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PubMed2003

Prehospital DNR orders: what do physicians in Washington know?

OBJECTIVES: To assess whether physicians know of Washington State's prehospital do-not-resuscitate (DNR) policy, 6 years after its implementation. DESIGN: Cross-sectional survey. SETTING: Washington State, April 2001. PARTICIPANTS: Four hundred seventy-one practicing physicians. MEASUREMENTS: Multivariate logistic regression was used to determine relationships between physician and practice characteristics with knowledge of policies governing advance care planning. RESULTS: Among respondents, 60% did not know that Washington State requires an emergency medical service (EMS)-specific DNR order authored by a physician. Seventy-nine percent did not know that patient-authored advance directives apply only in hospitals and medical offices. CONCLUSION: The findings in this study suggest that most physicians in Washington State lack knowledge about the documentation needed for EMS personnel to forgo pre-hospital attempts at cardiopulmonary resuscitation. Further study is needed to determine whether physician education or legislative change is necessary.

Cross-Sectional Studies↗
PubMed1999

Survey of attitudes of UK clinical oncologists towards radionuclide therapy.

A survey of UK consultants in clinical oncology was carried out in November 1997. The aim of this was to explore their attitudes towards radionuclide therapy and to determine the proportion of clinical oncologists involved in this modality. Three hundred and twenty-eight questionnaires were sent out and 227 (69.2%) were returned. Approximately one-half of those responding treat thyroid cancer or benign thyroid disease with radioactive iodine ((131)I) or prostate cancer with strontium ((89)Sr). The median number of patients treated per year with (131)I for benign thyroid disease was 12, with evidence of increasing subspecialization. Treatment with radioactive phosphorus ((32)P) for haematological disorders and yttrium ((90)Y) for intra-articular conditions was carried out by 31% (median number treated per year, two) and 6% (median number per year, five) respectively. There was strong support for the continuing involvement of clinical oncologists in radionuclide therapy for thyroid and prostate cancer. There was significant support for patients with benign thyroid disease or requiring intra-articular (90)Y to be treated by a specialist in nuclear medicine. However, this support was less strong amongst those currently involved in treatment compared with those not involved. There was support for the continued involvement of clinical oncologists in the use of (32)P. Attitudes appeared not to vary in different parts of the UK.

Attitude of Health Personnel↗
PubMed2001

Special aspects of cancer pain management in a Chinese general hospital.

China is still faced with a challenge in cancer pain management. The purposes of this study are to assess the current status of cancer pain management, and physicians' attitudes in China towards cancer pain management. The survey was done in a Chinese general hospital; 427 physicians and 387 cancer pain patients participated. The survey consisted of questionnaires to evaluate cancer pain management and physicians' knowledge of, and attitudes towards, cancer pain management. A total of 43% of patients with cancer pain and 51% with bone pain felt that they had been inadequately treated. The physicians rated the main reason for not using opioid drugs as the strong and difficult to control side-effects. The four main barriers to optimal management of cancer pain were: inadequate pain assessment; excessive state regulation of the prescribing of opioids; inadequate staff knowledge of pain management; and lack of access to powerful analgesics. To conclude: In China, there are some special aspects of cancer pain management, including physicians' concern about using opioid drugs, fear of being unable to manage adverse effects of opioids, and inadequately treated bone pain.

Adolescent↗
PubMed2001

Opioid use in chronic pain management in the Philippines.

The aim of this investigation was to determine current opioid use in the Philippines and the reasons why its use is very low. We surveyed 314 doctors in Metro Manila to determine their specialty, possession of narcotics license, and knowledge of opioid use beyond the terminal stage. We found that the majority of respondents possess a narcotics licence. All of them see pain patients in their practice. They agree that opioids should not be reserved for the terminally ill; 235 have prescribed opioids for non-cancer pain. A small minority believes that use of opioids for non-cancer pain can lead to addiction. Opioids that were most easily recalled were morphine, meperidine and nalbuphine. The survey contradicts the national data for opioid use. With an INCB (International Narcotics Control Board) allocation of 87 kilograms annually, less than 15 kilograms are consumed every year. Fentanyl has a 7 gram usage versus a 100 gram INCB allocation. We conclude that actual opioid use in the Philippines is minimal. However, the correlation between survey results and actual usage indicates a strong awareness of the usefulness of opioids but hesitancy in opioid prescription.

Analgesics, Opioid↗
PubMed2006

Cesarean delivery: background, trends, and epidemiology.

OBJECTIVE: To examine trends in cesarean delivery for the overall population and for women with "no indicated risk" for cesarean section, and to summarize the available literature on "maternal request" cesarean deliveries. FINDINGS: Nearly 3 in 10 births were delivered by cesarean section in 2004 (29.1%), the highest rate ever reported in the United States. The overall rate has increased by over 40% since 1996, reflecting two concurrent trends: an increase in the primary rate (14.6% to 20.6%), and a steep decline in the rate of vaginal birth after cesarean (28.3% to 9.2%). There has been a clear increase in primary cesarean delivery without a medical or obstetrical indication, and studies using hospital discharge data or birth certificate data estimate the rate of primary cesarean deliveries with no reported medical or obstetrical indication to be between 3% and 7% of all deliveries to women who had not had a previous cesarean delivery. However, these studies contain no direct information on whether these cesareans were the result of maternal request or because of physician recommendation. There was little data to support the contention that the rise in the cesarean rate was the result of maternal request. CONCLUSION: There are no systematic data available on cesarean delivery by "maternal request." However, the rate of primary cesarean delivery is increasing rapidly for women of all ages, races, and medical conditions, as well as for births at all gestational ages. Since a first cesarean section virtually guarantees that subsequent pregnancies will be cesarean deliveries (the repeat cesarean delivery rate is now almost 91%), research is needed on physician practice patterns, maternal attitudes, clinical outcomes for mother and infant (harms, benefits), and clinical and nonclinical factors (institutional, legal, economic) that affect the decision to have a cesarean delivery.

Age Factors↗
PubMed2002

Thromboprophylaxis in medical patients: focus on France.

In 2000, the French authorities licensed the low-molecular-weight heparin (LMWH) enoxaparin for thromboprophylaxis in acutely ill medical patients. However, the lack of official recommendations for this group of patients has contributed to inappropriate use of LMWH. The recent College of Internal Medicine of Paris (CIMOP) and Données Epidémiologiques chez les Patients A Risque Thromboembolique (DEPART) epidemiological studies have confirmed that LMWH is prescribed for 32% of medical inpatients and up to 44% of outpatients. However, they highlight overuse in elderly bedridden patients without acute illness and underuse in patients with severe infections or cardiopulmonary disease. Guidelines are urgently needed to encourage French physicians to target thromboprophylaxis for medical patients who are genuinely at high risk of thromboembolic disease and to prescribe the appropriate dose and duration of therapy.

Acute Disease↗
PubMed1993

Professional courtesy--current practices and attitudes.

BACKGROUND: Physicians have long provided care free of charge or at a reduced rate as a professional courtesy to other physicians and their families. We conducted a stratified national mail survey to assess the extent to which this practice has changed in recent years. METHODS: Using the American Medical Association's 1991 master list of physicians, we selected a random sample of 4800 practicing physicians from 12 direct-care specialties. These physicians were asked about their current policy and opinions regarding professional courtesy. RESULTS: Of the 2224 respondents, 2127 (96 percent) offered professional courtesy, defined as providing free or discounted health care to physicians and their families. Psychiatrists were less likely to offer professional courtesy than physicians in any of the other specialties (80 percent vs. 91 to 99 percent, P < 0.05). The forms of free or discounted care offered as a professional courtesy included billing only the insurance company (75 percent), providing care at no charge (49 percent), and giving a partial discount (23 percent). Twenty-three percent of the respondents reported that they had changed their policy regarding professional courtesy since starting to practice. Among those who had changed their policy, the most common changes were to increase the practice of billing only the insurance company (67 percent) and to provide care at no charge less often (58 percent). The majority of physicians responding to the survey thought that professional courtesy solidified bonds between physicians (79 percent) and was sound business practice (62 percent); 12 percent believed that it was too expensive to offer free or discounted care as a professional courtesy, and 14 percent thought that the practice had negative effects on the physician-patient interaction. CONCLUSIONS: Our survey of physicians involved in direct patient care indicates that, with the exception of psychiatrists, almost all American physicians offer free or discounted care as a professional courtesy and support the practice.

Adult↗
PubMed1998

A national survey of physician-assisted suicide and euthanasia in the United States.

BACKGROUND: Although there have been many studies of physician-assisted suicide and euthanasia in the United States, national data are lacking. METHODS: In 1996, we mailed questionnaires to a stratified probability sample of 3102 physicians in the 10 specialties in which doctors are most likely to receive requests from patients for assistance with suicide or euthanasia. We weighted the results to obtain nationally representative data. RESULTS: We received 1902 completed questionnaires (response rate, 61 percent). Eleven percent of the physicians said that under current legal constraints, there were circumstances in which they would be willing to hasten a patient's death by prescribing medication, and 7 percent said that they would provide a lethal injection; 36 percent and 24 percent, respectively, said that they would do so if it were legal. Since entering practice, 18.3 percent of the physicians (unweighted number, 320) reported having received a request from a patient for assistance with suicide and 11.1 percent (unweighted number, 196) had received a request for a lethal injection. Sixteen percent of the physicians receiving such requests (unweighted number, 42), or 3.3 percent of the entire sample, reported that they had written at least one prescription to be used to hasten death, and 4.7 percent (unweighted number, 59), said that they had administered at least one lethal injection. CONCLUSIONS: A substantial proportion of physicians in the United States report that they receive requests for physician-assisted suicide and euthanasia, and about 7 percent of those who responded to our survey have complied with such requests at least once.

Adult↗
PubMed2006

A population-based study of Swedish gynecologists' experiences of working in abortion care.

BACKGROUND: Legal abortion is a recurrent part of gynecologists' work. The aim of the study was to describe Swedish gynecologists' clinical and emotional experiences when working in abortion care. Further aims were to elucidate their perception of women's motives for having an abortion as well as looking for possible demographic and gender differences. METHODS: A questionnaire comprising both structured and semi-structured questions was sent to a random sample of 269 Swedish gynecologists. The response rate was 85%. RESULTS: The female gynecologists were younger (27-59 years) and more numerous than the males (33-66 years). Almost all believed that gynecologists should be involved in abortion care, and half were opposed to the privilege of refusing to work with termination of pregnancy. The gynecologists supported the shift from surgical to medical abortions but not to their being managed in primary healthcare. A few gynecologists (n = 42) had considered changing their job because of termination of pregnancy being part of their work. Misgivings occurred sometimes in connection with surgical and late abortions (n = 60 and n = 108 respectively). Few gynecologists (n = 33) had felt inadequate when encountering abortion patients and more than half thought that working with termination of pregnancy was a positive experience. The gynecologists believed that continuing professional development and ongoing guidance of termination of pregnancy matters were important. CONCLUSIONS: In general, Swedish gynecologists have no doubts about taking part in and performing termination of pregnancy. Their clinical and emotional experience, as expressed in this study, as well as their perception of women's motives for abortions, indicate that they have gained deep insights and developed their professionalism in their work with termination of pregnancy.

Abortion, Induced↗
PubMed1992

Cost inflation and resource distribution in the Korean healthcare sector under national insurance.

In 1989, Korea finally implemented a universal national health insurance policy. However, the expansion in coverage has created a number of ongoing problems: a rapid demand-pull inflation in medical costs stimulated by the fee-for-service payment system and an increasing maldistribution of available resources. The author discusses the sources of these problems and provides a taxonomy of possible methods to bring them under control.

Cost Control↗
PubMed1994

Compromise is surrender.

Lower standards. Waiting lists. Physician indifference. These are just some of the consequences of national healthcare in Britain, according to the author of this article, a family physician who trained in Scotland. Through a series of extraordinary anecdotes, Dr Anderson comments on Britain's underfunded medical system and the coping mechanisms that doctors rely on to function within it.

Adaptation, Psychological↗
PubMedDate not supplied

Differences in the evaluation and management of exercise-induced bronchospasm between family physicians and pulmonologists.

Previous studies have demonstrated that specialists and generalists differ in the evaluation and management of asthma especially in terms of use of objective testing. We speculated that there also may be differences in the diagnosis and management of exercise-induced respiratory complaints. An Internet survey was sent to samples of pulmonologists and family physicians. Our data suggests that pulmonologists are much more likely to order bronchoprovocation testing than family physicians, and family physicians are more likely to start any empiric therapy than perform bronchoprovocation testing when exercise-induced bronchospasm is suspected. These differences may lead to inaccurate or missed diagnoses and unnecessary morbidity.

Asthma, Exercise-Induced↗
PubMed2003

Attitudes and practices of doctors toward domestic violence victims in South Africa.

Our study intended to ascertain doctors' attitudes and practices toward domestic violence in a sample of 402 doctors randomly chosen for a mail survey from a list of registered medical practitioners in South Africa. We found that the mean number of patients treated for domestic violence per month was 11.4 (SD = 13.4); for White doctors 15.8, African Black 6.2, and for Asian doctors 5.3. The high frequency of domestic violence detected in this sample seems to reflect national surveys on domestic violence. Most doctors believed that they should play a role in prevention and treatment, and their attitudes toward victims of domestic violence were generally sympathetic and supportive. Male doctors and long-serving practitioners tended to have more conservative views of the causes and attitudes of spousal assault and of the doctors' role in prevention. Only 9.7% of the doctors had received any training on domestic violence. Further research is needed to establish the prevalence of domestic violence in women presenting to medical practitioners and to investigate how the problem currently is being addressed.

Adult↗