Experience Of Medical Staff Research Articles

Patient, nursing and medical staff experiences and perceptions of the care of people diagnosed with non-curative palliative esophago-gastric cancer: a systematic review protocol of the qualitative evidence

Review question/objective The overall objective of this systematic review is to synthesize the best available evidence on the experiences and perceptions of patients, nursing and medical staff with regard to the care of people diagnosed with non-curative palliative esophago-gastric cancer. In meeting this objective, this review will consider the following questions: 1. What are the expressed experiences and perceptions of patients, nursing and medical staff with regard to the care of people diagnosed with non-curative palliative esophago-gastric cancer? 2. What do patients, nursing and medical staff believe are the most appropriate and acceptable ways to deliver care to people diagnosed with non-curative palliative esophago-gastric cancer? 3. What do patients, nursing and medical staff believe influences achievement of the best quality of life for patients diagnosed with non-curative palliative esophago-gastric cancer? Inclusion criteria Types of participants This review will consider studies that include any participant involved in the delivery of palliative care to people diagnosed with palliative esophago-gastric cancer in a hospital, home or community setting. International evidence will be included, but only that written in the English language. Health care practitioner will include nursing, medical and allied health professionals, including registered and non-registered health care practitioners (e.g. health care support workers). The review will also consider studies of experiences and perceptions of patients diagnosed with palliative (non-curative) esophago-gastric cancer aged 18 years or older. Studies of experiences and perceptions of adult participants with potentially curative esophago-gastric cancer or of those adults with curative treatment intent for esophago-gastric cancer will be excluded. Phenomena of interest This review will consider studies that investigate the experience and perceptions of people diagnosed with non-curative palliative esophago-gastric cancer and the staff working with these people. By considering the experiences and perceptions of these people, information related to what patients, nursing and medical staff believe are the most appropriate and acceptable ways to deliver care to people diagnosed with non-curative palliative esophago-gastric cancer may become clear. Additionally, what the patients, nursing and medical staff believe influences achievement of the best quality of life for patients diagnosed with non-curative palliative esophago-gastric cancer may be found.

Improving the management and care of people with sepsis

Many hospitals struggle to implement the full sepsis care bundle, but research suggests that many patients with sepsis are transported to hospital by ambulance. In 2011, the Scottish Ambulance Service introduced a pre-hospital sepsis screening tool (PSST) to expedite sepsis identification and care delivery. However, ambulance clinicians have reported varying degrees of interest and enthusiasm from hospital staff during handover. Therefore, an online survey was set up to investigate medical and nursing staff perceptions and experiences of the introduction of a PSST. This article discusses the results, which show that participants perceive the PSST reduces time to treatment, improves continuity of care, benefits patients and is accurately applied by ambulance clinicians, but which also highlight problems with communication. The delivery of in-hospital and pre-hospital sepsis care is challenging, but simple measures such as improving and standardising communication and alert systems between ambulance services and receiving hospitals could improve the clinical effects of a PSST.

Approach to trauma biliary lesions at the João XXIII Hospital

Trauma biliary lesion is not common. It is observed, regardless of its mechanism, in 0.1% of admissions to trauma services. The gallbladder is the segment of the biliary extra-hepatic pathway most often affected. Lesions of bile ducts constitute a challenge to medical expertise, with significant morbidity; treatment is dependent on several factors such as degree of lesion, time of diagnosis, and medical staff experience in their approach. Due to the rarity of these lesions, surgical correction is difficult and controversial. This review presents the perspective on this topic from the Service of General Surgery and Trauma at the Joao XXIII Hospital and the Hospital Foundation of the State of Minas Gerais highlighting its incidence, mechanism of lesion, and treatment.

Medical staff experience and acceptance of an ICU insulin infusion protocol in a tertiary hospital in the Philippines

Medical staff experience and acceptance of an ICU insulin infusion protocol in a tertiary hospital in the Philippines

Abstract WP37: The Effect of Weekend Admission on Intracerebral Hemorrhage Outcome at High Volume Institutions

INTRODUCTION: Admission for urgent care on weekends has been suggested to result in increased risk of poor outcome. Studies have suggested that admissions for intracerebral hemorrhage (ICH) have resulted in a significant increase in in-hospital mortality on a national level. The utilization of regional, high volume centers specializing in the management of acute stroke may be a potential remedy to this variability in care. We sought to test this hypothesis by examining the outcomes of ICH patients admitted to the Columbia University Medical Center Neurological ICU (NICU). Methods: The medical records of 229 ICH patients admitted to the NICU from 2009 to 2012 were identified through the Intra-Cerebral Outcomes Project prospective database and examined for weekend versus weekday admission to the NICU, as well as day versus night admission. Multiple logistic regression was used to asses for predictors of in-patient mortality and poor outcome at 3 months, defined as a modified Rankin score of 4 or greater. Outcome measures were corrected for admission severity of presentation and demographics. Results: Sixty-five admissions were recorded to have occurred on the weekend, with 14 (21.5%) patients dying in hospital. Forty-nine (29.8%) of the 164 weekday admissions resulted in mortality (p=0.27). The 3 month follow up of surviving patients was 3.4 in weekend admissions and 3.1 in weekday admissions (p= 0.93). One hundred and one night admissions occurred, with 30 in-hospital mortalities. One hundred twenty-one patients were admitted during the day shift, with 32 in-patient mortalities occurring (p=0.54). The average outcome at 3 months was 3.0 in night admissions and 3.3 in day-time admissions (p=0.39). Conclusions: No significant difference in the mortality or 3 month outcome of patients was identified regardless of day or time of admission. This may be secondary to a higher number of weekend and night duty personnel capable of being mobilized during crisis situations compared to other centers, or the increased experience of medical staff in the work up and acute management of ICH patients. When possible, aggressive diversion of patients to high volume, specialized care centers may reduce the risk of variability in care based on time of admission.

Mammography and Ultrasonography Reports Compared with Tissue Diagnosis - An Evidence Based Study in Iran, 2010

Breast cancer is the most prevalent cancer and the fifth cause of cancer death in Iranian women. Early detection and treatment are important for appropriate management of this disease. Mammography and ultrasonography are used for screening and evaluation of symptomatic cases and the main diagnostic test for breast cancer is pathological. In this study we evaluated mammography and ultrasonography as diagnostic tools. In this cross-sectional study 384 mammography and ultrasonography reports for 255 women were assessed, divided into benign and malignant groups. Suspected cases were referred for pathology evaluation. The radiologic and pathologic reports were compared and also comparison was performed based on age groups (more and less than 50 years old), history of breastfeeding and gravidity. Statistical analysis was performed by SPSS. The mean ages of malignant and benign cases were 49±11.6 and 43±11.2 years, respectively. Sensitivity and specificity for mammography were 73% and 45%, respectively. Sensitivity and specificity for ultrasonography were 69% and 49%, respectively. There were statistical differences between specificity of mammography in patients based on factors such as history of gravidity, breastfeeding and sensitivity in patients equal or more than 50 years old and less. Factors affecting different results in mammography and ultrasonography reports were classified into three groups, consisting of skill, experience and training of medical staff, and setting of instruments. It is recommended that health managers in developing countries pay attention the quality of setting and man power more than current status. Policy-makers and managers must establish guidelines regarding breast imaging in Iran.

64P Mammography and Ultrasonography Reports Compared with Tissue Diagnosis: An Evidence-Based Study, Iran, 2010

IntroductionBreast cancer is the most prevalent cancer and the fifth most frequent cause of cancer death in Iranian women. Early detection and treatment are important for appropriate management of this disease. Mammography and ultrasonography are used for screening and evaluation symptomatic cases and the main diagnostic test for breast cancer is pathology. In this study we evaluate mammography and ultrasonography as diagnostic tools. MethodsIt is a cross-sectional study evaluating 384 mammography and ultrasonography reports belonging to 255 women. According to these reports, patients were divided into two groups. The suspected cases were referred for pathology evaluation. The radiologic and pathologic reports were compared and comparison was performed based on age groups (more or less than 50 years old), history of breastfeeding and gravidity. Statistical analysis was performed by SPSS. ResultsThe mean ages of malignant and benign cases were 49 ± 11.6 and 43 ± 11.2 years, respectively. Sensitivity and specificity for mammography were 73% and 55%, respectively. Sensitivity and specificity for ultrasonography were 69% and 51%, respectively. There were statistical differences between the specificity of mammography in patients with or without history of gravidity, with or without history of breastfeeding and sensitivity between patients aged 50 or more and those less than 50 years old. ConclusionFactors affecting different results in mammography and ultrasonography reports were classified into three groups consisting of: skill, experience and training of medical staff, and setting of instrument. It is recommended that health managers in developing countries pay attention to the quality of setting and manpower more than is currently the status. Policy makers and managers must develop guidelines regarding breast imaging in Iran. DisclosureAll authors have declared no conflicts of interest.

Support for Older People with COPD in Community Settings: A Systematic Review of Qualitative Research.

There are an estimated three million people affected by Chronic Obstructive Pulmonary Disease (COPD) in the UK with only about 900,000 of these being diagnosed according to the Healthcare Commission, and prevalence is increasing. Significant progress has been made in respect of treatment and management of the disease. However, there is limited evidence related to the perspective of those with COPD despite an acknowledgement that lung function, as determined by spirometry, does not necessarily equate with pulmonary disease and subsequent functional level or disability. The impact of COPD on patients, their family, carers and healthcare services demands that better ill health prevention and disease maintenance strategies be employed. The objective was to explore the common and shared experiences of those in caring partnership for patients with COPD receiving care and support in their community. For this review, the definition of support takes the view that support relates to 'any activity or intervention aimed at improving or maintaining the health status of a patient with COPD'. The review focused on the experiences of patients, carers, family members, nurses and doctors involved in providing support to patients with COPD in their own home. Patients aged 65 years and over were included.The review considered studies that represented patient, carer, nursing and medical staff experiences and perceptions of support relating to COPD.The review considered evidence from qualitative research including phenomenology, grounded theory, and descriptive studies, where support for COPD in a community context was the focus. The search set out to find published studies in English from 1990-2010. The studies were appraised and findings extracted using the JBI critical appraisal tool for qualitative research. Three reviewers appraised the studies independently. 72 studies were critically appraised and 39 met the inclusion criteria. Findings from included papers were aggregated, categorised and synthesised. If those with COPD received more consistent support in relation to information, rehabilitation, end of life care and other service provision then their quality of life could be enhanced.Better planned and more integrated support for home based care around self-care/management and in managing exacerbations can reduce patient and carer anxiety and distress related to COPD.Individualisation of care, which is not based on the patient's 'disease state' (i.e. physical parameters) but on assessed need, is a necessary part of care for those with COPD.

Support for Older People with COPD in Community Settings: A Systematic Review of Qualitative Research

There are an estimated three million people affected by Chronic Obstructive Pulmonary Disease (COPD) in the UK with only about 900,000 of these being diagnosed according to the Healthcare Commission, and prevalence is increasing. Significant progress has been made in respect of treatment and management of the disease. However, there is limited evidence related to the perspective of those with COPD despite an acknowledgement that lung function, as determined by spirometry, does not necessarily equate with pulmonary disease and subsequent functional level or disability. The impact of COPD on patients, their family, carers and healthcare services demands that better ill health prevention and disease maintenance strategies be employed.The objective was to explore the common and shared experiences of those in caring partnership for patients with COPD receiving care and support in their community.For this review, the definition of support takes the view that support relates to 'any activity or intervention aimed at improving or maintaining the health status of a patient with COPD'.The review focused on the experiences of patients, carers, family members, nurses and doctors involved in providing support to patients with COPD in their own home. Patients aged 65 years and over were included.The review considered studies that represented patient, carer, nursing and medical staff experiences and perceptions of support relating to COPD.The review considered evidence from qualitative research including phenomenology, grounded theory, and descriptive studies, where support for COPD in a community context was the focus.The search set out to find published studies in English from 1990-2010.The studies were appraised and findings extracted using the JBI critical appraisal tool for qualitative research. Three reviewers appraised the studies independently. 72 studies were critically appraised and 39 met the inclusion criteria.Findings from included papers were aggregated, categorised and synthesised.If those with COPD received more consistent support in relation to information, rehabilitation, end of life care and other service provision then their quality of life could be enhanced.Better planned and more integrated support for home based care around self-care/management and in managing exacerbations can reduce patient and carer anxiety and distress related to COPD.Individualisation of care, which is not based on the patient's 'disease state' (i.e. physical parameters) but on assessed need, is a necessary part of care for those with COPD.

James McKenna, Farhat Manzoor and Greta Jones, Candles in the Dark: Medical Ethical Issues in Northern Ireland during the Troubles (London: Nuffield Trust, 2009), pp. v + 149, no price given, paperback, ISBN: 978-1-905030-32-3.

This is an important book that will appeal, not only to historians of medicine, but to social historians and those interested in the history of the Troubles in Northern Ireland. The authors have given an insightful account, which at times makes difficult reading, but which, nevertheless, is significant in its contribution to the history of the Troubles, encompassing the period from 1969 until the second ceasefire in 1998. The research conducted for this book is a momentous achievement: the authors conducted oral history interviews with over two hundred people over a three-year period, with the chief objective of trying to find out how difficult it was to conduct medical work in Northern Ireland in the period, and ‘to maintain the medical codes of ethics governing health care’ (p. 2). The interviewees consisted of health professionals, patients, ex-prisoners and medical staff working in prisons. The authors draw attention to the particular problems of oral history in the case of Northern Ireland, but in spite of these, the book as a whole gives a balanced view of the issues of both sides of the Divide, and the oral history accounts are compelling and give a personal insight into the experiences of men and women during the Troubles. Following the introduction and a chapter on the background to the history of the Troubles in Northern Ireland, the main part of the book opens with two chapters that deal with the experiences of health professionals and patients. The first of these examines the effects of the Troubles on the work of general practitioners in Northern Ireland in the period, in particular, focusing on the difficulties that they encountered while trying to go about their daily work, such as unofficial roadblocks and the increased demand on mental health skills. In addition, the chapter examines the effects on patients, such as the difficulties they experienced in travelling to hospital and how their political and religious persuasions may have affected their choice of hospital and/or GP. The next chapter gives an insight into the particular problems that hospital staff and patients had to contend with during the Troubles. Notably, Northern Irish hospitals, such as the Mater Infirmorum, which straddles ‘one of the most fraught community interfaces in Belfast’, witnessed a great deal of civil strife and violence during the Troubles (p. 43). The chapter also addresses the issues of staff and patient security in Northern Irish hospitals in the period, indicating how these factors ‘complicated the lives of medical professionals and intruded directly on the delivery of medical care’ (p. 63). The final two chapters deal with the issue of medical care in prisons during the Troubles. The first of these is largely based on the allegations of prisoners and gives an insight into the effects of the Troubles on both prisoners and prison doctors during the period. The final chapter deals with the topic of ‘Prison Protests’, in particular, focusing on the ‘Dirty Protest’ and the strain it placed on medical services. This chapter was well balanced, and gave adequate focus to the experiences of prison medical staff, the stories of whom are often neglected in broader histories of the Troubles. Doctors working in prisons were targets for assassination on the outside, and the type of work they experienced resulted in consequences for their mental health, with one senior doctor, ‘Dr P’, who nursed most of the hunger strikers, representing a victim of this and committing suicide, arguably as a result of the pressures of his job (pp. 105-6). This book is a significant contribution to the history of Northern Ireland, examining the history of the Troubles from the perspective of those delivering and receiving medical care. The oral history accounts which form the basis of the book will represent a valuable historical resource for future generations of historians.

Epidemiology and outcomes of dermatology in-patient consultations in a midwestern U.S. university hospital

A paucity of data exists concerning the utilization of in-patient dermatologic consultations. Previous studies on this subject have indicated a knowledge deficit of primary care providers with regard to common dermatoses, prompting a need for more effective teaching mechanisms in this area. To identify dermatologic conditions in the in-patient setting that are frequently misdiagnosed by non-dermatologists in order to improve future patient care and cost reduction through physician education. Retrospective chart review of 271 consecutive dermatologic consultations from primary ward teams between January 20, 1998, and May 19, 1999. Non-dermatology in-patient services at a Midwestern state-supported university hospital system in the U.S. Patients hospitalized on non-dermatology wards with skin problems prompting a formal dermatologic consultation. None. Prevalence of dermatologic conditions that are most frequently misdiagnosed on non-dermatology in-patient services. Seventy-six percent of the dermatologic consults were requested by Internal Medicine, Surgery, and Psychiatry departments. Common skin conditions accounted for a large majority of dermatologic consultations including: dermatitis (21.0%) and drug eruption (10.0%). The primary ward team submitted a correct dermatologic diagnosis in only 23.9 percent of cases. Dermatology consultation resulted in a change in or addition to treatment in 77 percent of patients. Our results suggest that common skin conditions account for a large majority of dermatologic consultations in a University hospital setting. Modern hospital ward teams continue to struggle with accurately recognizing and appropriately managing common skin problems resulting in inappropriate treatment, wasted resources, and prolonged hospitalization. Increasing medical student and house staff knowledge and experience in the diagnosis and management of common skin disorders could help address this problem.

Medical knowledge management for specific hospital departments

Medical knowledge representation and management is concerned with how to organise the often vague clinical experience of medical staff required for computable models. However, few knowledge management and acquisition tools have entered routine use, since such tools are not perceived by physicians as part of the clinical information process. An attempt to partially solve this problem, we identify two key aspects of knowledge representation and management tasks. The first is to adopt a medical knowledge standardisation to provide a consistent terminology control and to simplify the integration between knowledge management tools and the health information system. The second is to establish an effective knowledge acquisition process in specific medical fields by adapting knowledge acquisition tools. Therefore, the main goal of this work is to define computational models and to design mechanisms for the effective acquisition and management of medical knowledge in real-life hospital departments. To this end, we analyse the representation of medical knowledge (based on deep-causal models) and the development of knowledge management tools (based on ontologies), integrated within the information processing activities of the clinical user. Finally, we illustrate its applicability in the Intensive Care Unit and Pediatry scenarios.

When a child says ‘no’: experiences of nurses working with children having invasive procedures

Experiencing invasive medical procedures can be a devastating experience for some children and their parents. The potential impact on staff who perform the procedure and who may have to restrain the child who is unwilling to have an essential procedure is a neglected area of research. Children's distress and their coping are affected by those around them so it is important to understand how nurses react in these situations. To explore the experiences of nursing staff involved in facilitating invasive procedures for children who do not want them. Participants were selected at random from staff lists of one hospital in the West Midlands. Data collection was undertaken using unstructured qualitative interviews with ten paediatric nurses and in two focus groups. Theories generated from each interview were tested and validated with participants in subsequent interviews and then in the focus groups. The most common experiences reported by the participants were 'getting upset' and 'getting stressed' by some aspect of the medical procedure, either because the child or parents became upset or the procedure had gone wrong in some way. Procedural protocols that exist to protect children, for example, by limiting the number of unsuccessful attempts to undertake the procedure, also protect staff by providing a framework to manage emotions during the procedure. Being able to explain the process and need for the procedure to the child and parents, obtaining consent where possible for the use of certain techniques, such as restraint, and having the time to adequately prepare a child for a procedure, all helped minimise the likelihood of an unsuccessful procedure, thereby reducing the risk of the nurse being emotionally affected by a distressed child. Nurses working with children who are unwilling to undergo invasive procedures experience negative emotions but these are short lived due to a combination of protective factors and coping strategies. Further research is needed to understand the experiences of medical staff and of nurses working outside paediatric environments who may not experience the same support and protection as those in paediatric settings.

Practice variation in initial management and transfer thresholds for infants with respiratory distress in Australian hospitals. Who should write the guidelines?

In Australian hospitals: (i) to identify current practices in the initial oxygen management of infants with respiratory distress; (ii) to identify factors important in deciding to transfer an infant; and (iii) to identify thresholds for transfer. All Australian hospitals with: >200 registered deliveries, a special care unit (SCU) or neonatal intensive care unit (NICU), and at least one paediatrician were surveyed in 2004 (n=176). The questionnaire sought information on the initial oxygen management and factors important in deciding to transfer. Three scenarios were also used to identify thresholds for pH, carbon dioxide and oxygen levels at which transfer should occur. Responses from SCU were compared with those from NICU. 15/19 (79%) NICUs and 118/157 (75%) SCUs responded. Initial oxygen management varies widely among SCUs and NICUs. NICUs set significantly lower saturation (SaO(2)) targets in two of the three scenarios. NICUs are statistically significantly more likely to regard 'Medical Staff Experience' and 'Time to Nearest NICU' as important compared with SCUs (P<0.05). NICUs would 'Probably' and 'Definitely Transfer' infants at significantly lower oxygen levels in all three cases (P<0.05). SCUs are significantly less likely to transfer babies with pH of <7.25 compared with NICUs. There was no difference between the centres for CO(2) level. The wide variation that exists between nurseries in the initial management of infants with respiratory distress and in the thresholds for transfer strongly suggests the need for the development of practice guidelines.

Mechanical Ventilation In Pediatric Surgery In The First Years Of Life: Spectrum And Mortality

Background/aim: Congenital diaphragmatic hernia (CDH), abdominal wall defects, esophageal atresia and congenital gastrointestinal anomalies are major indications for mechanical ventilation (MV) in the pediatric surgery. The aim of this study was to determine the spectrum and the results of MV treatment of in the surgical neonatal intensive care unit (NICU) . Patients and method: We did a retrospective analysis of all consecutive admissions of children to our pediatric NICU between 1995 and 2001 with various diagnoses on admission. The cases were examined for age, gender, duration of hospitalization, medication used, yearly distribution of cases that underwent MV and in regard to the effected system and mortality. Results: In this study charts of 692 cases were evaluated. The mean birth weight and the mean age of patients were 2732 g (900g-12 kg) and 3,6 days (1 day-12 months) respectively. The male: female ratio was 2,2: 1. Total 230 patients (33,2%) were mechanically ventilated. The most common indication for the MV was CDH (74%). Mean ventilation time was found to be 6,9 days (1 day-1 year), mean hospitalization time 11,4 (1 day-1 year). The overall mortality was found 53,1%. The highest mortality was 60,7%, in patients with CDH respectively. This mortality rate decreased in recent years. Conclusion: The results of this study showed, that the experience of pediatric surgical medical staff with MV improved and the mortality rate decreased with the use of MV.

Jobs for the Boys? A Study of the Employment of Club Doctors and Physiotherapists in English Professional Football

Using a mixture of semi-structured tape-recorded interviews and postal questionnaires, this article examines aspects of the employment of club doctors and physiotherapists in English professional football clubs, with particular emphasis on the methods of appointment, experience and qualifications of club medical staff. It is argued that the process of appointing club doctors and physiotherapists constitutes a catalogue of poor employment practice. Methods of appointment are very informal; medical posts are hardly ever publicly advertised and many doctors and physiotherapists are appointed on the basis of personal contacts, often without interview; few doctors have prior experience of or qualifications in sports medicine and half of all physiotherapists do not have chartered status.

Morsures et envenimations ophidiennes

Snakebites constitute a medico-surgical emergency observed in all the continents. Its frequency increases in tropical countries and major difficulties for medical cares appear in the developing countries. Not all the snakes are poisonous and the latters can inflict bites without clinical consequences. The annual number of snake-bites exceed 5 millions in the world; the number of envenomations is less than 3 millions and deaths reach about 125 000. Snake venoms are composed of enzymes which act on blood coagulation or cause the destruction of tissues and toxins active on neuromuscular conduction. Roughly, one distinguishes neurotoxic syndromes induced by Elapidae (cobras) and inflammatory, haemorrhagic or necrotic syndromes due to Viperidae (vipers and pit-vipers). The formers can result in death by respiratory paralysis, the latters by massive haemorrhages. The treatment of the confirmed envenomation is primarily based on the antivenom administration through venous route as soon as possible after the bite. Adjuvant treatment, notably resuscitation cares, should depend on symptoms and experience of medical staff.

Pain in children: qualitative research of Finnish school-aged children's experiences of pain in hospital.

The purpose of the study was to describe school-aged children's experiences of pain in the hospital. Data were collected from 20 children aged between seven and 11 years of age who were inpatients in the pediatric wards of the University Hospital, Oulu, Finland. Each of the children wrote of their experiences of pain in the hospital, and they were interviewed on the basis of this information. The data were analyzed inductively using content analysis. On the basis of the analysis, the situations that caused pain to all children in the hospital were found to be procedures connected with needles. The children described their experiences of pain as both physiological (e.g. poking, stinging, aching) and psychological feelings (unpleasant feelings, terror, anxiety, and fear). In addition, methods of relieving pain (coping mechanisms, help from the medical staff, parental presence, and previous experiences of similar situations) were acknowledged. The results indicate that school-aged children (aged 7-11 years) are able to describe their pain experiences, which should be considered in assessment and treatment of children's pain in nursing practice.

Wanted: A New Breed of Physician Drivers for Healthcareʼs Nitroglycerin Trucks

Nobody said it better than did Jeff Goldsmith in prescient article earlier this decade: The current generation of health care executives, medical school deans, and physician leaders are caught in the transition from an atomized entrepreneurship to an organized, collegial physician culture. Fostering collegiality-a scarce commodity in the current clinical environment-is the essential task in creating an integrated health care enterprise. In the explosive climate of many medical communities today, the task of is akin to driving nitroglycerin truck along bumpy road. Leaders without the political skills to sense the bumps before they hit them will never know what hit them. (Goldsmith 1993) As the millenium approaches and in the wake of all too many healthcare explosions since Goldsmith's classic article, Mike Guthrie's account of physician and management reverberates with experience and insight-and not surprisingly. My first acquaintance with Mike was in the mid-1980s, when he was president-elect of the American College of Physician Executives (ACPE). By then his evolution as what I call the evolved physician executive was well under way. He had been both practicing clinician and hospital vice president for medical affairs (VPMA). What especially drew my attention at this first acquaintance, however, was that he had already acquired his MBA degree. With this additional qualification he had transcended the typical medical staff liaison role of the VPMA to become vice president for business development of successful Colorado hospital on whose system board I then served. In this decade he has moved on to become hospital CEO in one of America's most dynamic markets and now occupies major role in national multihospital/system consortium. Suffice it to say, Mike speaks with genuine authority on physician leadership. As physician who has held modest roles during my active practice/ hospital medical staff experience and who has focused for the last 18 years on consultation and learning facilitation to physician leaders, I can fully endorse many of Mike's key points: Yes, leadership of physicians is because of the social and cultural differences among physicians. This reality most certainly creates unique obstacles to success as designated physician leaders attempt to move their colleagues in what the latter frequently perceive as dubious directions. A wellspring of potential physician currently exists. Individual institutions-if they have the true will to do so-can take variety of pathways toward developing this potential. Additionally Mike's concept of a self-- confident, articulate, and supportive physician who can keep the trust of other physicians in the organization while articulating and implementing the vision and the objectives necessary for the organization to succeed is not pipe dream. The actualization of this definition is necessity if healthcare is to bring forward the best of what the medical profession has achieved to the present and integrate this history with the organizational and systems concepts so vital to the healthcare system now emerging. Indeed, this goal might well be the core job description of the majority of physician leaders serving in roles within medical group practices, physician networks, hospitals, and health systems. Why can I so strongly support this definition? Because I believe that medicine is experiencing true industrial revolution, as it was termed by the physician leader of one system in volatile market. Our profession is moving from the context of craft-based endeavor that physicians-individually and collectively-largely dominated, to systems-based enterprise in which collaborative between clinicians and professional managers is absolutely essential if we are to move the best that American medicine has achieved to its next level of development. …

Clinical privileges for rural general practitioners.

Improved training programs and registrable qualifications are now available for graduates wishing to pursue a career in rural practice. In the near future, newly established rural doctors will be able to furnish documentation on substantial additional training, which will include competence in a range of procedural skills. In an environment of increasing regulation and litigation awareness, hospitals are developing systems for recognising the skills and experience of medical staff. However, most clinical privileges systems have been developed for larger hospitals and with procedural sub-specialists in mind. This paper proposes an approach to developing clinical privileges systems that are more appropriate to smaller rural hospitals, so that the skills of rural doctors are fully utilised by their communities.