General Medicine Specialists Research Articles

Real opinions on general medicine residency programs in Japan: Perspectives from medical students, residents, and young academic generalists.

Medical students and junior residents have five concerns about general medicine training, and senior residents and young academic generalists respond to these concerns. We hope that this paper will help to dispel some common concerns for those who wish to become specialists in general medicine.

Non-dialysis chronic kidney disease in primary care - a questionnaire study among general practitioners

Zusammenfassung Einleitung Die Mehrheit der von nicht dialysepflichtiger, chronischer Niereninsuffizienz betroffenen Patienten wird von Hausärzten betreut. Die Datenlage auf diesem Gebiet ist besonders in Deutschland lückenhaft. Ziel der Umfrage war es, die wahrgenommene Häufigkeit in der hausärztlichen Praxis, die Nutzung von Diagnostik und Therapie sowie verwendete Hilfsmittel unter Berücksichtigung des beruflichen Hintergrunds und der Erfahrung der antwortenden Hausärzte abzuschätzen. Methoden In Kooperation mehrerer Fachrichtungen wurde ein selbstentwickelter, diagnosespezifischer Fragebogen erstellt. Dieser wurde an 1130 Hausärzte aus Sachsen und Sachsen-Anhalt, die zufällig ausgewählt wurden, per Post versandt. Die Datenerhebung erfolgte von Juni 2019 bis Juli 2019. Ergebnisse Von 1130 versandten Fragebögen wurden 372 auswertbar zurückgesandt (Rücklaufquote: 32,9 %). Die Häufigkeit der nicht dialysepflichtigen, chronischen Niereninsuffizienz wurde auf 6–15 % geschätzt. Der Einstellung von Bluthochdruck und Diabetes mellitus messen 97 % der befragten Ärzte eine hohe bis sehr hohe Priorität bei. Zur Proteinurie-Diagnostik wurde die Nutzung von Urinteststreifen von 60,8 %, die Anforderung einer Albumin-Kreatinin-Ratio von 22,6 % der Befragten angegeben. Nur geringe Differenzen konnten im Antwortverhalten der teilnehmenden Arztgruppen offengelegt werden. Die Berufserfahrung ist bei der Wahl der Hilfsmittel, im Besonderen Leitlinien, ein wichtiger Einflussfaktor. Diskussion Die Ergebnisse zeigen, dass die Angaben und Prioritäten der befragten Ärzte in hohem Maße mit den internationalen Empfehlungen zur Versorgung niereninsuffizienter Patienten korrelieren. Verbesserungen im Bereich der Progressionsdiagnostik sind möglich und nötig. Allgemeinmediziner und hausärztliche Internisten besitzen ein vergleichbares Kompetenzniveau in der primärärztlichen Versorgung der nicht dialysepflichtigen, chronischen Niereninsuffizienz. Kernaussagen: Hausärzte schätzen die Prävalenz von nicht dialysepflichtiger, chronischer Niereninsuffizienz in ihrer Praxis auf 6–15 %.Die Albumin-Kreatinin-Ratio wird zur Proteinurie-Diagnostik gegenüber dem Urinstreifentest zu selten angefordert.Praktische Ärzte, Fachärzte für Allgemeinmedizin und hausärztlich tätige Internisten haben ein vergleichbares Kompetenzniveau bei der Versorgung von Patienten mit nicht dialysepflichtiger, chronischer Niereninsuffizienz.Die Berufserfahrung ist bei der Wahl der Hilfsmittel, im Besonderen Leitlinien, ein wichtiger Einflussfaktor.

Stavovi lekara primarne zdravstvene zaštite o istraživanjima u opštoj medicini

Introduction: General medicine is a specific scientific discipline and research is a constituting part of each medical discipline. Objective: We reviewed general physicians` (GPs) attitudes towards scientific research and their reasons for participating or not participating in them. Method: We made a specific questionnaire for the sake of this research. We got the data on age, gender, service periods, place of work (city/country), and specialty: GP or specialist in general medicine, as well as their opinions on research. We forwarded the questionnaire to 550 physicians' email addresses in November 2016. The acquired data were statistically processed using SPSS 20.0 for Windows. Results: The questionnaire was filled out by 233 physicians, of whom 83,3% were women, 67% specialists in general medicine, 68,7% physicians worked in city clinics; the average age of the participants was 46.46±10.29, the average service period 17.85±10.99 years. Out of the total number, 67.8% of the participants thought research was important and useful, even more so by specialists in general medicine, which was statistically significant (p=0.000). There were 71.2% of the physicians who already participated in the research projects, mostly working in the cities (p=0.008), physicians older than 50 (p=0.000), and physicians with service period >20 years (p=0,000). Physicians 30 or younger (p=0.017) and physicians with ≤ 10 years of service (p=0.002) thought research improved work quality. The most frequent reason for not participating in the research projects was lack of time due to a patient and administration overload. The most frequent reason for participating, for physicians with 11-20 and over 20 years of service, was improving work quality (p=0.007). Conclusion: Physicians think research is necessary and useful in general medicine and it improves work quality. The most frequent reason for not participating in the research projects was lack of time due to a patient and administration overload.

Glavne karakteristike sprovođenja programa organizovanog skrininga karcinoma grlića materice, karcinoma dojke i kolorektalnog karcinoma u Republici Srbiji

The paper aims to provide a descriptive, detailed review of the organized screening programs for cervical cancer, breast cancer and colorectal cancer in the Republic of Serbia. In this research, data from the Regulations on the National Program for Early Detection of Breast Cancer, Cervical Cancer and Colorectal Cancer were used, as well as published and unpublished data from the Institute of Public Health of Serbia. Screening for cervical cancer, breast cancer and colorectal cancer is carried out on the territory of the Republic of Serbia in the form of an organized decentralized program. Cervical cancer screening program encompasses women aged 25-64 years; the breast cancer screening program covers women aged 50-69 years; and the colorectal cancer screening program is offered to men and women aged 50-74 years. All three screening programs aim to cover at least 75% of the target population. The screening cycle for cervical cancer is three years, and for breast cancer and colorectal cancer, two years. The screening test used in the organized cervical cancer screening program is the PAP test; for breast cancer, the screening methodology relies on mammography; and for colorectal cancer, the screening program involves an immunohistochemical FOB test. Organized screening for cervical and breast cancers are offered through gynaecology specialists, while the organized screening for colorectal cancer is provided through the family physician, a medical doctor (or general medicine specialist) at the health centre. Organized cervical cancer, breast cancer and colorectal cancer screening programs represent a key activity at all levels of the healthcare system for early detection, prevention and reduction of mortality from malignant diseases. All programs are a part of continual healthcare activities in the Republic of Serbia, as a highly efficient cancer control strategy.

Current preparation of the integral general medicine specialist for the ophthalmological diagnosis in systemic diseases

Current preparation of the integral general medicine specialist for the ophthalmological diagnosis in systemic diseases

Befragung von Hausärzt*innen zur Versorgung von Patienten unter oralen Tyrosinkinaseinhibitoren

IntroductionOral tyrosine kinase inhibitor (TKI) therapies are becoming increasingly more important in the treatment of malignant diseases. Monitoring with focus on adherence, side effects and interactions poses new challenges for medical care. The role and capabilities of family doctors in the care of TKI patients are yet unclear and should be uncovered in a nationwide survey. MethodsFrom April to July 2016, 3,000 family doctors in Germany were asked to complete a written questionnaire regarding their capabilities for co-supervision of TKI patients. ResultsThe response rate was 18% (n=553). The peak age was between 50 and 60 years. 81% were specialists in general medicine, 14% specialists in internal medicine and 5% general practitioners. 98% cared for no or less than 10 TKI patients per quarter. Knowledge of side effects and interaction potential of TKIs was low in over 90%. 83% preferred monitoring by the treating oncologist and 93% felt uncertain about treatment monitoring. The control of adherence was of little importance in 66%. The number of treated TKI patients had a significant impact on knowledge and opportunities for treatment monitoring. There was a significant correlation between knowledge about TKIs and confidence in treatment monitoring. In general, younger doctors tended to be more confident in treatment monitoring, and specialists in internal medicine tended to have more knowledge than specialists in general medicine general practitioners and general practitioners. DiscussionCurrently, the low number of TKI patients, little knowledge about TKI, and the desire for specialist care are limiting the possibilities of co-caring for TKI patients by family doctors. ConclusionAlthough family doctors are generally motivated to care for tumor patients, routine treatment controls of TKI patients conducted by family doctors seem hardly possible at the moment and should currently remain with the specialist.

General medicine at the frontline of acute care delivery: Comparison with family medicine hospitalist model implementation in Singapore

Introduction This mixed methods study seeks to assess the clinical outcomes and qualitative insights associated with the pragmatic implementation of a general medicine (GM) physician-led inpatient care model, first at Alexandra Hospital (AH) and then at Sengkang General Hospital (SKH), and to compare them with findings reported in an earlier implementation of the family medicine (FM) hospitalist model in Singapore. Methods Anonymous quantitative demographic and clinical data including length of stay, 30-day readmission rate, inpatient mortality rate and gross cost of hospitalisation bills were extracted from the hospital information system. Comparative analyses with the FM hospitalist model and usual care were made. Secondary qualitative data that were gathered focused on increased understanding of the proposed model, its perceived challenges and future opportunities for its implementation. Results The adapted GM care model implemented first at AH and then at SKH seemed to suggest that such a model run by physicians from various backgrounds was capable of producing similarly superior outcomes when compared with the FM hospitalist model piloted in 2011, which was juxtaposed with usual care. With regard to qualitative insights, three findings were reported: (a) perception of and mindset in relation to generalists, which illustrates the barriers to implementing GM; (b) education and training of generalists, which underlines the current lack of adequate supply of GM specialists; and (c) operational issues of care model implementation, which highlights the current mismatches between the prevailing healthcare philosophy and the requirements for successful implementation of the GM care model. Conclusion The success of a GM care model hinges on how it is operationalised. With clear protocols, definitions, and a high level of protocol compliance by healthcare team members, the intended outcomes show promise for replication at other interested sites.

Diagnosis of Acoustic Neuroma through Telemedicine

A 65-year-old male individual presented to an electronic urban primary health center with complaints of impaired hearing in the left ear, loss of sensations on the left side of the face, loss of sensation of taste of the left side of the tongue, and tingling and numbness of the left side of the face for 2 months. He had a history of diabetes for 8 years and hypertension for 5 years and on regular medication. The patient was completely evaluated by the medical officer and referred to a general medicine doctor for teleconsultation. The general medicine specialist had clinical evaluation, and after detailed discussion with the medical officer, he was referred to a neurosurgeon for further evaluation and management to Guntur Medical College. He had evaluated the client and recommended magnetic resonance imaging scans, and imaging revealed an extra-axial cerebellopontine angle solid mass lesion of size 3 cm × 2 cm with cystic component, arising from the left internal auditory canal causing mass effect on the middle cerebellar peduncle, suggestive of left acoustic neuroma without mass effect. He had specialized radiation therapy of 30 fractions of 25 gray in 5 cycles from July 20 to August 5, 2019, currently on regular medication for diabetes and hypertension and Vitamin B12 supplements, and follow-up scheduled in July 2020.

Social differences in the utilization of medical services by children and adolescents in Germany. Results of the cross-sectional KiGGS Wave 2 study.

Data from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) enable conclusions about the utilization of outpatient and inpatient medical services by children and adolescents accounting the family’s socioeconomic status (SES). Results from the second follow-up to the KiGGS survey (KiGGS Wave 2), which covers the years 2014 to 2017, clearly demonstrate that children and adolescents from families with a low SES visit specialists in general medicine, gynaecologists and psychiatrists, as well as child and adolescent psychiatrists, psychotherapists and psychologists more frequently. In contrast, children and adolescents from families with a high SES visit paediatric, dermatological, dental and orthodontic practices more often. No statistically significant differences between the status groups with regard to the utilization of outpatient medical services in hospitals were identified. However, children and adolescents from the low status group received inpatient hospital treatment more frequently and, on average, spent more nights in hospital. These results reflect status-specific differences both in disease prevalence and care, as well as in patterns related to the utilization of medical services.

GPs\u2019 and child and adolescent psychiatry specialists\u2019 experiences of joint consultations in the GP\u2019s office: a qualitative study

BackgroundThe study is an exploration of a joint consultation model, a collaboration between general practitioners (GPs) and specialists from child and adolescent mental health services (CAMHS) in Lillehammer, Norway.MethodsA qualitative study based on two focus group interviews, one with participating GPs and one with participating specialists from the local CAMHS. Participants were five GPs, with work experience varying from 6 months to 20 years (four of them specialists in general medicine) and two CAMHS specialists—a psychiatrist and a psychologist—both with more than 20 years of experience.ResultsThe focus group discussions revealed that both GPs and CAMHS specialists saw the joint consultations as a good teaching method for improving GPs’ skills in child and adolescent psychiatry. Both groups believed that this low-threshold service benefits the patients and that the joint consultation is especially suited to sort problems and determine the level of help required.ConclusionsThe GPs and CAMHS specialists shared the impression that the collaboration model is beneficial for both patients and health care providers. Close collaboration with primary health care is recommended in the guidelines for child and adolescent psychiatry outpatient clinics. We suggest that the joint consultation model could be a good way for GPs and CAMHS specialists to collaborate.

Rural specialists: The nature of their work and professional satisfaction by geographical location of work.

Systematically describe the characteristics of rural specialists, their work and job satisfaction by geographical location of work. Cross-sectional. Three thousand, four hundred and seventy-nine medical specialists participating in the 2014 Medicine in Australia: Balancing Employment and Life (MABEL) survey of doctors. Location of practice, whether metropolitan, large (>50000 population) or small regional centres (<50000 population). Specialists working in large regional centres had similar characteristics to metropolitan specialists, however, those in small regional centres were more likely men, later career, overseas-trained and less likely to work privately. Rural specialists had more on-call requirements and poorer professional development opportunities. However, satisfaction with work hours, remuneration, variety of work, level of responsibility, opportunities to use abilities and overall satisfaction did not differ. Specialists in general medicine and general surgery were significantly more likely to work rurally compared with anaesthetists, particularly in small regional centres, whereas a range of other relevant specialists had lower than the average rural distribution and paediatricians and endocrinologists were significantly less likely to work in large regional centres. Rural specialists are just as satisfied as metropolitan counterparts reporting equivalent variety and responsibility at work. Better support for on-call demands and access to professional development could attract more specialists to rural practice. Increased rural training opportunities and regional workforce planning is needed to develop and recruit relevant specialties. Specifically, targeted support is warranted for training and development of specialists in general medicine and general surgery and overseas-trained specialists, who provide essential services in smaller regional centres.

Physician Related Delays in the Diagnosis of Lung Cancer in India.

Lung cancer is associated with a poor prognosis, if detected late in the disease course. Delay in seeking health care, wrong diagnosis and delay in specialist referral can contribute to delay in diagnosis. This study was done to assess physician related delays in the diagnosis of lung cancer and the treatments given before presenting to our center. A total of 96 consecutive patients diagnosed with lung cancer were enrolled in this study. Details of previous physician consultations, their specialization, diagnoses made and treatments given were obtained from records available with the patients. Patients, on an average consulted two physicians before presenting to our center. Less than half of the physicians (45%) suspected lung cancer during their evaluation. Around 18% of physicians made an incorrect diagnosis of tuberculosis, out of whom, 88.6% had prescribed anti-tuberculous therapy. Only 27% of physicians referred the patients to higher medical centres for evaluation. Pulmonology Specialists (PS) were the most likely to diagnose lung cancer (p<0.0001). General Medicine Specialists (GMS) were the most likely to misdiagnose cancer as tuberculosis, followed by General Practioners (GP) when compared to PS (p-value =0.0422). Our study demonstrates that, many physicians have a low index of suspicion to diagnose lung malignancy and most commonly misdiagnose it as tuberculosis. It is likely that most patients failed to seek the services of PS directly or through referral either due to a shortage of PS or due to other reasons.

Decentralized Laboratory Testing: Attitudes of physicians and medical students

Attitudes regarding the use of decentralized laboratory testing were examined in two groups of district physicians (DP; n = 15), a group of physicians undergoing postgraduate training as specialists in general medicine (PP; n = 17), and a group of medical students who had completed five years of basic studies (MS; n = 15). A sorting test was employed involving 56 cards with names of laboratory tests presently or soon available for use within primary health care. The DPs showed a relatively high consensus concerning which analyses were needed most for near-to-patient testing. MSs (who had a basically hospital-oriented education) differed from DPs and PPs in emphasizing the need for a greater number of directly available tests in primary health care. The differences probably reflect differences in clinical experience. The importance of practically oriented education is stressed.