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Biomedical subjects

L S Linn

Publications and source records attributed to L S Linn.

At least 55 records · Page 3Linked to original sources
PubMed1986

Health habits and coping behaviors among practicing physicians.

Practicing physicians on the full-time academic and clinical (volunteer) faculty of an urban university department of medicine (N = 211) completed questionnaires that examined their coping behaviors, health habits, life satisfaction, job stress, conflict between work and home life, health status and moods. Attempts to organize and restructure work activities were more frequently practiced by physicians who were more satisfied with work. Socializing, exercising and discussing feelings with others were not associated with any measures of physician health status, job stress, conflict or satisfaction. Those with higher scores on a health habits index tended to be less anxious, experienced less job stress, less conflict between work and home life and were more satisfied with their lives in general. Full-time academic faculty engaged in fewer positive or negative coping behaviors than clinical faculty. There were few strong intercorrelations among the various positive and negative coping behaviors or health habits; physicians often simultaneously engaged in both positive and negative activities, indicating complex patterns of coping behaviors that were not dramatically associated with life or work satisfaction.

Activities of Daily Living↗
PubMed1985

Health status, job satisfaction, job stress, and life satisfaction among academic and clinical faculty.

The present study compares academic and clinical faculty affiliated with a major teaching hospital in terms of work characteristics, job stress, conflict between work and personal life, job and life satisfaction, and perceived health. There were no significant differences between the two physician groups on job satisfaction, total stress, anxiety, or depression scores. However, academic faculty reported working longer hours, taking less vacation time, and spending more time in research and teaching, but seeing fewer outpatients. Academic physicians experienced more conflict between work and personal life, were burdened by a variety of time pressures, and were less satisfied with their finances, but experienced fewer recent episodes of physical illness than clinical faculty. However, compared with what is known about the general population, both physician samples seemed equally or more satisfied with their health and their lives.

Adult↗
PubMed1985

Affect and neutrality in physician behavior: a study of patients' values and satisfaction.

Physicians' emotional expressivity was contrasted with emotional neutrality in a study of consumers' preferences regarding physician behavior in the medical encounter. Two hundred twenty-seven health-science students completed instruments designed to measure the values they held regarding physicians' emotional expressions as well as their perceptions of and satisfaction with the emotional behavior of a physician presented in a videotape simulation. Overall, consumers attached a low value to neutrality and preferred affective behavior to it, although their previously held values did significantly influence their degree of satisfaction with neutral behavior by the physician. Values did not influence recognition of or satisfaction with the nonneutral emotions. This research also shed light on consumer reactions to other emotions including reassurance and humor.

Affect↗
PubMed1985

Physician and patient satisfaction as factors related to the organization of internal medicine group practices.

The present study compares patient satisfaction scores with job satisfaction scores of the physicians providing their care in 16 general internal medicine teaching hospital group practices. Practice sites with more satisfied patients were also more likely to have more satisfied housestaff and faculty physicians. Additionally, higher satisfaction scores for both physician groups and patients were consistently associated with a greater percentage of patients experiencing continuity of care, lower patient no-show rates, more efficient use of ancillary staff in providing direct patient care, and more reasonable charges for a routine follow-up visit. These findings suggest that improving physician and patient satisfaction may have economic as well as psychological and social benefits.

Consumer Behavior↗
PubMed1985

General medical care and the education of internists in university hospitals. An evaluation of the teaching hospital general medicine group practice program.

Fifteen general internal medicine group practices in university teaching hospitals were studied to evaluate their primary care services and education. Data were collected over 9 months from physicians, patients, and medical records, and by observation. All institutions had closed their general medical clinics. Many patients being treated in group practices were very sick; 57% had hypertension; 21% were diabetic; and 45% could not work. Most were satisfied with their care. Care for acute problems from a health care provider in the practice was available quickly; regular physicians were harder to see. House staff and faculty spent little time in the practices. Few practices used teams; most used traditional attending and house staff models. Practice physicians could not easily determine when patients were seen in the institution's emergency department or were hospitalized. Quality of care standards were not uniformly met. Finally, the structure of academic centers appeared to inhibit the practices' performance, suggesting a need for further appraisal of relationships between university hospitals and their ambulatory care units.

Appointments and Schedules↗
PubMed1984

Psychiatric consultation in a medical clinic: what do medical providers want?

A participant observation needs assessment of the use of a psychiatrist in a primary care medical setting was undertaken to quantify details of the interaction between a psychiatrist and primary care providers. Two hundred seventeen encounters involving 63 providers were recorded over a five and one-half month period. Utilization of the psychiatrist was widespread but skewed, with only 17% of the sample using 50% of the services. The mean number of encounters for all providers was 3.44. Consultation occurred mainly in a private area of the clinic, usually in an unplanned fashion. Only 21% of encounters involved seeing a patient. The range and content of these interactions was broad. Initial reasons for consultation were often redefined as the consultation ensued. The kinds of help most frequently requested involved discussing nonpsychopharmacologic treatments (35%), assisting providers with evaluations (31%), and exploring unresolved feelings about patients or patient care issues (29%). Slightly more than 50% of encounters required some type of follow-up. The findings suggest that psychiatrists who wish to work in primary care settings must have expertise in a multitude of areas and must be flexible in adapting themselves to the setting in which the primary care providers work.

Counseling↗
PubMed1984

Consumer values and subsequent satisfaction ratings of physician behavior.

The role of respondents' values in their evaluation of and satisfaction with medical care was explored in four health education settings. Two hundred and twenty-seven nursing, medical, and health psychology students completed a forced-choice instrument designed to measure their value preferences for technical quality of care, psychosocial concern, courtesy, and mutual participation style of interacting in a medical visit. They subsequently watched a standardized 14-minute videotape of a simulated physician-patient interaction and evaluated the physician's behavior from the patient point of view on the four dimensions using two popular methods for assessing patient satisfaction. Respondents' ratings of the medical encounter were more often significantly influenced by their values when the more subjective satisfaction measure was considered. In addition, respondents who valued technical quality more highly were more satisfied with the other three dimensions of physician behavior, while respondents who more highly valued psychosocial concerns were less satisfied with these three dimensions. Ratings of satisfaction with technical quality were not affected by respondents' values. The importance of these findings in assessing patient satisfaction is discussed.

Adult↗
PubMed1984

Crimes against discharged mental patients in board-and-care homes.

A survey of 278 persons discharged from mental hospitals who were living in board-and-care homes showed that one-third of them had been victims of crime during the preceding year. In a comparison of nonvictims, victims of theft, and victims of violence, it was found that victims of violence were younger, were more active socially, reported more psychopathology and less satisfaction with their lives, and engaged in more criminal behaviors themselves than the other groups. Both victim groups used emergency mental health services more than nonvictims did during the preceding year. Strategies for future research and interventions are discussed.

Adult↗
PubMed1984

Social and structural factors affecting psychiatric consultation in the ambulatory medical setting.

The kinds of help primary care physicians requested from a psychiatric consultant in an ambulatory medical clinic are described. Based upon data from 173 encounters involving fifty-four physicians over a five and one-half month period, no single issue characterized a majority of encounters, and the nature of the help requested was diverse. Female physicians were more likely to initiate encounters that dealt with personal feelings about themselves or their patients. Male physicians were more likely to ask for assistance in evaluating patients. Whether or not a patient was seen as part of the consultation also significantly influenced the type of interaction that ensued as did the location of the interaction (hallway, room, or telephone) and whether or not the interaction was planned. Implications of these findings with regard to the training of primary care psychiatrists as well as the use of their services in ambulatory medical settings are explored.

Ambulatory Care↗
PubMed1984

Differences in the numbers and costs of tests ordered by internists, family physicians, and psychiatrists.

One hundred forty-six physicians responded to two written patient vignettes by recording problem lists, diagnostic impressions, and the tests and procedures they would have ordered after the initial encounter with the hypothetical patient described in each vignette. Wide variations within medical specialty were found in the number and types of tests or procedures ordered and their costs. We conclude that little consensus exists among physicians as to types of tests and procedures to order, and that private habits or rituals may account for much of the variation in ordering patterns. These findings point to the need for intensive study of how physicians respond to clinical ambiguity as well as how test-ordering habits and rituals arise and persist in different practice settings even within the same specialty. The health care cost implications are substantial.

Adult↗
PubMed1983

Reverse consultations: the profiles of patients referred from subspecialists to generalists.

To determine the characteristics of patients referred by subspecialists to generalists, we compared 67 patients referred by three medical subspecialty clinics to the general internal medicine clinic to 162 randomly chosen patients who were retained by those clinics, with respect to the patients' need for a broad array of services. A trained abstractor reviewed the records for the prior year for patient characteristics indicating a need for broad-based care. The mean referred patient age was 53.7 yr compared to 46.2 yr in the retained group (p = 0.001); 33% of referred patients, as compared to 20% of those retained, had references to psychosocial problems in the physician notes (p = 0.03). Referred patients had 2.34 diagnoses outside of the subspecialty, compared to 1.27 for retained patients (p = 0.001). Referred patients had more recorded complaints outside of the subspecialty, 1.18 vs 0.71, (p = 0.02). Referred patients also had significantly more total clinic visits and visited twice as many different types of clinics in the past year (p = 0.001). There were no differences in payment method or insurance status. These findings suggest that university based subspecialists prefer to refer medically and psychosocially complex patients. If it is desirable that subspecialists value such patients more highly, changes in subspecialty training programs might be needed. If not, more generalists may be needed to care for such patients.

Adult↗
PubMed1983

Humor and other communication preferences in physician-patient encounters.

In light of recent evidence suggesting the importance of communication in the health care setting, an instrument to measure communication style preferences was developed. This reliable and content-valid paper-and-pencil measure consisted of six scenarios depicting physician-patient interactions, each followed by four potential verbal responses from the physician. The four responses, representing four communications styles--humor, hostility, reassurance, and neutrality--were ranked by respondents according to their preferences. Among both physicians and consumers, reassuring responses were the most preferred, followed by neutral, humorous, and hostile responses. The intercorrelations of the four preferences and their relationships to standardized tests of both facilitating verbal response preferences and nonverbal expressiveness are presented. Potential uses of the instrument are discussed.

Adult↗
PubMed1982

Patient suffering and patient satisfaction among the chronically ill.

In a patient population with serious, debilitating chronic disease, the present study tested the hypothesis that a significant amount of variance in patient satisfaction ratings of provider behavior would be explained by patients' current assessment of their health and their social circumstances. More favorable patient ratings of the art, technical quality and efficacy of their care givers were found to be significantly associated with more positive general health perceptions, fewer days spent in bed due to health problems and lower scores on a widely used depression scale, as well as with age and ethnic background. These data provide evidence indicating that patient satisfaction measures are sensitive to and confounded by patients' perceived health, view of life and social circumstances. It is suggested that if patient satisfaction ratings are to be used as indicators of the quality of health care delivery, there is a need to account for the variance attributable to measurable psychological, social and demographic factors.

California↗
PubMed1982

Screening of depression in relationship to subsequent patient and physician behavior.

When internal medicine clinic patients were prescreened for depression and this information was fed back to their physicians, significant effects could be noted on the medical records. On the initial visit, prescreening and previsit feedback about depression increased its notation in the medical record by three times, and among depressed patients, resulted in significantly fewer laboratory tests being orders (X = 2.85 vs. 8.12 for depressed patients with feedback after). During the following year, record notations about depression were more likely to be made for those depressed patients that initially were in the "feedback before" group. These patients also saw twice as many providers, made three times as many visits, had three times as any tests ordered, and twice as many medications prescribed as those depressed patients in the "feedback after" group. These findings demonstrate that simple prescreening and feedback techniques may have significant and persistent influences on several dimensions of patient and physician behavior.

Attitude of Health Personnel↗
PubMed1982

Chronic mental patients: the quality of life issue.

Quality of life issues must be addressed more vigorously in the care of chronic mental patients. In a survey of 30 large board-and-care homes in Los Angeles, 278 mentally disabled residents described their life conditions and satisfaction in eight areas: living situation, family relations, social relations, leisure activities, work, finances, safety, and health. Residents were less satisfied than the general population in most life areas, especially finances, unemployment, safety, and family and social relations (p less than .001). Of particular concern was the finding that 34% had been recent victims of crime. The results underscore the need for better social programs for these patients.

Adult↗