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Biomedical subjects

M A Bowman

Publications and source records attributed to M A Bowman.

At least 19 recordsLinked to original sources
PubMed1992

Assessment of the patient-doctor interaction scale for measuring patient satisfaction.

This study assessed the validity, reliability and usability of the Patient-Doctor Interaction Scale (PDIS) in a university-based family practice center. Health maintenance visits and problem visits were included, and data were collected at the time of the visit and again 1 month later. Three different methods of administration (in-person, telephone, and mail) were used to assess usability. Of 91 patients approached, 1 refused to participate. A total of 64 (70%) patients completed the instrument adequately to permit analysis. PDIS scores correlated with overall assessment of patient satisfaction (P < 0.01), suggesting criterion-based validity. Internal consistency (reliability) of the PDIS was indicated by Cronbach's alpha which were consistently greater than 0.80. Scores and return rates varied by method of administration, with the telephone method performing best. The PDIS appears to fulfill the requirements for a valid, reliable and useful instrument to assess patient satisfaction in family practice settings.

Adult↗
PubMed1992

The effect of educational preparation on physician performance with a sexually transmitted disease-simulated patient.

BACKGROUND: Simulated patients are used with increased frequency for medical students and residents, but have not been used very often with practicing physicians. We hypothesized that educational materials could improve primary care physicians sexual practices history taking and counseling as assessed by a simulated patient in the physician's office. METHODS: Simulated patient (SP) visits were made to 232 (75% of eligible) primary care physicians. The patient simulated was a sexually active young woman with vaginitis and sexually transmitted disease/human immunodeficiency virus risk behaviors. In advance of the visit, physicians were provided educational materials (monograph, pamphlet, and audiotape) developed for the study, including a risk assessment questionnaire that could be used with patients. RESULTS: Most physicians randomly allocated to the intervention participated. Twenty-one percent of physicians refused to schedule an SP visit. Physicians who received an SP rated the experience highly. Physicians who prepared for the visit with the educational materials performed significantly better than those who did not. About two thirds of physicians reviewed the materials, many for the second time, after the SP visit. Physicians who used the study risk assessment questionnaire performed better. Many physicians (24.9% to 39.8%) did not meet each of the four goals for the visit, as assessed subjectively by the SP. Physician performance was better for measures of general patient interaction than for measures of sexual practices history taking and counseling techniques. CONCLUSION: The SP visit was acceptable to most physicians practicing in a community and was evaluated by them as an appealing and an effective educational experience. The SP, however, has limited feasibility because of cost. The SP led to review of materials by nearly all physicians either before or after the visit. Physicians who prepared before the visit performed better on every dimension, eliciting more information, displaying better patient interaction skills, and meeting more of the educational goals. Even with educational preparation, however, many physicians were not perceived as being effective counselors.

Adult↗
PubMed1992

Risk management and medical malpractice.

Medical malpractice claims are common and may be emotionally difficult for physicians. Most malpractice suits claim negligence. The most frequent types of claims include failure or delay in diagnosis, negligent treatment with drugs, failure to obtain consultation, failure to obtain informed consent, and negligent management of procedures. The most important risk-management strategy is the provision of good medical care. If a claim is filed, physicians should cooperate fully with the malpractice insurance carrier and refrain from discussing the case with colleagues.

Insurance, Liability↗
PubMed1991

Women physicians.

Explore the source record for details and available documents.

Career Choice↗
PubMed1991

Screening for sexually transmitted diseases by primary care physicians.

The acquired immunodeficiency syndrome epidemic has drawn attention to screening for sexually transmitted diseases by primary care physicians. A telephone survey of primary care physicians in an area with a high incidence of STDs (Washington, DC) to ascertain the determinants and the extent of screening and counseling for STDs was completed in 1987. Ninety-nine physicians (33 internists, 38 obstetrician/gynecologists, and 28 family/general practitioners), representing 61% of those eligible, completed the interview. One third (39.4%) were screening for gonorrhea, more than one half (57.5%) for syphilis, and almost all (94%) had tested at least one individual for human immunodeficiency virus infection. Analysis suggested that concomitant screening for hepatitis B was significantly and positively associated with screening for gonorrhea and syphilis. Less than half (45.9%) of the physicians asked new patients about their sexual practices. Physicians should take histories of sexual practices and do more preventive counseling.

Counseling↗
PubMed1991

Computerized literature searching in a teaching family practice center.

Computerized literature searching was introduced into a family practice residency office site after a series of training sessions. BRS Colleague was the searching program used. Over 15 months, 147 searches were conducted, primarily by faculty. Because residents used the system infrequently, they preferred to find a faculty member to help with the search rather than complete the search by themselves. The mean number of searches per faculty user was 6.4 and the median number of documents found per search was 15. The users were moderately satisfied with the search process (2.4 on a scale of 1 as excellent to 5 as unusable). Search strategies tended to be unsophisticated, often using only one of several possible related search terms. Most searches took a limited amount of time (5 to 20 minutes). The program was sufficiently successful to warrant continuation. Computerized literature searching offers a method to meet the physicians' needs for ready access to information on patient-related questions.

Follow-Up Studies↗
PubMed1990

A comparison of morbidity and mortality for family physicians' and internists' admissions.

The quality of medical care delivered by physicians of different specialties has been the subject of debate for some time. Studies have suffered from a variety of flaws. This study used the MedisGroups comparative database to compare outcome measures in hospitalized patients aged 65 years and older treated either by the family physicians or internists as attending physicians. Using the 10 most common diagnostic related groups for internal medicine, 10,353 admissions to internists were compared with 5,473 admissions to family physicians. Patients admitted by family physicians had a significantly higher admission illness severity and were significantly older. There was no significant difference in morbidity and mortality. The lower average charges for patients admitted to family physicians were statistically significant.

Age Factors↗
PubMed1989

Cost, correlates and effects of malpractice litigation in family practice residency programmes in the United States.

A survey of family practice residency programme directors in the United States was undertaken to look at the impact of malpractice and malpractice insurance on residency education. Of 385 programmes 276 (71.7%) responded to the 20 question survey. The results indicated a mean rate of 0.043 claims per resident or faculty member in the previous year. One-fifth of the respondents did not report the type of malpractice insurance retained for residents and over half did not report the cost of insurance for residents. Current problems with liability were most often related to the region of the country, number of visits to the family practice centre, the number of residents, the number of faculty, the type of faculty employer and the type of resident employer. Programmes which anticipated future problems with liability were most likely to be those with current problems. The areas identified as most concerning to residents included: obstetrics, cost of malpractice insurance, difficulty obtaining coverage, and the general anxiety created by malpractice litigation.

Education, Medical, Graduate↗
PubMed1989

Analogical reasoning abilities of recovering alcoholics.

This study investigated analogical reasoning abilities of alcoholics who had been abstinent from alcohol for at least 1 year. Their performance was compared to that of nonalcoholic controls matched as a group for education, age, and gender. Solution times and error rates were modeled using a regression model. Results showed a nonsignificant trend for alcoholics to be faster, but more error prone, than controls. The same componential model applied to both groups, and fit them equally well. Although differences have been found in analogical reasoning ability between controls and alcoholics immediately following detoxification, we find no evidence of differences after extended periods of sobriety.

Adult↗
PubMed1989

The quality of care provided by family physicians.

In the debate about which specialty should provide primary care for adults in the United States, part of the issue is the type of training given to the primary care provider and the overall quality of care provided by those who complete the training. This paper presents a literature review that summarizes the quality of care of family physicians by outcome and process measures. Studies in the literature are flawed by methodologic weaknesses, including the frequent lumping of all general and family physicians as a group and the general lack of description of the physicians involved. Some studies measuring the process of care indicate poorer process by family physicians or general practitioners, such as recording fewer medical process criteria used to measure quality of care. The quality of care by outcome measures, however, appears to be similar to that of other specialties. In general, the study of quality of care is in its infancy, and further work needs to be done to assess what training is needed to produce the highest quality primary care physicians.

Family Practice↗
PubMed1987

Pseudotumor cerebri.

Pseudotumor cerebri is characterized by increased intracranial pressure and papilledema, with an essentially normal neurologic examination. The major complication is visual loss. Many patients will have spontaneous remissions. The main method of following patients with pseudotumor cerebri is repeated visual field measurements. Several modes of treatment have been described, but their value is unclear.

Acetazolamide↗
PubMed1986

Continuing medical education for flexible sigmoidoscopy--toward a conceptual model for procedural skills training.

Participants in two one-day continuing medical education courses on flexible sigmoidoscopy were surveyed before, immediately after and ten months after the courses. 52 (29.5% of 176) participants completed all three survey forms. Before the course 32 (61.5%) expected to immediately use the flexible sigmoidoscope without further training. Ten months after the course 33 (63.4%) were using the flexible sigmoidoscope; four additional respondents were expecting to begin using the instrument. Twenty three of these (69.7%) had only attended the course without additional training. Those who found the instrument more difficult to use, or decided immediately after the course that more education was necessary, were less likely to use the instrument. Those not using the instrument also were older, more likely to be in solo practice and more likely to be surgeons. The course altered the educational plans of 23.1% of the respondents. This one-day format combining didactic and laboratory work with the instrument proved to be an efficient and effective means of education for using the instrument.

Adult↗