Private Medical Practice Research Articles

Switching statin-treated patients from fenofibrate to the prescription omega-3 therapy icosapent ethyl: a retrospective case series.

IntroductionPatients receiving statin therapy for dyslipidaemia often require treatment with an additional agent to control triglyceride levels. Options for add-on therapy include fibrates and omega-3 fatty acids. This case series describes the effects of switching add-on therapy from fenofibrate to icosapent ethyl (the ethyl ester of the omega-3 fatty acid, eicosapentaenoic acid) on patient lipid profiles.MethodsThis was a retrospective analysis of patient records from a private medical practice in western New York. Statin-treated patients with dyslipidaemia who had been treated with fenofibrate and later switched to icosapent ethyl were selected for analysis. Lipid profiles before and after the switch to icosapent ethyl were compared.ResultsThe records of five patients were analysed. All patients had hypertension and were overweight, male, and at high cardiovascular risk. After the switch to icosapent ethyl (treatment duration 3.9–5.8 months), triglyceride levels decreased in four patients, and low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, and total cholesterol levels decreased in all patients. High-density lipoprotein levels increased in four patients. Icosapent ethyl was well tolerated.ConclusionsSwitching from fenofibrate to icosapent ethyl as add-on to a statin therapy due to clinical need may provide an option for patients to maintain or improve lipid parameters.

Angioplastie coronaire, coronarographie et pontage aorto-coronarien en France : une approche géographique

There are major geographic disparities in the practice of coronary angioplasty and coronarography in France. Their study shows that the frequency of these procedures is linked to the density of private medical practice (cardiologist's offices or clinics). This is not observed as far as coronary artery bypass surgery is concerned. This indicates an induction effect from simply on demand. However, this cannot give indication on the pertinence of those acts since this induction effect may as well be beneficial to patients. Nevertheless, this study gives an insight to the regulatory authorities (Regional Health Agencies and the National "Direction Générale de l'Offre de Soins") which have to manage health care system performance on the basis of the principles set out and international guidelines so as to provide equal access for all to a quality healthcare system.

The Business of Private Medical Practice: Doctors, Specialization, and Urban Change in Philadelphia, 1900–1940 by James A. Schafer, Jr. (review)

The Business of Private Medical Practice: Doctors, Specialization, and Urban Change in Philadelphia, 1900–1940 by James A. Schafer, Jr. (review)

Civil Liability for Medical Malpractice. Damage Resulting from Doctor’s Negligence (Breach of Professional Duties)

Abstract Civil liability for medical malpractice may be attributed either to a doctor or a hospital when any of these persons’ acts or omissions cause injuries to a patient; it may be also the hospital’s liability for the damage caused by negligence of its staff (doctors and other personnel). The rules that govern this liability and the way of compensating the damage are different due to the grounds on which the doctor performs medical services and, in case of hospital’s liability, the relation between a doctor and a health care institution. A doctor who runs his private medical practice bears civil liability individually and is obliged to pay damages if any of his patient suffers injury in connection with the treatment. However, a doctor who acts as employee of a health care institution is protected by the provisions of the Labour Code and exempted from civil liability to a patient. On the other hand, a so-called independent contractor’s liability is joint and several with a hospital that has engaged him. However, case law seems to protect such doctors and treat them as hospital’s employees if certain premises are fulfilled (like de facto subordination of the doctor to the head of the ward).

Removal of a facial fibroepithelial polyp in private medical aesthetic practice

The removal of a benign skin lesion is considered to be a cosmetic procedure of low clinical priority. Therefore, this procedure is rarely available via the routine referral pathway of the NHS. Funding to perform such procedures is also rare. Although no definitive guidelines for this procedure exist, most health boards have a treatment policy whereby a restricted access criterion has been stringently agreed. This case study is a critical incident review exploring all aspects of communication and care delivered to a 49-year-old female patient who sought private care for the removal of an unsightly facial fibroepithelial polyp.

The Business of Private Medical Practice: Doctors, Specialization, and Urban Change in Philadelphia, 1900–1940

The Business of Private Medical Practice: Doctors, Specialization, and Urban Change in Philadelphia, 1900–1940

The Business of Private Medical Practice: Doctors, Specialization, and Urban Change in Philadelphia, 1900-1940

Journal Article The Business of Private Medical Practice: Doctors, Specialization, and Urban Change in Philadelphia, 1900–1940 Get access James A. Schafer. (New Brunswick: Rutgers University Press, 2014. xii, 250 pp. Cloth, $72.00. Paper, $32.95.) Journal of American History, Volume 101, Issue 4, March 2015, Pages 1295–1296, https://doi.org/10.1093/jahist/jav024 Published: 01 March 2015

Devaluation of a Constitutional Guarantee: The History of Section 51 (xxiiiA) of the Commonwealth Constitution

This article describes constitutional and socio-historical background to the referendum that led to the insertion of s 51(xxiiiA) into the Commonwealth Constitution. It traces judicial interpretations of the clause 'but not so as to authorise any form of civil conscription' through the major cases, including British Medical Association v. Commonwealth, General Practitioners Society v. Commonwealth, and Alexandra Private Geriatric Hospital Pty. Ltd. v. Commonwealth. The issue of the powers of the Commonwealth to regulate private medical practice without infringing the constitutional guarantee against civil conscription is analysed in the context of the development of National Health Care Schemes for financing medical benefits (Health Insurance Commission v. Peverill). Constitutional aspects of the 1995 legislation enabling the introduction into Australia of purchaser-provider agreements ('managed care') are also examined. Finally, the article questions the constitutionality of the Australian Competition and Consumer Commission's powers to regulate the essential elements of the patient-doctor relationship.

James A. Schafer Jr. The Business of Private Medical Practice: Doctors, Specialization, and Urban Change in Philadelphia, 1900–1940.

James A. Schafer Jr. The Business of Private Medical Practice: Doctors, Specialization, and Urban Change in Philadelphia, 1900–1940.

The Business of Private Medical Practice: Doctors, Specialization and Urban Change in Philadelphia, 1900–1940

The Business of Private Medical Practice: Doctors, Specialization and Urban Change in Philadelphia, 1900–1940

Two decades of using the combination of tetracycline derivatives and niacinamide as steroid-sparing agents in the management of pemphigus: Defining a niche for these low toxicity agents

The twin goals of long-term disease control and minimizing toxicities related to immunosuppression necessitate efforts to find effective steroid-sparing agents in the management of patients with autoimmune bullous diseases. Pemphigus especially requires a long view, because the disease can persist throughout a patient's lifetime, yet few clinical trial reports exist to guide the practitioner. We review the response of pemphigus patients to tetracycline, doxycycline, or minocycline plus niacinamide (TCN/NAM) as steroid-sparing therapy and to determine the effects of TCN/NAM on autoantibody levels during the long-term treatment of pemphigus. This was a retrospective chart review in a private medical dermatology practice setting of all pemphigus patients treated between 1993 and 2013. Clinical responses to TCN/NAM therapy after initial high-dose steroid induction therapy and pemphigus antibody levels were recorded over the course of disease flares and treatment cycles along with any related side effects. Anti-desmoglein 1 and 3 titers were compared in a subset of patients over time, and a statistical analysis was performed to correlate the clinical response with antibody levels. Fifty-one pemphigus patients (43 with pemphigus vulgaris, 7 with pemphigus foliaceous, and 1 with pemphigus erythematosus) received at least 3 months of TCN/NAM, and 16 patients with pemphigus vulgaris had 1 set of pemphigus antibody titers correlating to a baseline/flare and clinical remission. TCN/NAM was associated with disease control in 43 of 51 patients, with a duration of response ranging from 1 to 13 years (mean, 3.14 ± 2.97 years). Thirteen of 51 patients needed no additional treatment for complete disease control, while 33 of 51 needed intermittent topical clobetasol or short courses of oral steroids for long-term management. There were 5 nonresponders. Antidesmoglein titers trended lower in TCN/NAM responders, but only desmoglein 3 approached statistical significance (anti-desmoglein 1, P= .21; anti-desmoglein 3, P= .02). This is a retrospective analysis from a single practice. A lack of serial autoantibody titers limited statistical analyses. TCN/NAM may be useful as a steroid-sparing therapy for pemphigus.

Ethical and deontological dominants in ophthalmology

In the article the ethical and deontological dominants as scientific and practical strategy that prevents the medical errors, and humanization doctor-patient relationship through a formation of culture of communication are presented. Ophthalmology as a branch of practical and scientific medicine requires special relationship between doctor and patient, and because of this it also requires particular ethical and deontological interpretation. Formal signs of ethics laws concerning ophthalmic practice aren’t worth anything in case of unskilled diagnosis and treatment. Possibility of errors on the part of the doctor-ophthalmologist while aiding a patient is of a special importance. In planed and in urgent cases irreparable flaws are not excluded. Consideration should be given, in particular, to the errors in the initial examination, insufficient amount of additional methods of examination, overdiagnosis, errors in determining the treatment strategy (conservative or surgical) and others. Identification and analysis of the errors in order to prevent them is the ethical imperative in medical practice and effective way to improve clinical medicine. The author of the article describes the causes of errors, indicating that they are objective and subjective. The first are related to the change of views on the treatment of a certain disease. The complex of therapeutic measures, that was considered the most rational until recently, can be proven as wrong from the perspective of the latest achievements of science. Mistakes made by doctors in their communication with patients as a result of not following the basic deontological principles are also included here. In addition, the classification of medical errors on deontological, diagnostic, therapeutic is made and their essence is analyzed in the article. The violation of the principles of appropriate behavior of the doctor in treating the patient, that is not following the ethics of medical practice by the doctor, is the base of deontological errors. The main reasons for diagnostic errors are: ignorance or inept use of medical history, incomplete examination of the patient, a false interpretation of clinical data, erroneous assessment of radiological and laboratory tests; carelessness and haste in the examination, the wrong formulation of diagnosis. Medical errors are related to the incorrect clinical diagnosis. As a result of such diagnoses, patients are assigned the treatment that does not correspond to the true nature of the disease, and at the same time the required therapy is not applied. Private practice in medicine promotes the development of many positive human qualities, which include displays of personal responsibility, activity and initiative, self-reliance and independence. But a direct financial interest of the doctor contains the danger of degradation of their internal spiritual and moral qualities. Gradual loss of spiritual qualities of a doctor leads to the loss of professional skills, confidence of patients and eventually - to cease of medical practice as such. The negative effects of private medical practice are analyzed in the article. Continuous efforts to implement in medical practice such qualities as honesty, openness, honesty, kindness, humanity, selflessness and others promotes the strength of the relationship between the doctor and the patient, increases the credibility of doctors in dealing with governmental establishments, the public and patients personally. Timely implementation of new technologies and materials promotes the development of doctor’s creative approach to the process of medical treatment. Also, the author focuses on the problem of doctor-patient communication as a social, psychological phenomenon that encompasses a wide variety of spiritual and material forms of human activity and is its urgent need. The moral value of communication is that it is a direct source of understanding of good and evil through the exchange of activities, their evaluation and judgment. The most difficult problem of humanizing of the relationship between doctor and patient is methodological work of the formation of ethical and pedagogical skills in communication. In medicine ethical guidelines become social direction. Therefore, these aspects of medical ethics and deontology occupy in our article prominent place among professional considerations and advice.

Do clinical trials fit in a private medical practice?

Although traditionally thought to be the purview of academic health centers, clinical trials to evaluate new drugs, tests, and devices are being done more and more in private medical practices or in healthcare organizations with little or no academic affiliation. There are many reasons for this observation. First, the sheer number of new medications and devices which are in development that need large numbers of patients to evaluate their effectiveness or readiness for clinical care requires a large number of study sites. There simply are not enough sites in academic settings to get the work done. One estimate puts the number of new products being studied at 37 000 [1]. Clearly, to enroll enough patients to study this number of products requires sites outside the academic environment. Second, the pace of development and the importance of rapid enrollment to keep costs down to improve the return on investment for the sponsoring company pushes many companiesto seek sites in nontraditional locations. Slow recruitment is costly for many reasons including the obvious delays in getting a product to market but also in the delay of cancelling development of a nonviable product that maybe even more costly. Third, participation by nonacademic study sites provides the opportunity for them to offer treatments or devices for their patients before their general availability. This process tends to create an additional level of credibility for the site because they are now working closely with well known academic locations to help develop new treatments for disease. This activity can be used to promote an image of innovation and knowledge that creates more prestige and patient volume. Fourth, a well developed clinical trial program can improve the finances of a practice or healthcare facility by providing an income stream not directly related to traditional patient care activities. Because this income stream comes through a contract with a for-profi tc ompany and not from a government program or healthcare insurance company, it provides a diversifi

Chronic Non-Communicable Disease and Healthcare Access in Middle-Aged and Older Women Living in Soweto, South Africa

The aim of the current study was to describe the healthcare access, beliefs, and practices of middle-aged and older women residing in Soweto. This is a cross-sectional study of the primary (female) caregivers of the Birth to Twenty Cohort, based in Soweto, South Africa. The study instrument was administered to 1 102 caregivers as part of routine annual data collection. Over half the respondents (50.7%) reported having at least one chronic non-communicable disease (CND), only a small portion (33.3%) of whom reported accessing a healthcare service in the last 6 months. Reported availability of private medical practice and government clinics was high (75.1% and 61.5% respectively). The low utilisation of healthcare services by women with CND is a concern in terms of healthcare management. There is a need to further investigate how healthcare beliefs are formed, as well as the feasibility of programmes to support the ongoing management of CND in Soweto.

Overview of the Global Trend in Private Medical Practice

Free health care delivery is expensive world wide. In addition, there are many challenges facing the public health institutions with regards to health care financing and management. More over, many governments face various constraints that force them to prioritize and restrict government spending. This make it impossible for any government to provide free health care for her ever increasing population. Private medical practice is an alternative to complement government efforts in providing health care to reach a greater population. This has evolved from the rudimentary solo practice with its numerous disadvantages to more advance and superior group medical practices. The group medical practice in the developed world has transformed into huge public and private partnerships, developing into large corporation. This has transformed the economy of these countries. In contrast to this, developing countries have a long way to go. Solo practice is slowly revolving with its attendant risk for extinction. However, as more qualified specialists are produced and with increasing awareness and requirement for quality care, specialists will come together in groups to start decent and quality practice. The government of these countries can set up regulatory bodies to monitorand enforce discipline in the private sector. Key words : Global; private; medical practice

An empirical analysis of public and private medical practice in Australia

The combination of public and private medical practice is widespread in many health systems and has important consequences for health care cost and quality. However, its forms and prevalence vary widely and are poorly understood. This paper examines factors associated with public and private sector work by medical specialists using a nationally representative sample of Australian doctors. We find considerable variations in the practice patterns, remuneration contracts and professional arrangements across doctors in different work sectors. Both specialists in mixed practice and private practice differ from public sector specialists with regard to their annual earnings, sources of income, maternity and other leave taken and number of practice locations. Public sector specialists are likely to be younger, to be international medical graduates, devote a higher percentage of time to education and research, and are more likely to do after hours and on-call work compared with private sector specialists. Gender and total hours worked do not differ between doctors across the different practice types.

Howard Andrew Knox: Pioneer of Intelligence Testing at Ellis Island by John T. E. Richardson (review)

Reviewed by: Howard Andrew Knox: Pioneer of Intelligence Testing at Ellis Island by John T. E. Richardson Alan M. Kraut John T. E. Richardson . Howard Andrew Knox: Pioneer of Intelligence Testing at Ellis Island. New York: Columbia University Press, 2011. xxxii + 309 pp. Ill. $55.00 (978-0231-14168-0). In the second decade of the twentieth century, during a peak period of immigration to the United States, Dr. Howard Andrew Knox was physician in the U.S. Marine Hospital Service (later renamed the Public Health Service) assigned to the medical inspection of immigrants at New York's Ellis Island depot. He served there for only four years, May 1912 to May 1916. However, Knox's interest in psychology and his concern about the questionable mental capacity of immigrants seeking admission to the United States led him to make a significant contribution to intelligence testing, according to biographer John T. E. Richardson, professor of student learning and assessment at the Open University in the United Kingdom and former psychology professor at Brunel University. Richardson's stated purpose is to recover from obscurity Knox's legacy and to restore his rightful place of importance in the history of intelligence testing. Born in 1885, Knox was raised in Michigan by his mother, the daughter of Irish immigrants, and a stepfather who was a physician. After graduating with a medical degree from Dartmouth, Knox joined the Army Medical Corps. When he resigned his position to care for his ailing, widowed mother, he was refused reinstatement. In the absence of evidence, Richardson speculates that the refusal resulted from Knox's departure from his post for family reasons, Knox's own divorce and rapid remarriage, which suggested to superiors a troubling instability, or the scorn of prudish superiors resulting from Knox's distribution of prophylactic kits to enlisted men and prostitutes to curb rampant venereal disease at Fort Hancock, New Jersey. Knox resumed government service in 1912, successfully passing the rigorous U.S. Marine Hospital Service examination. Assigned to Ellis Island, Knox joined the line inspection of immigrants traveling third class and steerage. Ellis Island medical officers became sharp observers. Based on a brief clinical gaze, they surmised whether the immigrant before them required further examination to confirm a diagnosis of disease or disability that would prevent newcomers from supporting themselves and might even pose a health risk to the American population. Mental deficiency was harder to diagnose. Often a gesture or facial expression provided a clue. But appearances could be deceiving. [End Page 128] In an era when definitions of mental deficiency were protean and terms such as moron and imbecile had clinical meaning, there were no reliable measures of intelligence. Examinations developed in Europe, such as the Binet exam, required language skills and a cultural familiarity beyond most immigrants' capability. Researcher H. H. Goddard's use of the Binet test on Ellis Island produced problematic results, and Ellis Island inspectors trusted their own instincts more than Goddard's data. Intrigued by psychology, Howard Knox developed performance tests requiring language comprehension only for instructions. Knox's Diamond Frame Test required associating the shape of blocks with their places in a board within a certain amount of time. His Cube Imitation Test required tapping other blocks in a particular pattern. An Inkblot Imagination Test called for immigrants to interpret the shape of an inkblot as they perceived it. Knox's articles describing these tests and several others were commercially packaged and marketed with the blessing and cooperation of the U.S. Public Health Service. Later, other distinguished intelligence testers proceeded to develop more sophisticated performance tests and explanations for precisely what such tests measured. Some cited Knox's tests in their scholarly papers; others did not. Knox's contribution fell into obscurity. As distinguished psychologist Robert J. Sternberg observes in a preface, "[P]art of becoming a revered pioneer in a field is a matter of luck, which eluded Knox." After Knox left Ellis Island in 1916, he engaged in an undistinguished private medical practice until his death in 1949. Richardson makes the case for Knox's contribution to intelligence testing. Less apparent is whether its significance warrants a biography rather than a lengthy article...

Acceptability and Intention to Seek Medical Care After Hypothetical Receipt of Patient-Delivered Partner Therapy or Electronic Partner Notification Postcards Among Men Who Have Sex With Men

Little is known about how men who have sex with men (MSM) exposed to a sexually transmitted infection respond to receiving patient-delivered partner therapy (PDPT) or electronic partner notification postcards (e-cards). We anonymously surveyed MSM in a sexually transmitted disease (STD) clinic and a private medical practice. Three scenarios were presented in which participants had oral or anal sex with a new partner and were subsequently notified of a chlamydia or gonorrhea exposure and offered PDPT by the partner. A fourth scenario described partner notification via an anonymous inSPOT e-card. We asked participants if they would see a doctor, test for HIV/STD, and/or notify other partners in each situation. Among 198 MSM, the percentage indicating that they would seek a medical evaluation was higher when scenarios described proctitis (97%-98%) versus pharyngitis (84%) or no symptoms (84%-89%). In the absence of symptoms, men indicated that they would be less likely to seek care (62% vs. 84%-88%, P < 0.0001) and notify partners (85% vs. 69%, P < 0.0001) if notified via an anonymous e-card than if notified directly by a partner. Approximately half reported that they would use PDPT provided by a partner. In the absence of symptoms, men who indicated that they would use PDPT reported that they would seek medical care less frequently than men who indicated that they would not take PDPT (74% vs. 92% [P = 0.0007 for oral sex exposure] 82% vs. 94%-94% [P = 0.01 or unprotected anal sex exposure]). Although many MSM express interest in using PDPT and anonymous e-cards, these methods may result in missed opportunities to test for HIV and other STDs.

John Jeremiah Bigsby, MD: British Army physician and pioneer North American geologist

Abstract In the years from 1817 to 1825 when Dr John Bigsby was stationed in Canada with the British Army, he studied the geology from the lower St Lawrence Valley to the centre of the continent. In sedimentary strata of the Great Lakes, he collected a wealth of fossils, many of unusual size. He described the mineralogy of the Canadian Shield, recognizing the igneous origin of the basalt precipices of the north shore of Lake Superior. In 1819 when the International Boundary Commission was surveying the western end of Lake Erie, the whole staff fell ill with malarial fevers and some died. Bigsby was appointed in 1820 as medical officer to the Commission. He accompanied the British survey team from 1820 to 1823 to provide medical care. In his leisure time he collected fossils from the shores of the Great Lakes. In 1823 Bigsby travelled by canoe with the surveyors completing the survey from Lake Superior to Lake of the Woods. During the journey he observed the great volcanic formations of that region. Bigsby returned to England in 1825, resigning from the British Army in 1830. He entered private medical practice but maintained a life-long interest in geology, particularly fossils.

The DIAGONALE study: A survey designed to analyze the diagnosis and management of goiter in France

ObjectiveEuthyroid goiter is frequent for general practitioners (GPs) and endocrinologists (ENDOs). It may induce complications especially in elderly subjects when it becomes nodular and hyperfunctional whereas in young subjects prevention of iodine deficiency may prevent this evolution. The primary objective of the observational study diagnosis of iodine deficiency induced goiter and national medical practices (DIAGONALE) was to determine the circumstances of diagnosis of euthyroid goiter, its incidence, the patient characteristics and the management. MethodsA representative sample of GPs and ENDOs working in a private medical practice (exclusively or not) was randomly drawn from a national file without changing the physician-patient relationship. ResultsFour hundred and sixty-nine GPs and 195 ENDOs participated in the study. Goiter was diagnosed in 0.86% of patients seen by GPs and 15.7% of patients seen by ENDOs. Pregnant women were mainly and teenagers exclusively seen by ENDOs. The interview and clinical examination were an important time in the management of euthyroid goiter. TSH level was systematically assayed as well as an ultrasonography; 22.6% of GPs did not perform a scintigraphy versus 63.1% of ENDOs. Levothyroxine treatment was frequently prescribed and the objective of TSH levels was 2mU/L for GPs and 1mU/L for ENDOs. ConclusionThis observational study showed differences in the management of euthyroid goiter between GPs and ENDOs but also many common practices. It also highlighted a higher incidence rate of goiter in pregnant women and teenagers seen by ENDOs.