Swiss Doctors Research Articles

Advanced practice nurses\u2019 and general practitioners\u2019 first experiences with introducing the advanced practice nurse role to Swiss primary care: a qualitative study

BackgroundPrimary care is facing a multimorbid, ageing population and a lack of general practitioners (GPs), especially in rural areas. In many countries, advanced practice nurses (APNs) may be a potential solution for these challenges. Switzerland, however, is in the early stages of APN role development with a handful of pilot projects that are unresearched. Our aim was to explore the experiences of APNs and GPs involved in introducing the APN role to Swiss primary care.MethodsWe organised two focus group discussions with APNs (n = 9) engaged in primary care across German-speaking Switzerland and individual interviews with APNs (n = 2) and GPs (n = 4) from two pilot projects in remote areas. Data analysis followed an exploratory hybrid approach of thematic analysis and was guided by the PEPPA Plus framework.ResultsThe analysis resulted in five main themes: The participants considered themselves pioneers developing a new model in primary care, seeking to shape and improve future health care ((1) pioneering spirit). Both nurses and doctors agreed on the additional value of the APN role, a role seen as having more time for and a different approach to patient care, bringing higher quality of care and flexibility to the practice ((2) added value from the APN role). Participants also emphasized the importance of asking for advice when unsure about diagnostic steps or appropriate treatment ((3) awareness of limited knowledge and skills). The main barriers identified included the impression that Swiss doctors have little knowledge about nurses in advanced roles ((4) GP’s lack of knowledge regarding the APN role), and that further regulations will be important to foster role clarity and accountability ((5) political and legal obstacles in introducing the APN role).ConclusionsThe early phase of introducing APNs to Swiss primary care is characterised by heterogeneous, small-scale projects of pioneering GPs and APNs recognising the added value and limits of APNs despite a lack of governance and knowledge regarding the APN role among GPs. Experiences gained from ongoing projects provide elements of good practice for political discussions and regulations.

The United Kingdom system for appraisal of doctors

All doctors in the UK must have an appraisal from a professional colleague every year. This article explains how the system works, its advantages and disadvantages, and asks whether Swiss doctors should consider developing a similar system.

The benefits prevail – why electronic immunization records are advantageous to the general practitioner and his patients

Immunization coverage throughout the Swiss population is still not optimal and therefore preventable diseases such as measles have not been eliminated in Switzerland yet. In addition, new vaccination protocols are available and official recommendations are becoming increasingly complex. The website www.myvaccines.ch has been in use since 2011 with the primary goal to increase immunization coverage. This service was established by Vaccinologist Professor Claire-Anne Siegrist from the University of Geneva and is free of charge for all Swiss doctors and pharmacists. It enables general practitioners and pediatricians to document the vaccination history of their patients in a new electronic immunization record. After a simple and quick process, the web-based software proposes up-to-date recommendations of new or follow-up vaccinations following the current Swiss Immunization Plan by the Federal Department of Health. Within this single practice, 1446 files have been recorded within the past three years. As a consequence, a total of 4378 immunizations have been administered, leading to a mean of 3.03 immunizations per patient. After introducing the electronic immunization record, the rates of immunizations have increased dramatically for all antigens (factor 2.1 to 41.5). Overall, patient acceptance was high – the doctor’s investment was positively recognized and his approach to patient care was perceived as modern. As a result, the practice has become competent in immunization. In summary, the positive outcome of using the electronic record highly supports the free program www.myvaccines.ch to all general practitioners and pediatricians in Switzerland.

What should be the basis for compulsory and optional health insurance premiums? Opinions of Swiss doctors

Little is known about doctors' opinions on how to finance health services. In Switzerland, mandatory basic health insurance currently uses regional flat fees that are unrelated to health and ability to pay, and optional complementary insurance uses risk-based premiums. Our objective was to assess Swiss physicians' opinions on what should determine health insurance premiums. We surveyed doctors in the canton of Geneva, Switzerland, about the desirable funding mechanism for mandatory health insurance and complementary health insurance. The proposed determinants of insurance premiums were current health and past medical history, lifestyle, healthcare costs in the previous year, genetic susceptibility to disease, regional average healthcare costs, household income, and wealth and demographic characteristics. Among the 1,516 respondents, only a few (<5%) believed that the mandatory health insurance premium should depend on health risk (health status, previous costs, genetics, and age and sex). More than 30% of respondents supported premiums based on lifestyle (34.6%), regional average health expenditures (31.2%), and household income and wealth (39.6%). For complementary health insurance, most respondents supported premiums based on lifestyle (74.6%) and on health risk (46.4%), but surprisingly also on household income and wealth (44.9%) and regional average health expenditures (39.4%). The characteristic most influencing the answers was the medical specialty. Doctors' opinions about healthcare financing mechanisms varied considerably, for both mandatory and complementary health insurance. Lifestyle was a surprisingly frequent choice, even though this criterion is not currently used in Switzerland. Ability to pay was not supported by the majority.

Competency in interpretation of 12-lead electrocardiogram among Swiss doctors

Competency in interpretation of 12-lead electrocardiogram among Swiss doctors

Growing discontent of Swiss doctors, 1998-2007

Work satisfaction of doctors is a useful indicator of the functioning of the health-care system. We documented the work satisfaction of doctors nine years apart, before and after the implementation of several health-care reforms (limitation of working hours for medical trainees, restrictions on new doctors' offices, new reimbursement fee schedule, greater administrative controls). Two surveys of all doctors working in the Canton of Geneva, Switzerland (1998: 1146 respondents, 2007: 1546 respondents). The doctors filled in a 17-item questionnaire rating their satisfaction with different aspects of their professional life, each on a scale between 1 and 7. For each item, proportions of highly satisfied (scores 6-7) and highly dissatisfied (scores 1-2) doctors were compared over time. The proportion of doctors who were highly satisfied decreased significantly for 15 out of 17 items between 1998 and 2007. Meanwhile, 'time available for family, friends, or leisure' improved, and 'opportunity for continuing education' remained stable. Proportions of highly satisfied respondents decreased the most for 'enjoyment of work' (-17.2%), 'autonomy in treating your patients' (-15.8%), 'autonomy in referring patients to a specialist' (-14.0%), 'relations with patients' (-13.9%) and 'global satisfaction with current work situation' (-13.3%). The proportion of respondents who were highly dissatisfied (score 1-2) increased the most for 'administrative burden' (+8.9%) and 'social status and respect' (+5.0%). Doctors' satisfaction with most aspects of their professional lives has decreased sharply during the past decade. This trend may be linked, tentatively, with specific policy changes.

The impact of mentoring during postgraduate training on doctors’ career success

Although mentoring is perceived as key to a successful and satisfying career in medicine, there is a lack of methodologically sound studies to support this view. This study made use of a longitudinal design to investigate the impact of mentoring during postgraduate specialist training on the career success of doctors. We analysed data pertaining to 326 doctors (172 women, 52.8%; 154 men, 47.2%) from a cohort of medical school graduates participating in the prospective SwissMedCareer Study, assessing personal characteristics, the possession of a mentor, mentoring support provided by the development network, and career success. The impact of personal characteristics on having a mentor was investigated using multiple linear regression analysis. The impacts of having a mentor and of having development network mentoring support on career success were analysed using hierarchical multiple regression analysis. Up to 50% of doctors reported having a mentor. A significant gender difference was found, with fewer female than male doctors having a mentor (40.7% versus 60.4% at the fifth assessment; p ≤ 0.001). Apart from gender, significant predictors of having a mentor were instrumentality (β = 0.24, p ≤ 0.01) and extraprofessional concerns (β = -0.15, p ≤ 0.05). Both having a mentor and having career support from the development network were significant predictors of both objective (β = 0.15, p ≤ 0.01; β = 0.17, p ≤ 0.01) and subjective (β = 0.17, p ≤ 0.01; β = 0.14, p ≤ 0.05) career success, but not of career satisfaction. This study confirmed the positive impact of mentoring on career success in a cohort of Swiss doctors in a longitudinal design. However, female doctors, who are mentored less frequently than male doctors, appear to be disadvantaged in this respect. Formal mentoring programmes could reduce barriers to mentorship and promote the career advancement of female doctors in particular.

Shared decision making development in Switzerland: room for improvement!

In Switzerland there is a strong movement at a national policy level towards strengthening patient rights and patient involvement in health care decisions. Yet, there is no national programme promoting shared decision making. First decision support tools (prenatal diagnosis and screening) for the counselling process have been developed and implemented. Although Swiss doctors acknowledge that shared decision making is important, hierarchical structures and asymmetric physician-patient relationships are still prevailing. The last years have seen some promising activities regarding the training of medical students and the development of patient support programmes. Swiss direct democracy and the habit of consensual decision making and citizen involvement in general may provide a fertile ground for SDM development in the primary care setting.

Trend of burnout among Swiss doctors

Over the last decade the Swiss health care system has undergone several changes, resulting in stronger economic constraints, a heavier administrative workload and limited work autonomy for doctors. In this context we examined the change in burnout prevalence over time among Swiss doctors surveyed during this period. Cross-sectional survey data collected by mail in 2002, 2004 and 2007 throughout the country were used. Measures included the Maslach Burnout Inventory (MBI), several socio-demographics (gender, living alone, having children), and work-related characteristics (number of years in current workplace, hours worked). Answers to the MBI were used to classify respondents into moderate (high score on either the emotional exhaustion or the depersonalisation/cynicism subscale) and high degree of burnout (scores in the range of burnout in all three scales). Rates of moderate-degree burnout increased from 33% to 42% among general practitioners (p = 0.002) and from 19% to 34% among paediatricians (p = 0.001) (high degree of burnout: 4% to 6% [p = 0.17] and 2% to 4% [p = 0.42] respectively). After adjustment for significant socio-demographic and work-related characteristics, an increased risk of moderate burnout was found for doctors surveyed in 2004 and 2007 (OR 1.6, 95%CI 1.3 to 2.0), general practitioners (OR 1.6, 95%CI 1.3 to 2.0) and French-speaking doctors (OR 1.5, 95%CI 1.3 to 1.9). An increased risk of high-degree burnout was found only for general practitioners (OR 1.8, 95%CI 1.05 to 3.0). Burnout levels among Swiss doctors have increased over the last decade, in particular among French-speaking doctors.

Cost-consciousness among Swiss doctors: a cross-sectional survey

BackgroundKnowing what influences physicians attitudes toward health care costs is an important matter, because most health care expenditures are the results of doctors' decisions. Many decisions regarding medical tests and treatments are influenced by factors other than the expected benefit to the patient, including the doctor's demographic characteristics and concerns about cost and income.MethodsDoctors (n = 1184) in Geneva, Switzerland, answered questions about their cost-consciousness, practice patterns (medical specialty, public.vs. private sector, number of patients per week, time spent with a new patient), work satisfaction, and stress from uncertainty. General linear models were used to identify independent risk factors of higher cost-consciousness.ResultsMost doctors agreed that trying to contain costs was their responsibility ("agree" or "totally agree": 90%) and that they should take a more prominent role in limiting the use of unnecessary tests (92%); most disagreed that doctors are too busy to worry about costs (69%) and that the cost of health care is only important if the patient has to pay for it out-of-pocket (88%). In multivariate analyses, cost-consciousness was higher among doctors in the public sector, those who saw fewer patients per week, who were most tolerant of uncertainty, and who were most satisfied with their work.ConclusionThus even in a setting with very high health care expenditures, doctors' stated cost-consciousness appeared to be generally high, even though it was not uniformly distributed among them.

National questionnaire survey on what influences doctors' decisions about admission to intensive care

Objectives To determine what influences doctors' decisions about admission of patients to intensive care.Design National questionnaire survey using eight clinical vignettes involving hypothetical patients.Setting Switzerland.Participants 402 Swiss doctors specialising in...

PWS syndrome: A genetic disorder

PRADER-WILLI Syndrome (PWS), discovered by Swiss Doctors in 1956, affects roughly one in 16,000 children.

Alternative Medicine on the Internet

If you go to a bookstore to look for information on a particular health problem you will have a choice between the "medicine" corner with scientific manuals for professionals and the "health" corner with all kinds of books about acupuncture, ayurveda, natural healing, homeopathy, nutrition, massage, and so on! How is it on the Net? Even a short tour will bring you a lot of "medical" information, but when you look for alternative approaches in the "health" corner you will be rather disappointed. Interesting sites are rare and the amount of information very sparse. In many cases the lists of therapists are seriously incomplete; professional therapists with long experience do not appear in them. Recommendations for alternative treatments are superficial and encourage the user to buy some specialties or some book. Many sites are inflated by just quoting other sites so that, in the end, the basic information is rather poor.As we know, "health" information is becoming increasingly important since patients want to take more responsibility for themselves. They look for alternative methods. Doctors too, as 46% of Swiss doctors use alternative methods in one way or another (Médecine et Hygiène, 1996). That is why we should not leave this part of the Internet in the hands of unqualified people. To some doctors, alternative medicine may seem a chaotic maelstrom of superstition and odd techniques. That is not so. Nearly every alternative therapy has a long tradition with its own rules and principles. All reliable therapists have undergone years of training and expect the same from their colleagues. Why should this search for quality not be present online?What is needed? Good quality information. The identity of the author must be clear (education, tradition, professional experience, training). As many schools claim to be "the only one", the user should be informed about the differences and conflicts between all the approaches. Ethical behavior must be encouraged: respect the right to be different, show respect and tolerance, act correctly regarding copyright. More good authors should put their articles on the Net to increase the amount of basic data available online (theory, case reports, FAQ etc.). The need to create a specific (virtual) team in order to establish quality criteria, screen, control and grade the online information about alternative medicine seems obvious. This team must include professional experts with specific knowledge and experience. A homeopath should evaluate homeopathy, an acupuncturist should evaluate acupuncture. Serious thought has to be given to creating a central data bank on alternative medicine, to provide quality information to different portals and websites, as well as to patients, doctors, educators and journalists.

Suicide with psychotropic drugs in Switzerland.

All suicides in Switzerland in 1990 where drugs were involved (179 persons; 12.2% of all suicides) were analyzed by examination of death certificates and direct contacts with physicians and medico-legal institutions. Nearly 50% of these people took overdoses of combinations of different drugs and in 26% of the cases alcohol was reported to have been taken with the drugs. Unexpectedly, we found 29 suicides in which persons had obviously used drug combinations recommended by EXIT, an organization advocating the freedom of the individual to decide about his own time and nature of death. In EXIT-suicides usually barbiturates and anticholinergic drugs were taken together. Interestingly, the barbiturate compound used most often had officially been withdrawn from the market the previous year. Altogether, psychotropic drugs represented 78.7% of all drugs taken, with benzodiazepines being named most often (38.9%), followed by barbiturates (16.6%) and antidepressants (13.6%). Among the benzodiazepines flunitrazepam, diazepam, and triazolam were used most often and surprisingly, benzodiazepines were named as single drugs on 27 death certificates. Among the antidepressants (taken in 20.3% of overdoses) maprotiline was the most common drug used, followed by mianserin and trimipramine. This order of frequency reflects the prescribing habits of Swiss doctors. Two suicides were recorded with neuroleptics alone.

The process of change in medical education in Switzerland

Centuries of tradition have instilled in Swiss medical doctors a healthy skepticism for innovations in professional practice. This same attitude seems to apply to medical education, with Swiss medical associations and interest groups taking various initiatives in observing and reporting international changes. Recently, a small delegation of Swiss doctors representing practitioners—and professors from the medical schools in Geneva and Berne— visited selected North American medical schools that have adopted problem‐based curricula. That visit led to insights being discussed at a national conference in Berne in 1989. The conference was well represented—with faculty and students from all five Swiss medical schools, invited health professionals, politicians, and administrators. The main challenge confronting any likely major curriculum reform in Switzerland will be whether faculty can accept the kind of educational principles now being implemented at the University of Berne and those recommended at the 1988 Wo...

Morbidité et consommation médicale des médecins: vers un nouvel indicateur d'efficacité?

The purpose and methodology of a year (1981) analyse about morbidity and medical care consomption (specially drugs) on 466 Swiss doctors is presented. Some results are shown and also a definition of a new efficiency index. It is defined as the difference between doctor's and population's consomption.

ICRC Meeting on Medical Matters

The ICRC Medical Division organized a seminar from 3 to 5 May at Cartigny, near Geneva, for about 50 Swiss doctors who had carried out medical missions abroad. Those taking part in the meetings included ICRC staff, members of the Swiss Red Cross and of the Swiss Disaster Relief Corps. Two Danish doctors were also invited.

What is the role of an ICRC doctor-delegate?

One of the duties assigned to the International Committee of the Red Cross by the 1949 Geneva Conventions is to provide medical care, whether in an emergency, in the context of a relief operation or in the course of routine visits to places of detention. In an emergency, the ICRC calls upon Swiss doctors who have a private practice or who work in a hospital, and upon National Red Cross Societies which supply doctors or complete teams.