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Physician Perceptions (physician + perception)

Distribution by Scientific Domains

Medical Sciences	90%

Selected Abstracts

Physicians' perceptions of protocol-directed weaning in an intensive care unit in Norway

NURSING & HEALTH SCIENCES, Issue 1 2009
Britt Sætre Hansen ccrn, mnsc
Abstract The aim of this paper is to identify physicians' perceptions of protocol-directed weaning from mechanical ventilation in an intensive care unit in Norway. Errors occur in the absence of procedures, plans, and a team culture. Standardized weaning protocols, or pathways, offer a systematic approach. The focus group method was used. Four themes emerged: (i) acceptance, where the participants perceived the protocol as having a positive influence on the weaning process, although some barriers were identified, such as its failure to facilitate the "difficult-to-wean" patient; (ii) indignant responses, which gave the impression that the protocol was prescribed for the benefit of the nurses; (iii) ambivalence was evident in the two different approaches to the weaning process when problems occurred, which were "directing" and "collaborating"; and (iv) continuity and professional competence were perceived as important aspects of the weaning process. An unclear pattern of responsibility and poor interprofessional collaboration and communication were reported. [source]

Is there a discrepancy between patient and physician quality of life assessment?,

NEUROUROLOGY AND URODYNAMICS, Issue 3 2009
Sushma Srikrishna
Abstract Aims Quality of Life (QoL) assessment remains integral in the investigation of women with lower urinary tract dysfunction. Previous work suggests that physicians tend to underestimate patients' symptoms and the bother that they cause. The aim of this study was to assess the relationship between physician and patient assessed QoL using the Kings Health Questionnaire (KHQ). Methods Patients complaining of troublesome lower urinary tract symptoms (LUTS) were recruited from a tertiary referral urodynamic clinic. Prior to their clinic appointment they were sent a KHQ, which was completed before attending. After taking a detailed urogynecological history, a second KHQ was filled in by the physician, blinded to the patient responses, on the basis of their impression of the symptoms elicited during the interview. These data were analyzed by an independent statistician. Concordance between patient and physician assessment for individual questions was assessed using weighted kappa analysis. QoL scores were compared using Wilcoxons signed rank test. Results Seventy-five patients were recruited over a period of 5 months. Overall, the weighted kappa showed relatively poor concordance between the patient and physician responses; mean kappa: 0.33 (range 0.18,0.57). The physician underestimated QoL score in 4/9 domains by a mean of 5.5% and overestimated QoL score in 5/9 domains by a mean of 6.9%. In particular, physicians underestimated the impact of LUTS on social limitations and emotions (P,<,0.05). Conclusion This study confirms that physicians often differ from patients in the assessment of QoL. This is most likely due to a difference in patient,physician perception of "significant" LUTS and clearly demonstrates the importance of patient evaluated QoL in routine clinical assessment. Neurourol. Urodynam. 28:179,182, 2009. © 2008 Wiley-Liss, Inc. [source]

The Medical Interview: Differences Between Adult and Geriatric Outpatients

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 1 2001
Sandeep Mann MD
BACKGROUND: There is a perception that primary care physicians spend less time with older patients and little is known about physician and older patient satisfaction during clinical encounters. OBJECTIVE: To determine how primary care interviews of geriatric patients differ from those of other adults. DESIGN: Descriptive, analytic study. SETTING: Ten primary care sites in the United States and one in Canada, including public, voluntary, and private clinics and practices. PARTICIPANTS: Of the 544 patients, 45.6% were 65 and older and 17.8% were 75 or older. There were 127 participating physicians. MEASUREMENTS: Encounters were audiotaped and analyzed. Patients and physicians also completed exit questionnaires. RESULTS: Interview length increased significantly with age for men but not for women. Physician satisfaction did not change as patient age increased. Patient satisfaction, on the other hand decreased with age among women but not for men. Although physicians' and younger patients' perceptions of health were moderately associated, there was no association for men ages 75 and over. CONCLUSIONS: There is no evidence that physicians spend less time or are more uncomfortable with older patients. Both physician and male patient satisfaction remain stable with increasing patient age, despite greater disparity in patient and physician perceptions of health. Older female patients are less satisfied with physician visits than their younger counterparts, in the absence of changes in interview length or disparities between older female patients and their physicians in health perception. [source]

Perceptions of Effective and Ineffective Nurse,Physician Communication in Hospitals

NURSING FORUM, Issue 3 2010
F. Patrick Robinson PhD
PROBLEM., Nurse,physician communication affects patient safety. Such communication has been well studied using a variety of survey and observational methods; however, missing from the literature is an investigation of what constitutes effective and ineffective interprofessional communication from the perspective of the professionals involved. The purpose of this study was to explore nurse and physician perceptions of effective and ineffective communication between the two professions. METHODS., Using focus group methodology, we asked nurses and physicians with at least 5 years' acute care hospital experience to reflect on effective and ineffective interprofessional communication and to provide examples. Three focus groups were held with 6 participants each (total sample 18). Sessions were audio recorded and transcribed verbatim. Transcripts were coded into categories of effective and ineffective communication. FINDINGS., The following themes were found. For effective communication: clarity and precision of message that relies on verification, collaborative problem solving, calm and supportive demeanor under stress, maintenance of mutual respect, and authentic understanding of the unique role. For ineffective communication: making someone less than, dependence on electronic systems, and linguistic and cultural barriers. CONCLUSION., These themes may be useful in designing learning activities to promote effective interprofessional communication. [source]

Attending and Resident Satisfaction with Feedback in the Emergency Department

ACADEMIC EMERGENCY MEDICINE, Issue 2009
Lalena M Yarris MD
Abstract Objectives:, Effective feedback is critical to medical education. Little is known about emergency medicine (EM) attending and resident physician perceptions of feedback. The focus of this study was to examine perceptions of the educational feedback that attending physicians give to residents in the clinical environment of the emergency department (ED). The authors compared attending and resident satisfaction with real-time feedback and hypothesized that the two groups would report different overall satisfaction with the feedback they currently give and receive in the ED. Methods:, This observational study surveyed attending and resident physicians at 17 EM residency programs through web-based surveys. The primary outcome was overall satisfaction with feedback in the ED, ranked on a 10-point scale. Additional survey items addressed specific aspects of feedback. Responses were compared using a linear generalized estimating equation (GEE) model for overall satisfaction, a logistic GEE model for dichotomized responses, and an ordinal logistic GEE model for ordinal responses. Results:, Three hundred seventy-three of 525 (71%) attending physicians and 356 of 596 (60%) residents completed the survey. Attending physicians were more satisfied with overall feedback (mean score 5.97 vs. 5.29, p < 0.001) and with timeliness of feedback (odds ratio [OR] = 1.56, 95% confidence interval [CI] = 1.23 to 2.00; p < 0.001) than residents. Attending physicians were also more likely to rate the quality of feedback as very good or excellent for positive feedback, constructive feedback, feedback on procedures, documentation, management of ED flow, and evidence-based decision-making. Attending physicians reported time constraints as the top obstacle to giving feedback and were more likely than residents to report that feedback is usually attending initiated (OR = 7.09, 95% CI = 3.53 to 14.31; p < 0.001). Conclusions:, Attending physician satisfaction with the quality, timeliness, and frequency of feedback given is higher than resident physician satisfaction with feedback received. Attending and resident physicians have differing perceptions of who initiates feedback and how long it takes to provide effective feedback. Knowledge of these differences in perceptions about feedback may be used to direct future educational efforts to improve feedback in the ED. [source]

ORIGINAL RESEARCH,SURGERY: A Large Multicenter Outcome Study of Female Genital Plastic Surgery

THE JOURNAL OF SEXUAL MEDICINE, Issue 4pt1 2010
Michael P. Goodman MD
ABSTRACT Introduction., Female Genital Plastic Surgery, a relatively new entry in the field of Cosmetic and Plastic Surgery, has promised sexual enhancement and functional and cosmetic improvement for women. Are the vulvovaginal aesthetic procedures of Labiaplasty, Vaginoplasty/Perineoplasty ("Vaginal Rejuvenation") and Clitoral Hood Reduction effective, and do they deliver on that promise? For what reason do women seek these procedures? What complications are evident, and what effects are noted regarding sexual function for women and their partners? Who should be performing these procedures, what training should they have, and what are the ethical considerations? Aim., This study was designed to produce objective, utilizable outcome data regarding FGPS. Main Outcome Measures., 1) Reasons for considering surgery from both patient's and physician's perspective; 2) Pre-operative sexual functioning per procedure; 3) Overall patient satisfaction per procedure; 4) Effect of procedure on patient's sexual enjoyment, per procedure; 5) Patient's perception of effect on her partner's sexual enjoyment, per procedure; 6) Complications. Methods., This cross-sectional study, including 258 women and encompassing 341 separate procedures, comes from a group of twelve gynecologists, gynecologic urologists and plastic surgeons from ten centers in eight states nationwide. 104 labiaplasties, 24 clitoral hood reductions, 49 combined labiaplasty/clitoral hood reductions, 47 vaginoplasties and/or perineoplasties, and 34 combined labiaplasty and/or reduction of the clitoral hood plus vaginoplasty/perineoplasty procedures were studied retrospectively, analyzing both patient's and physician's perception of surgical rationale, pre-operative sexual function and several outcome criteria. Results., Combining the three groups, 91.6% of patients were satisfied with the results of their surgery after a 6,42 month follow-up. Significant subjective enhancement in sexual functioning for both women and their sexual partners was noted (p = 0.0078), especially in patients undergoing vaginal tightening/perineal support procedures. Complications were acceptable and not of major consequence. Conclusions., While emphasizing that these female genital plastic procedures are not performed to correct "abnormalities," as there is a wide range of normality in the external and internal female genitalia, both parous and nulliparous, many women chose to modify their vulvas and vaginas. From the results of this large study pooling data from a diverse group of experienced genital plastic surgeons, outcome in both general and sexual satisfaction appear excellent. Goodman MP, Placik OJ, Benson RH III, Miklos JR, Moore RD, Jason RA, Matlock DL, Simopoulos AF, Stern BH, Stanton RA, Kolb SE, and Gonzalez F. A large multicenter outcome study of female genital plastic surgery. J Sex Med 2010;7:1565,1577. [source]

Sexual dysfunction and physicians' perception in medicated patients with major depression in Taiwan

DEPRESSION AND ANXIETY, Issue 9 2008
Kao Ching Chen M.D.
Abstract Although prevalent during antidepressant treatment, sexual dysfunction (SD) is frequently ignored by both physicians and patients in Asia. In spite of impact of SD on medicated patients with major depression, sexual issues and illness remain a forbidden topic for most Asian people. The aims of this study were to: (1) estimate the prevalence of SD among stable outpatients taking different antidepressants in Taiwan; (2) investigate the factors related to SD; (3) compare physician-perceived with patient-reported prevalence rates of antidepressant-associated SD; and (4) study the differences of SD among antidepressant subgroups. In this cross-sectional observational study, 125 medicated patients with major depression were recruited. Patients were assessed using the Changes in Sexual Functioning Questionnaire (CSFQ), Taiwanese Depression Questionnaire (TDQ), Quality of Life Index (QOL), and neuroticism scores in the Maudsley Personality Inventory (MPI). Sixty-two physicians completed the Physician Antidepressant Experience Questionnaire. The estimated prevalence rate of SD was 53.6% (95% CI = 44.9,62.3%) in medicated patients with major depression. There were no significant differences in prevalence rate of SD among different antidepressants. The SD subgroup had poorer quality of life and lower moods than the non-dysfunction subgroup. An underestimation of the prevalence of SD by physicians was noted. Because antidepressant-associated SD is highly prevalent and seriously underestimated by physicians, greater physicians' recognition and better patients' education are imperative when prescribing antidepressants. Depression and Anxiety. © 2007 Wiley-Liss, Inc. [source]

The expanding clinical spectrum of Anderson,Fabry disease: a challenge to diagnosis in the novel era of enzyme replacement therapy

JOURNAL OF INTERNAL MEDICINE, Issue 6 2004
A. C. Hauser
Abstract. Anderson,Fabry disease is an X-linked recessive lysosomal storage disease resulting from deficient ,-galactosidase A activity. The conception of the disease has changed within the last decade. Studies of the last years have shown that the disease is not limited to the classical full-blown manifestation in affected males, which is well known since more than a century, but may also occur in carrier females. The phenomenology may differ in severity and kind of organ manifestation. Cardiac and renal variants with solely disease manifestation of these organs have also been described in an increasing number. It is likely that a spectrum exists regarding ,-galactosidase A activity in both genders on the one hand, and an additional one regarding the severity and the number of organs affected on the other. The purpose of this review is to sharpen physicians' perception of this disease. Early and accurate diagnosis is mandatory considering that this disorder is now, after introduction of the novel enzyme replacement therapy, a treatable disease. [source]

Paper Versus Electronic Medical Records: The Effects of Access on Physicians' Decisions to Use Complex Information Technologies,

DECISION SCIENCES, Issue 2 2009
Virginia Ilie
ABSTRACT This study examines physicians' responses to complex information technologies (IT) in the health care supply chain. We extend individual-level IT adoption models by incorporating a new construct: system accessibility. The main premise of the study is, when faced with a decision between alternate IT systems, individual users tend to select and make use of the technology or system that is most readily accessible. We discuss both physical and logical dimensions of accessibility as they relate to adoption of electronic medical records (EMR). Physical accessibility refers to the availability of computers that can be used to access EMR, while logical accessibility refers to the ease or difficulty of logging into the system. Using data from a survey of 199 physicians practicing in a large U.S. hospital, we show that, when deciding between the paper chart and EMR, accessibility is an important consideration in a physician's decision to use the system. Both dimensions of accessibility act as barriers to EMR use intentions through their indirect effect on physicians' perceptions of EMR usefulness and ease of use. Logical access also has a direct effect on EMR use intentions. We conclude that accessibility is an important factor that limits acceptance of complex IT such as EMR. [source]

Comparing Norwegian nurses' and physicians' perceptions of the needs of significant others in Intensive Care Units

JOURNAL OF CLINICAL NURSING, Issue 5 2005
Christina Takman CCRN
Aim and objectives., To illuminate and compare the perceptions of registered nurses (n = 243) and physicians (n = 29) in medical and surgical ICUs for adults on the needs of significant others. Background., Previous studies have established the necessity for healthcare professionals in Intensive Care Units (ICUs) to identify and meet the needs of critically ill adult patients' significant others. Design., A survey was conducted and data from the Critical Care Family Needs Inventory were analysed using descriptive and inferential statistics. Results., The findings revealed four factors: ,attentiveness and assurance', ,taking care of themselves', ,involvement', and ,information and predictability'. Nurses scored higher than physicians on ,attentiveness and assurance'. Nurses with experience of being a patient or a significant other in an ICU placed a higher value on ,involvement' compared with nurses without such experience, while physicians with such experience scored higher on ,information and predictability' compared with those without such experience. Older physicians and those with extensive professional and ICU experience had a low score on ,involvement', but scored higher on ,information and predictability' compared with physicians with less experience. Nurses with extensive ICU and professional experience also scored higher on ,information and predictability' than nurses with less experience. Women placed a higher value on each of the four factors than men. Conclusion., The study revealed variations in ICU professionals' perceptions of significant others' needs. Relevance to clinical practice., There is a need for nurses and physicians to acknowledge that varying perceptions on significant others needs could lead to different ways of conducting themselves in encounters with significant others in ICUs. There is also a risk that the patients' significant others could be forced to adapt themselves to professionals' different and perhaps contradictory perceptions of their needs in ICUs. [source]