelphia, Pennsylvania) was implemented for medical students, comprising interactive live-streamed surgeries, outpatient telehealth visits, and virtual small group didactics.ResultsMedical students enrolled in the virtual surgical rotation were able to engage with attending surgeons and operating room staff while remotely viewing surgical procedures captured with first-person audiovisual technology. Students participated in several different aspects of care delivery in both the inpatient and outpatient setting, similar to their typical responsibilities of an in-person rotation.ConclusionsThe authors will continue to develop the virtual surgical education methodology to further disseminate an interactive video-based medical student elective to other procedural specialties and institutions.

Effect of COVID-19 on Urology Residency Training: A Nationwide Survey of Program Directors by the Society of Academic Urologists.

Coronavirus disease (COVID-19) has profoundly impacted residency training and education. To date, there has not been any broad assessment of urological surgery residency changes and concerns during the COVID-19 pandemic. The Society of Academic Urologists distributed a questionnaire to urology residency program directors on March 30, 2020 exploring residency program changes related to the COVID-19 pandemic. Descriptive statistics are presented. A qualitative analysis of free response questions was undertaken. A post hoc analysis of differences related to local COVID-19 incidence is described. The survey was distributed to 144 residency programs with 65 responses for a 45% response rate. Reserve staffing had started in 80% of programs. Patient contact time had decreased significantly from 4.7 to 2.1 days per week (p <0.001). Redeployment was reported by 26% of programs. Sixty percent of programs reported concern that residents will not meet case minimums due to COVID-19. Wellness activities centered on increased communication. All programs had begun to use videoconferencing and the majority planned to continue. Programs in states with a higher incidence of COVID-19 were more likely to report resident redeployment (48% vs 11%, p=0.002) and exposure to COVID-19 positive patients (70% vs 40%, p=0.03), and were less likely to report concerns regarding exposure (78% vs 97%, p=0.02) and personal protective equipment availability (62% vs 89%, p=0.02). As of April 1, 2020 the COVID-19 pandemic had resulted in significant changes in urology residency programs. These findings inform a rapidly changing landscape and aid in the development of best practices.

Medical Students Are Not Essential Workers: Examining Institutional Responsibility During the COVID-19 Pandemic.

In light of the evolving COVID-19 pandemic, the Association of American Medical Colleges (AAMC) and Liaison Committee on Medical Education (LCME) released a joint statement in March 2020 recommending an immediate suspension of medical student participation in direct patient contact. As graduating medical students who will soon begin residency, the authors fully support this recommendation. Though paid health care workers, like residents, nurses, and environmental services staff, are essential to the management of COVID-19 patients, medical students are not. Students’ continued involvement in direct patient care will contribute to SARS-CoV-2 exposures and transmissions and will waste already limited personal protective equipment. By decreasing nonessential personnel in health care settings, including medical students, medical schools will contribute to national and global efforts to “flatten the curve.”The authors also assert that medical schools are responsible for ensuring medical student safety. Without the protections provided to paid health care workers, students are uniquely disadvantaged within the medical hierarchy; these inequalities must be addressed before medical students are safely reintegrated into clinical roles. Although graduating medical students and institutional leadership may worry that suspending clinical rotations might prevent students from completing graduation requirements, the authors argue the ethical obligation to “flatten the curve” supersedes usual teaching responsibilities. Therefore, the authors request further guidance from the LCME and AAMC regarding curricular exemptions/alternatives and adjusted graduation timelines. The pool of graduating medical students affected by this pause in direct patient contact represents a powerful reserve, which may soon need to be used as the COVID-19 pandemic continues to challenge the U.S. health care infrastructure.

Nurse Practitioner Job Satisfaction and the Healthy Work Environment.

Nurse Practitioner Job Satisfaction and the Healthy Work Environment.

Medicine Pharmacy Interprofessional Exercise Pilot: Lessons Learned.

This article was migrated. The article was marked as recommended. The Association of American Medical Colleges and the American Association of Colleges of Pharmacy with leaders of other health professions formed the Interprofessional Education Collaborative (IPEC) in 2009. Interprofessional education (IPE) is now a component of accreditation standards for academic programs in both medicine and pharmacy. While geographically separated, the Medical College of Georgia (Augusta University) and the College of Pharmacy (University of Georgia) have over 40 year history of collaboration but never intentionally added joint curricular offerings.To address IPE competencies, we developed and evaluated a medicine pharmacy collaborative exercise. Specifically, to compare the attitudes and perception toward interprofessional education and practice of students from two disciplines. An observational cross sectional study with 208 third year medical (M3) students and 108 third year pharmacy (P3) students was conducted in two consecutive academic years. Groups consisted of 6-8 M3 and 3-4 P3 students from all campuses across the state. The M3 student was to choose a patient they had seen who was taking at least 3 prescription medications. Objectives for students were to discuss the case (medications, side effects, cost, pharmacogenetics, drug-drug interactions, and cost effectiveness). A report of M3-P3 findings was to be submitted for grading by the Pharmacy faculty. Once the exercises were completed surveys were distributed and the de-identified data was analyzed in relation to IPEC competencies. The study was conducted in one academic year and 316 responses were obtained. Within medical students 48.2 % agreed and 21.2 % strongly agreed to consult with Pharm D in the future. Perception of leadership in the groups was shifted more toward pharmacy students (56.5% vs. 27.4%, p<0.0001). Students confidence in working with other professionals was improved more for pharmacy students than medical students (50.0% in P3 and 30.2% in M3 p =0.0014). Communication skills improved more in P3 than M3 (48.2% in P3 and 28.3% in M3, p=0.0043). More research is needed on equal adoption of IPE by medical and pharmacy students. Emphasis should be made on equal state of training (theory vs. clinical) on both sides with focus on working as a team and value of each team member. More direct involvement in patient care is needed with both M3 and P3 having face to face contact with patients and each other.

A qualitative study of factors that influence active family involvement with patient care in the ICU: Survey of critical care nurses

ObjectiveFamily caregiver involvement may improve patient and family outcomes in the intensive care unit. This study describes critical care nurses’ approaches to involving family caregivers in direct patient care. Research Methodology & DesignThis is a qualitative content analysis of text captured through an electronic survey. SettingA convenience sample of 374 critical care nurses in the United States who were subscribers to one of the American Association of Critical Care Nurses social media sites or electronic newsletters. Main outcome measureCritical care nurses’ responses to five open-ended questions about their approaches to family involvement in direct patient care. FindingsNurse, patient and family caregiver factors intersected in the context of the professional practice environment and the available resources for family care. Two main themes were identified: “Involving family caregivers in patient care in the intensive care unit requires careful ssessment” and “There are barriers and facilitators to caregiver involvement in patient care in the intensive care unit.” ConclusionPatient care demands, the professional practice environment and a lack of resources for families hindered nursing family caregiver involvement. Greater attention to these barriers as they relate to family caregiver involvement and clinical outcomes should be a priority in future research.

The Implications of Missouri's First-in-the-Nation Assistant Physician Legislation.

E ach year, thousands of medical school graduates fail to secure postgraduate training through the National Resident Matching Program. To date, job opportunities for these individuals who would like direct involvement in patient care have been limited. They cannot work as medical practitioners because their lack of postgraduate training renders them ineligible for licensure in any state. US graduates may pursue health care– related employment with the intent of reapplying for residency training, or pursue a nonclinical career path altogether. Additionally, foreign medical graduates may practice in certain countries outside of the United States indefinitely while attempting to obtain a residency position. Recently, Missouri created another option for those lacking residency training. Legislation enacted in 2014 established the position of ‘‘assistant physician,’’ defined as an individual who may be licensed to function as a primary care provider following a brief apprenticeship. This novel approach may draw the interest of stakeholders in other states. However, the consequences of the assistant physician legislation for patient safety and health care quality should be addressed before this approach is considered for broader adoption.

Mastery learning: it is time for medical education to join the 21st century.

Clinical medical education in the 21st century is grounded in a 19th-century model that relies on longitudinal exposure to patients as the curriculum focus. The assumption is that medical students and postgraduate residents will learn from experience, that vicarious or direct involvement in patient care is the best teacher. The weight of evidence shows, however, that results from such traditional clinical education are uneven at best. Educational inertia endorsed until recently by medical school accreditation policies has maintained the clinical medical education status quo for decades.Mastery learning is a new paradigm for medical education. Basic principles of mastery learning are that educational excellence is expected and can be achieved by all learners and that little or no variation in measured outcomes will result. This Commentary describes the origins of mastery learning and presents its essential features. The Commentary then introduces the eight reports that comprise the mastery learning cluster for this issue of Academic Medicine. The reports are intended to help medical educators recognize advantages of the mastery model and begin to implement mastery learning at their own institutions. The Commentary concludes with brief statements about future directions for mastery learning program development and research in medical education.

Trends in lumbar puncture over 2 decades: a dramatic shift to radiology.

The purpose of this study is to evaluate national trends in lumbar puncture (LP) procedures and the relative roles of specialty groups providing this service. Aggregated claims data for LPs were extracted from Medicare Physician Supplier Procedure Summary master files annually from 1991 through 2011. LP procedure volumes by specialty group and place of service were studied. Between 1991 and 2011, the overall numbers of LP procedures increased, with a slight increase in diagnostic LP procedures (90,460 vs 90,785) and a marked increase in therapeutic LP procedures (2868 vs 6461) in Medicare fee-for-service beneficiaries. Although radiologists performed 11.3% (n = 10,533) of all LP procedures in 1991, they performed 46.6% (n = 45,338) in 2011. For diagnostic LPs, radiology (11.4% [n = 10,272] in 1991 and 48.0% [n = 43,601] in 2011) now exceeds emergency medicine, neurosciences, and all others as the dominant provider group. For therapeutic LP procedures, radiology now performs the second greatest number of LP procedures (9.0% [n = 261] in 1991 and 26.9% [n = 1737] in 2011). Although volumes remain small (< 10% of all procedures), midlevel practitioners have experienced over 100-fold growth for most services. The inpatient hospital setting remains the dominant site of service (71,385 in 1991 vs 44,817 in 2011: -37%), followed by procedures performed in the emergency department (297 in 1991 vs 26,117 in 2011: 8794%). Over the last 2 decades, LP procedures on Medicare beneficiaries have increased, with radiology now the dominant overall provider. Although this trend may have relatively negative financial implications for radiology practices in current fee-for-service payment models, it has the potential to cement radiology's more central position through direct involvement in patient care in emerging accountable care organizations.

The customer is always right, even when you are justifiably wrong.

Customer surveys are useful tools for understanding and improving a business. If performed well and interpreted in the appropriate context, they are also useful vehicles for the education of staff members and for the stimulation of positive corporate change. Whether we choose to acknowledge it or not, imaging is a service industry that provides a product. That product is our opinion and advice in the form of a written report. Although our training and the traditions of western medicine may lead us to believe otherwise, in imaging the client is generally the patient’s doctor rather than the patient. Through the process of referral, we are at least one step away from direct involvement in patient care, even though the information that we provide may be absolutely crucial to treatment choices and patient outcomes. Accordingly, a survey of the opinions of referring clinicians regarding imaging reports is, in essence, an assessment of customer satisfaction. The article by Karantanis et al. in the current issue of The Journal of Nuclear Medicine (1 )p rovides some interesting insights with respect to oncologic 18 FFDG PET/CT reporting. The authors surveyed 662 clinicians from See page 1925 a range of pertinent specialties, with the major groups being oncologists (36.1%) and surgeons (33.8%). There was representation from several continents, but most respondents were from Europe (47.3%) or North America (35.0%), and the vast majority (85.8%) of respondents were practicing in an academic environment. Because PET/CT systems have been widely available in academic centers in both of these regions for more than a decade, one can assume a reasonably high level of experience in both the users and the providers of PET/CT services. The specified aim of the survey was to understand the frequency and nature of errors in reporting, as perceived by the end user of the information provided. Overall, 59.3% of respondents estimated that rates of misinterpretation ranged from 5% to 20%. Although this range reflects the typical accuracy reported in individual series and meta-analyses of PET/CT across various malignancies, the upper end of this range may be higher than we, as providers, would like to imagine is the proportion of cases in which we are incorrect. Perhaps the most instructive finding of the survey was that a significantly greater proportion of respondents believed that the major source of errors in reporting of PET/CT studies related to overinterpretation (68.9%) rather than underinterpretation (8.7%). This finding may come as a surprise to many expert PET/CT interpreters, who may have expected the opposite. Since the days of stand-alone 18 F-FDG PET, multiple causes of falsepositive results have been recognized (2). The availability of the additional information provided by the CT component should fur