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1.  Analysis of questions asked by family doctors regarding patient care 
BMJ : British Medical Journal  1999;319(7206):358-361.
Objectives
To characterise the information needs of family doctors by collecting the questions they asked about patient care during consultations and to classify these in ways that would be useful to developers of knowledge bases.
Design
Observational study in which investigators visited doctors for two half days and collected their questions. Taxonomies were developed to characterise the clinical topic and generic type of information sought for each question.
Setting
Eastern Iowa.
Participants
Random sample of 103 family doctors.
Main outcome measures
Number of questions posed, pursued, and answered; topic and generic type of information sought for each question; time spent pursuing answers; information resources used.
Results
Participants asked a total of 1101 questions. Questions about drug prescribing, obstetrics and gynaecology, and adult infectious disease were most common and comprised 36% of all questions. The taxonomy of generic questions included 69 categories; the three most common types, comprising 24% of all questions, were “What is the cause of symptom X?” “What is the dose of drug X?” and “How should I manage disease or finding X?” Answers to most questions (702, 64%) were not immediately pursued, but, of those pursued, most (318, 80%) were answered. Doctors spent an average of less than 2 minutes pursuing an answer, and they used readily available print and human resources. Only two questions led to a formal literature search.
Conclusions
Family doctors in this study did not pursue answers to most of their questions. Questions about patient care can be organised into a limited number of generic types, which could help guide the efforts of knowledge base developers.
Key messagesQuestions that doctors have about the care of their patients could help guide the content of medical information sources and medical trainingIn this study of US family doctors, participants frequently had questions about patient care but did not pursue answers to most questions (64%)On average, participants spent less than 2 minutes seeking an answer to a questionThe most common resources used to answer questions included textbooks and colleagues; formal literature searches were rarely performedThe most common generic questions were “What is the cause of symptom X?” “What is the dose of drug X?” and “How should I manage disease or finding X?”
PMCID: PMC28191  PMID: 10435959
2.  Answering Physicians' Clinical Questions: Obstacles and Potential Solutions 
Objective: To identify the most frequent obstacles preventing physicians from answering their patient-care questions and the most requested improvements to clinical information resources.
Design: Qualitative analysis of questions asked by 48 randomly selected generalist physicians during ambulatory care.
Measurements: Frequency of reported obstacles to answering patient-care questions and recommendations from physicians for improving clinical information resources.
Results: The physicians asked 1,062 questions but pursued answers to only 585 (55%). The most commonly reported obstacle to the pursuit of an answer was the physician's doubt that an answer existed (52 questions, 11%). Among pursued questions, the most common obstacle was the failure of the selected resource to provide an answer (153 questions, 26%). During audiotaped interviews, physicians made 80 recommendations for improving clinical information resources. For example, they requested comprehensive resources that answer questions likely to occur in practice with emphasis on treatment and bottom-line advice. They asked for help in locating information quickly by using lists, tables, bolded subheadings, and algorithms and by avoiding lengthy, uninterrupted prose.
Conclusion: Physicians do not seek answers to many of their questions, often suspecting a lack of usable information. When they do seek answers, they often cannot find the information they need. Clinical resource developers could use the recommendations made by practicing physicians to provide resources that are more useful for answering clinical questions.
doi:10.1197/jamia.M1608
PMCID: PMC551553  PMID: 15561792
3.  Reasons for Consulting a Doctor on the Internet: Web Survey of Users of an Ask the Doctor Service 
Background
In 1998 the Swedish noncommercial public health service Infomedica opened an Ask the Doctor service on its Internet portal. At no charge, anyone with Internet access can use this service to ask questions about personal health-related and disease-related matters.
Objective
To study why individuals choose to consult previously-unknown doctors on the Internet.
Methods
Between November 1, 2001, and January 31, 2002 a Web survey of the 3622 Ask the Doctor service users, 1036 men (29%) and 2586 (71%) women, was conducted. We excluded 186 queries from users. The results are based on quantitative and qualitative analysis of the answers to the question "Why did you choose to ask a question at Infomedica's 'Ask the Doctor' service?"
Results
1223 surveys were completed (response rate 34%). Of the participants in the survey 322 (26%) were male and 901 (74%) female. As major reasons for choosing to consult previously-unknown doctors on the Internet participants indicated: convenience (52%), anonymity (36%), "doctors too busy" (21%), difficult to find time to visit a doctor (16%), difficulty to get an appointment (13%), feeling uncomfortable when seeing a doctor (9%), and not being able to afford a doctors' visit (3%). Further motives elicited through a qualitative analysis of free-text answers were: seeking a second opinion, discontent with previous doctors and a wish for a primary evaluation of a medical problem, asking embarrassing or sensitive questions, seeking information on behalf of relatives, preferring written communication, and (from responses by expatriates, travelers, and others) living far away from regular health care.
Conclusions
We found that an Internet based Ask the Doctor service is primarily consulted because it is convenient, but it may also be of value for individuals with needs that regular health care services have not been able to meet.
doi:10.2196/jmir.5.4.e26
PMCID: PMC1550573  PMID: 14713654
Internet; remote consultation; physician-patient relations; access to information; information services; anonyms and pseudonyms
4.  How do primary care physicians seek answers to clinical questions? A literature review  
Objectives: The authors investigated the extent to which changes occurred between 1992 and 2005 in the ways that primary care physicians seek answers to clinical problems. What search strategies are used? How much time is spent on them? How do primary care physicians evaluate various search activities and information sources? Can a clinical librarian be useful to a primary care physician?
Methods: Twenty-one original research papers and three literature reviews were examined. No systematic reviews were identified.
Results: Primary care physicians seek answers to only a limited number of questions about which they first consult colleagues and paper sources. This practice has basically not changed over the years despite the enormous increase in and better accessibility to electronic information sources. One of the major obstacles is the time it takes to search for information. Other difficulties primary care physicians experience are related to formulating an appropriate search question, finding an optimal search strategy, and interpreting the evidence found. Some studies have been done on the supporting role of a clinical librarian in general practice. However, the effects on professional behavior of the primary care physician and on patient outcome have not been studied. A small group of primary care physicians prefer this support to developing their own search skills.
Discussion: Primary care physicians have several options for finding quick answers: building a question-and-answer database, consulting filtered information sources, or using an intermediary such as a clinical librarian.
PMCID: PMC1324772  PMID: 16404470
5.  Time to rethink the role of the library in educating doctors: driving information literacy in the clinical environment 
Question:
Can information literacy (IL) be embedded into the curriculum and clinical environment to facilitate patient care and lifelong learning?
Setting:
The Australian School of Advanced Medicine (ASAM) provides competence-based programs incorporating patient-centred care and lifelong learning. ASAM librarians use outcomes-based educational theory to embed and assess IL into ASAM's educational and clinical environments.
Methods:
A competence-based IL program was developed where learning outcomes were linked to current patients and assessed with checklists. Weekly case presentations included clinicians' literature search strategies, results, and conclusions. Librarians provided support to clinicians' literature searches and assessed their presentations using a checklist.
Main Results:
Outcome data showed clinicians' searching skills improved over time; however, advanced MEDLINE searching remained challenging for some. Recommendations are provided.
Conclusion:
IL learning that takes place in context using measurable outcomes is more meaningful, is enduring, and likely contributes to patient care. Competence-based assessment drives learning in this environment.
doi:10.3163/1536-5050.100.4.011
PMCID: PMC3484954  PMID: 23133329
6.  Can primary care physicians' questions be answered using the medical journal literature? 
Medical librarians and informatics professionals believe the medical journal literature can be useful in clinical practice, but evidence suggests that practicing physicians do not share this belief. The authors designed a study to determine whether a random sample of "native" questions asked by primary care practitioners could be answered using the journal literature. Participants included forty-nine active, nonacademic primary care physicians providing ambulatory care in rural and nonrural Oregon, and seven medical librarians. The study was conducted in three stages: (1) office interviews with physicians to record clinical questions; (2) online searches to locate answers to selected questions; and (3) clinician feedback regarding the relevance and usefulness of the information retrieved. Of 295 questions recorded during forty-nine interviews, 60 questions were selected at random for searches. The average total time spent searching for and selecting articles for each question was forty-three minutes. The average cost per question searched was $27.37. Clinician feedback was received for 48 of 56 questions (four physicians could not be located, so their questions were not used in tabulating the results). For 28 questions (56%), clinicians judged the material relevant; for 22 questions (46%) the information provided a "clear answer" to their question. They expected the information would have had an impact on their patient in nineteen (40%) cases, and an impact on themselves or their practice in twenty-four (51%) cases. If the results can be generalized, and if the time and cost of performing searches can be reduced, increased use of the journal literature could significantly improve the extent to which primary care physicians' information needs are met.
PMCID: PMC225885  PMID: 7772099
7.  Decision-Making of Older Patients in Context of the Doctor-Patient Relationship: A Typology Ranging from “Self-Determined” to “Doctor-Trusting” Patients 
Background. This qualitative study aims to gain insight into the perceptions and experiences of older patients with regard to sharing health care decisions with their general practitioners. Patients and Methods. Thirty-four general practice patients (≥70 years) were asked about their preferences and experiences concerning shared decision making with their doctors using qualitative semistructured interviews. All interviews were analysed according to principles of content analysis. The resulting categories were then arranged into a classification grid to develop a typology of preferences for participating in decision-making processes. Results. Older patients generally preferred to make decisions concerning everyday life rather than medical decisions, which they preferred to leave to their doctors. We characterised eight different patient types based on four interdependent positions (self-determination, adherence, information seeking, and trust). Experiences of a good doctor-patient relationship were associated with trust, reliance on the doctor for information and decision making, and adherence. Conclusion. Owing to the varied patient decision-making types, it is not easy for doctors to anticipate the desired level of patient involvement. However, the decision matter and the self-determination of patients provide good starting points in preparing the ground for shared decision making. A good relationship with the doctor facilitates satisfying decision-making experiences.
doi:10.1155/2013/478498
PMCID: PMC3652207  PMID: 23691317
8.  Does the medical literature contain the evidence to answer the questions of primary care physicians? Preliminary findings of a study. 
OBJECTIVE: To assess the quality of information retrieved in MEDLINE searches performed to answer clinical questions of primary care physicians. SETTING: Ambulatory rural and nonrural practices. PARTICIPANTS: Active, non-academic primary care physicians; professional medical librarians, a general internist. DESIGN: Descriptive study in 3 stages: 1) Office Interviews, to record questions that arise in primary care practice; 2) Online Searches, to locate information that might answer these questions; and 3) Critical Appraisal to determine the quality of the information contained in the articles retrieved. MAIN RESULTS: Of 74 articles judged by clinicians to be relevant to their questions, 2 were critical reviews, 14 reported results of randomized controlled trials, and 4 reported results of cohort studies. The remainder contained weaker evidence: 1 reported results of a case-control study, 6 were longitudinal case series, 13 were cross-sectional descriptions of disease, 12 were cross-sectional descriptions of diagnostic testing, and 22 were review articles which did not meet criteria for a critical review. CONCLUSION: Searching the medical literature to answer the questions of primary care physicians was successful in retrieving recent, relevant information, and often provided "a clear answer" to the question, but the cost of using bibliographic retrieval was high, and fewer than a third of the articles retrieved contained high quality evidence.
PMCID: PMC2850641  PMID: 8130538
9.  Attachment in the doctor–patient relationship in general practice: A qualitative study 
Objective
To explore why interpersonal continuity with a regular doctor is valuable to patients.
Design, setting, and subjects
A qualitative study based on 22 interviews with patients, 12 who saw their regular general practitioner (GP) and 10 who saw an unfamiliar GP. The patients were selected after an observed consultation and sampled purposively according to reason for encounter, age, and sex. The research question was answered by means of psychological theory.
Results
A need for attachment was a central issue for the understanding of the value of interpersonal continuity for patients. The patients explained that they preferred to create a personal relationship with their GP and the majority expressed a degree of vulnerability in the doctor–patient relationship. The more sick or worried they were the more vulnerable and the more in need of a regular GP. Furthermore, patients stated that it was difficult for them to change GP even if they had a poor relationship.
Conclusion
Attachment theory may provide an explanation for patients' need to see a regular GP. The vulnerability of being a patient creates a need for attachment to a caregiver. This need is fundamental and is activated in adults when they are sick or scared.
doi:10.3109/02813432.2010.505447
PMCID: PMC3442335  PMID: 20642396
Attachment; doctor–patient relationship; family practice; interpersonal continuity; qualitative study
10.  Analysis of questions asked by family physicians regarding patient care 
Western Journal of Medicine  2000;172(5):315-319.
Objectives To characterize the information needs of family physicians by collecting the questions they asked about patient care during consultations and to classify these in ways that would be useful to developers of knowledge bases. Design An observational study in which investigators visited physicians for two half-days and collected their questions. Taxonomies were developed to characterize the clinical topic and generic type of information sought for each question. Setting Eastern Iowa. Participants Random sample of 103 family physicians. Main outcome measures Number of questions posed, pursued, and answered; topic and generic type of information sought for each question; time spent pursuing answers; and information resources used. Results Participants asked a total of 1,101 questions. Questions about drug prescribing, obstetrics and gynecology, and adult infectious disease were most common, comprising 36% of the total. The taxonomy of generic questions included 69 categories; the three most common types, comprising 24% of all questions, were “What is the cause of symptom X?” “What is the dose of drug X?” and “How should I manage disease or finding X?” Answers to most questions (n = 702 [64%]) were not immediately pursued, but of those pursued, most (n = 318 [80%]) were answered. Physicians spent an average of less than 2 minutes pursuing an answer, and they used readily available print and human resources. Only two questions led to a formal literature search. Conclusions Family physicians in this study did not pursue answers to most of their questions. Questions about patient care can be organized into a limited number of generic types, which could help guide the efforts of knowledge-base developers.
PMCID: PMC1070879  PMID: 18751285
11.  Evidence-based databases versus primary medical literature: an in-house investigation on their optimal use*† 
Objective: The objective is to investigate the effectiveness of evidence-based medicine (EBM) resources in providing evidence for complex clinical questions versus general care management questions to identify situations for their optimal use.
Methods: In this investigation, forty complex clinical questions were randomly selected from an in-house archival database of questions received by librarians during clinical rounds. An additional forty questions were selected from a list of general care management questions received by the library from Pathways teams. To measure the effectiveness of resources in answering the questions, a team of librarians was asked to search UpToDate, the Cochrane Database of Systematic Reviews, and HealthGate Clinical Guidelines (formerly, EBM Solutions). The team then established consensus on whether a question was fully or partially answered by one of the above-mentioned EBM resources and was instructed to record the instances in which the primary literature needed to be used to answer the question completely.
Results: The study found that the EBM resources completely answered 20.0% of the 40 complex clinical questions and 47.5% of the 40 general care management questions, partially answered 40.0% of the complex clinical questions and 22.5% of the general care management questions, and did not answer 40.0% of the complex clinical questions and 30.0% of the general care management questions.
Conclusion: The pervasive use of EBM resources in answering clinical questions is making it imperative for information specialists to develop an expertise on their appropriate use. By exploring their use in answering complex clinical questions and general care management questions, this paper underlines the strengths and weakness of EBM resources and provides information specialists with some basic knowledge about how these resources can be combined with the primary literature to strengthen their effectiveness.
PMCID: PMC521511  PMID: 15494755
12.  Improving Communication between Doctors and Parents after Newborn Screening 
Background
Newborn screening (NBS) enables early treatment and some consider it a natural vehicle for genetic screening. Bioethicists argue for caution since families of carrier infants can develop psychosocial complications. This paper describes methods and feasibility of our statewide project for quality improvement of communication and psychosocial outcomes after NBS.
Methods
When NBS identifies carrier status for cystic fibrosis or sickle cell, we contact primary care providers (PCPs), answer questions, and invite them to rehearse informing the parents. Three months later we telephone parents, assess knowledge and psychosocial outcomes, provide counseling, and assist with self-referral to further resources. Afterwards, anonymous evaluation surveys are provided.
Results
Birthing facilities provided accurate PCP names for 73% of 817 infants meeting inclusion criteria; we identified PCPs for 21% more. We reached 47.3% of PCPs in time to invite a rehearsal; 60% of these accepted. We successfully called 50.2% of eligible parents; 61% recalled a PCP explanation and 48.5% evaluated the explanation favorably. Evaluations by parents with limited health literacy were less favorable.
Conclusion
It is feasible to follow parents for psychosocial outcomes after NBS. Preliminary data about communication is mixed, but further data will soon describe psychosocial outcomes, and investigate outcomes’ associations with communication.
PMCID: PMC3594768  PMID: 22164579
Newborn Screening; Genetic counseling; Genetic screening; Cystic fibrosis; Sickle cell trait; Provider-patient communication; Communication quality assurance
13.  Doctors, ethics and special education. 
Journal of Medical Ethics  1998;24(1):49-55.
This discussion paper is drawn from a qualitative research project comparing the effect of special and ordinary schools on the lives of children, young people and their families. Special schools are recommended by health professionals who seldom know how ineffective these schools are. We question the beneficence and justice of health professionals' advice on education for children with disabilities and other difficulties. Cooperation with local education authorities (LEAs) plays a considerable part in the work of community paediatricians, clinical medical officers, therapists and other health professionals encountering children with "special needs". The "needs" range from physical disability and sensory impairment to learning difficulties and emotional or behavioural difficulties. This cooperation involves routine administrative problems, but it raises broad ethical issues too, particularly in respect of current tendencies in state schooling towards the integration or inclusion of these children in mainstream schools and classes.
PMCID: PMC1377432  PMID: 9549683
14.  What doctors tell patients with breast cancer about diagnosis and treatment: findings from a study in general hospitals. GIVIO (Interdisciplinary Group for Cancer Care Evaluation) Italy. 
British Journal of Cancer  1986;54(2):319-326.
In a study aimed at assessing whether and how patients with breast cancer are informed on their diagnosis and treatment a large group of physicians participating in a quality of care evaluation program were asked to report what they told patients about diagnosis and treatment. The completeness of such communication was then assessed using an explicit protocol designed to measure precision and lack of ambiguity of reported phrases. By this measure 39% patients received 'thorough' information on diagnosis and 11% 'detailed' information on surgery. These proportions become 48% and 14%, respectively, when only cases for whom answers were available are considered. Physicians, however, considered this communication 'thorough' for 69% of patients. Among patient-related characteristics, age, education and stage of disease were independent predictors of quality of information. Setting-dependent features more than individual provider attitudes seemed to account for at least part of the quality of information sharing behaviour as both hospital size (comparing centres larger than 500 beds and smaller ones) and degree of hospital organization (comparing centres adhering to the Italian Breast Cancer Task Force, FONCaM and those not) were - simultaneously - significant predictors of quality of communication, independently from patients' case-mix. Physicians' judgement - measured assuming the explicit protocol as standard - proved to be of acceptable sensitivity only when information was 'Thorough' by the protocol. However, its specificity and predictive values were consistently low in all three categories defined by the protocol, leading to high misclassification rates. The implications of these findings for studies aimed at assessing the quality of patients-providers communication are discussed.
PMCID: PMC2001524  PMID: 3741767
15.  MEDLINE as a Source of Just-in-Time Answers to Clinical Questions 
Clinicians increasingly use handheld devices to support evidence-based practice and for clinical decision support. However, support of clinical decisions through information retrieval from MEDLINE® and other databases lags behind popular daily activities such as patient information or drug formulary look-up. The objective of the current study is to determine whether relevant information can be retrieved from MEDLINE to answer clinical questions using a handheld device at the point of care. Analysis of search and retrieval results for 108 clinical questions asked by members of clinical teams during 28 daily rounds in a 12-bed intensive care unit confirm MEDLINE as a potentially valuable resource for just-in-time answers to clinical questions. Answers to 93 (86%) questions were found in MEDLINE by two resident physicians using handheld devices. The majority of answers, 88.9% and 97.7% respectively, were found during rounds. Strategies that facilitated timely retrieval of results include using PubMed® Clinical Queries and Related Articles, spell check, and organizing retrieval results into topical clusters. Further possible improvements in organization of retrieval results such as automatic semantic clustering and providing patient outcome information along with the titles of the retrieved articles are discussed.
PMCID: PMC1839449  PMID: 17238329
16.  Utilization of the PICO framework to improve searching PubMed for clinical questions 
Background
Supporting 21st century health care and the practice of evidence-based medicine (EBM) requires ubiquitous access to clinical information and to knowledge-based resources to answer clinical questions. Many questions go unanswered, however, due to lack of skills in formulating questions, crafting effective search strategies, and accessing databases to identify best levels of evidence.
Methods
This randomized trial was designed as a pilot study to measure the relevancy of search results using three different interfaces for the PubMed search system. Two of the search interfaces utilized a specific framework called PICO, which was designed to focus clinical questions and to prompt for publication type or type of question asked. The third interface was the standard PubMed interface readily available on the Web. Study subjects were recruited from interns and residents on an inpatient general medicine rotation at an academic medical center in the US. Thirty-one subjects were randomized to one of the three interfaces, given 3 clinical questions, and asked to search PubMed for a set of relevant articles that would provide an answer for each question. The success of the search results was determined by a precision score, which compared the number of relevant or gold standard articles retrieved in a result set to the total number of articles retrieved in that set.
Results
Participants using the PICO templates (Protocol A or Protocol B) had higher precision scores for each question than the participants who used Protocol C, the standard PubMed Web interface. (Question 1: A = 35%, B = 28%, C = 20%; Question 2: A = 5%, B = 6%, C = 4%; Question 3: A = 1%, B = 0%, C = 0%) 95% confidence intervals were calculated for the precision for each question using a lower boundary of zero. However, the 95% confidence limits were overlapping, suggesting no statistical difference between the groups.
Conclusion
Due to the small number of searches for each arm, this pilot study could not demonstrate a statistically significant difference between the search protocols. However there was a trend towards higher precision that needs to be investigated in a larger study to determine if PICO can improve the relevancy of search results.
doi:10.1186/1472-6947-7-16
PMCID: PMC1904193  PMID: 17573961
17.  Survey of perceived stress and work demands of consultant doctors. 
OBJECTIVES: The objectives of this study were to assess the work demands as potential stressors of health service consultants, and to describe the development of tools for measuring stress experiences of consultants. METHODS: A stratified random sample of 500 NHS consultants in Scotland was targeted by a postal questionnaire and 375 (75%) returned a valid response. They completed questionnaires, including information on demographic factors, work demands, occupational stressors, and burnout. RESULTS: Principal components analysis showed that professional work demands of consultants fell into three categories: clinical, academic, and administrative. Their perceived stressors separated into four main factors: clinical responsibility, demands on time, organisational constraints, and personal confidence. These were assessed by 25 questions in the specialist doctors' stress inventory. Specific questions about perceived stressors which resulted in a high positive response included questions about demands on time, and organisational change in the NHS. CONCLUSION: These self reported data characterise and measure the consultants' work demands and their role as potential stressors. These measurements could form the basis for strategies to reduce occupational stress in these workers.
PMCID: PMC1128453  PMID: 8664957
18.  Improving the use of research evidence in guideline development: 14. Reporting guidelines 
Background
The World Health Organization (WHO), like many other organisations around the world, has recognised the need to use more rigorous processes to ensure that health care recommendations are informed by the best available research evidence. This is the 14th of a series of 16 reviews that have been prepared as background for advice from the WHO Advisory Committee on Health Research to WHO on how to achieve this.
Objectives
We reviewed the literature on reporting guidelines and recommendations.
Methods
We searched PubMed and three databases of methodological studies for existing systematic reviews and relevant methodological research. We did not conduct systematic reviews ourselves. Our conclusions are based on the available evidence, consideration of what WHO and other organisations are doing and logical arguments.
Key questions and answers
There is little empirical evidence that addresses these questions. Our answers are based on logical arguments and standards put forward by other groups.
What standard types of recommendations or reports should WHO use?
• WHO should develop standard formats for reporting recommendations to facilitate recognition and use by decision makers for whom the recommendations are intended, and to ensure that all the information needed to judge the quality of a guideline, determine its applicability and, if needed, adapt it, is reported.
• WHO should develop standard formats for full systematically developed guidelines that are sponsored by WHO, rapid assessments, and guidelines that are endorsed by WHO.
• All three formats should include the same information as full guidelines, indicating explicitly what the group preparing the guideline did not do, as well as the methods that were used.
• These formats should be used across clinical, public health and health systems recommendations.
How should recommendations be formulated and reported?
• Reports should be structured, using headings that correspond to those suggested by the Conference on Guideline Standardization or similar headings.
• The quality of evidence and strength of recommendations should be reported explicitly using a standard approach.
• The way in which recommendations are formulated should be adapted to the specific characteristics of a specific guideline.
• Urgent attention should be given to developing a template that provides decision makers with the relevant global evidence that is needed to inform a decision and offers practical methods for incorporating the context specific evidence and judgements that are needed.
doi:10.1186/1478-4505-4-26
PMCID: PMC1702351  PMID: 17156458
19.  Doctors’ willingness to give honest answers about end-of-life practices: a cross-sectional study 
BMJ Open  2013;3(5):e002598.
Objectives
We aimed to (1) evaluate the extent to which doctors in New Zealand would be willing to answer honestly questions about their care of patients at the end of their lives and (2) identify the assurances that would encourage this. Results were compared with findings from a previous pilot study from the UK.
Design
Survey study involving a mailed questionnaire.
Setting
New Zealand hospital and community-based medical care settings.
Participants
The questionnaire was mailed to a random sample of 800 doctors in New Zealand who were vocationally registered with the Medical Council of New Zealand in disciplines involving caring for patients at the end of their lives.
Primary and secondary outcome measures
Willingness to provide honest answers about various aspects of end-of-life care; assurances that might increase willingness to provide honest answers to questions about end-of-life practices.
Results
Completed questionnaires were returned by 436 doctors. The majority of respondents (59.9–91.5%) indicated willingness to provide honest answers to such questions. However, more than a third of doctors were unwilling to give honest answers to certain questions regarding euthanasia. These results are comparable with the UK data. Complete anonymity was the assurance most likely to encourage honest answering, with most of the respondents preferring the use of anonymous written replies. Respondents were less reassured by survey endorsements from regulatory bodies. Themes in free comments included the deterrent effect of medicolegal consequences, fear of censure from society, peers and the media and concerns about the motivations and potential uses of such research.
Conclusions
Many New Zealand doctors were willing to give honest answers to questions about end-of-life practices, particularly if anonymity was guaranteed; others, however, expressed doubts or indicated that they would not be willing to provide honest answers to questions of this sort.
doi:10.1136/bmjopen-2013-002598
PMCID: PMC3664351  PMID: 23793694
Medical Ethics; Medical Law; Palliative Care
20.  Who's My Doctor? First-Year Residents and Patient Care: Hospitalized Patients' Perception of Their “Main Physician” 
Background
Studies have shown that a large portion of patient satisfaction is related to physician care, especially when the patient can identify the role of the physician on the team. Because patients encounter multiple physicians in teaching hospitals, it is often difficult to determine who the patient feels is his or her main caregiver. Surveys evaluating resident physicians would help to improve patient satisfaction but are not currently implemented at most medical institutions.
Intervention
We created a survey to judge patient satisfaction and to determine who patients believe is their “main physician” on the teaching service.
Methods
Patients on a medical teaching service at The Miriam Hospital during 20 days in March 2008 were asked to complete the survey. A physician involved in the research project administered the surveys. Surveys included 3 questions that judged patient's perception and identification of their primary physician and 7 questions regarding patient satisfaction. Completed surveys were analyzed using averages.
Results
Of the 126 patients identified for participation, 102 (81%) completed the survey. Most patients identified the intern (first-year resident) as their main physician. Overall, more than 90% of patients expressed satisfaction with their main physician.
Conclusion
Most patients on the teaching service perceived the intern as their main physician and were satisfied with their physician's care. One likely reason is that interns spend the greatest amount of time with patients on the teaching service.
doi:10.4300/JGME-D-09-00082.1
PMCID: PMC2930311  PMID: 21975620
21.  A taxonomy of generic clinical questions: classification study 
BMJ : British Medical Journal  2000;321(7258):429-432.
Objective
To develop a taxonomy of doctors' questions about patient care that could be used to help answer such questions.
Design
Use of 295 questions asked by Oregon primary care doctors to modify previously developed taxonomy of 1101 clinical questions asked by Iowa family doctors.
Setting
Primary care practices in Iowa and Oregon.
Participants
Random samples of 103 Iowa family doctors and 49 Oregon primary care doctors.
Main outcome measures
Consensus among seven investigators on a meaningful taxonomy of generic questions; interrater reliability among 11 individuals who used the taxonomy to classify a random sample of 100 questions: 50 from Iowa and 50 from Oregon.
Results
The revised taxonomy, which comprised 64 generic question types, was used to classify 1396 clinical questions. The three commonest generic types were “What is the drug of choice for condition x?” (150 questions, 11%); “What is the cause of symptom x?” (115 questions, 8%); and “What test is indicated in situation x?” (112 questions, 8%). The mean interrater reliability among 11 coders was moderate (κ=0.53, agreement 55%).
Conclusions
Clinical questions in primary care can be categorised into a limited number of generic types. A moderate degree of interrater reliability was achieved with the taxonomy developed in this study. The taxonomy may enhance our understanding of doctors' information needs and improve our ability to meet those needs.
PMCID: PMC27459  PMID: 10938054
22.  Doctors as patients: a systematic review of doctors' health access and the barriers they experience 
Background
The need to improve doctors' access to health care by reducing the barriers they experience has been regularly described in the literature, yet the barriers experienced are not well defined, despite the volume of expert opinion in this area.
Aim
To define what is known about doctors' access to health care from the data within the current literature.
Design of study
A systematic review of studies of doctors' health access.
Method
A systematic search of MEDLINE® and CINAHL, supplemented by citation searches and searches of the grey literature, identified both quantitative and qualitative studies. Two reviewers used specific criteria for inclusion of studies and quality assessment. The data were tabulated and analysed.
Results
Twenty-six articles met the inclusion criteria. The paucity of data and the overall poor quality of those data are highlighted. Despite this, many doctors appear to have a GP, but this does not ensure adequate health access. Systemic barriers to healthcare access (long hours and cultural issues) are more significant than individual barriers.
Conclusion
Expert opinion in this field is supported by poor-quality data. The current knowledge reveals important similarities between doctors and the general population in their healthcare access, especially with mental health issues. Understanding this may help the medical profession to respond to these issues of ‘doctors’ health' more effectively.
doi:10.3399/bjgp08X319486
PMCID: PMC2441513  PMID: 18611318
attitude of health personnel; health behaviour; physician health; systematic review
23.  Essential therapeutics skills required of junior doctors 
Perspectives on Medical Education  2012;1(5-6):225-236.
Junior doctors are responsible for the majority of in-hospital prescription errors. Little research has explored their confidence to prescribe, or practical therapeutics related tasks which they are required to perform in day-to-day practice. This survey aimed to explore these areas, gather feedback regarding therapeutics teaching at undergraduate level, and to apply findings to undergraduate training at University of Birmingham. Questionnaire-based survey of all first-year postgraduate doctors (PG1) attending teaching hospitals in the Birmingham and Worcester regions towards the end of the PG1 year. Doctors were asked about difficulties in prescribing, satisfaction with undergraduate training, and how frequently they undertook particular tasks pertaining to therapeutics. Qualitative data on suggestions for improving the curriculum were also collected. Difficulties were commonly encountered with prescribing warfarin, controlled drugs and syringe-driven drugs. Most (87.4 %) had been required to administer intravenous medications. Nearly all had prescribed to ‘special groups’ such as the elderly (100 %) and patients with renal disease (98.3 %). Thirty-seven percent were not satisfied with their undergraduate therapeutics teaching, and many (56.2 %) recommended making teaching more relevant to clinical practice. Many PG1s expressed difficulties in prescribing potentially dangerous medications. Although better than other UK surveys, significant numbers were not satisfied with undergraduate teaching. The strong opinion was for teaching to become more practical and more relevant. Prescriptions which PG1s are commonly asked to write have been described. Findings have guided improvements to undergraduate teaching and assessment in therapeutics at the University of Birmingham, and may offer guidance to other medical schools.
doi:10.1007/s40037-012-0032-1
PMCID: PMC3518801  PMID: 23240101
Clinical pharmacology and therapeutics; Junior doctors; Prescribing; Undergraduate medical education
24.  Changes in paediatric resuscitation knowledge among doctors 
Archives of Disease in Childhood  2001;84(5):412-414.
AIMS—To investigate whether paediatricians have improved their resuscitation knowledge since 1992, and whether those who have attended a paediatric resuscitation course have greater knowledge than those who have not.
METHODS—Telephone survey of 94 resident paediatricians admitting emergency cases. Questions on clinical scenarios were asked and adherence to internationally agreed guidelines in answering was determined.
RESULTS—There were significantly more correct answers to 9/10 questions in 1999 compared to 1992. The 1999 doctors who had attended a course scored significantly better in 3/10 questions and achieved a higher total score (5.43 versus 4.55).
CONCLUSIONS—Knowledge has improved since 1992; this has been over the period in which paediatric resuscitation courses were introduced. In 1999 those who had been on a course were more knowledgeable than those who had not.


doi:10.1136/adc.84.5.412
PMCID: PMC1718765  PMID: 11316685
25.  Interpretation of the emergency electrocardiogram by junior hospital doctors. 
OBJECTIVE: To assess the ability of a cohort of junior hospital doctors to interpret ECGs which have immediate clinical relevance and influence subsequent management of patients. METHODS: 57 junior hospital doctors were interviewed and asked to complete a standard questionnaire which included eight ECGs for interpretation and a supplementary question relating to the administration of thrombolytic treatment. Each doctor was assessed over a 48 h period while they performed their daily clinical duties. RESULTS: The major abnormality of anterior myocardial infarction was recognised by almost all doctors. There was difficulty in the interpretation of posterior myocardial infarction and second degree heart block. Most myocardial infarctions would have been given satisfactory thrombolysis, but there was a reluctance to use this treatment in patients with posterior myocardial infarction and left bundle brach block. A few patients without myocardial infarction would have received thrombolytic treatment. CONCLUSIONS: There is varying ability among junior hospital doctors in the interpretation of the emergency electrocardiogram. The results are of concern as poor interpretation of the ECG can result in inappropriate management. As a result of the findings of this study it is proposed to introduce more formal training in the interpretation of clinically relevant ECG abnormalities for junior hospital doctors.
PMCID: PMC1342806  PMID: 8947796

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