Quality and cost of healthcare: a cross-national comparison of American and Dutch attitudes.
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OBJECTIVE: To compare attitudes of consumers in America and Holland toward the quality and cost of healthcare. STUDY DESIGN: Data were derived from one American (n = 466) and two Dutch (n = 260, n = 1629) surveys. PATIENTS AND METHODS: Questionnaires were completed by respondents. Pairwise comparisons requiring respondents to compare statements with one another were used to assess preferences for quality of care. Respondents were asked to "indicate the extent to which each of the factors listed plays a role in placing demands on the American (Dutch) healthcare system." Factors included the public's tendency to consume, high technology, defensive medicine, decrease in informal care, increase in standard diagnostic procedures, and medicalization. RESULTS: Americans reported comparatively greater concern with empathy, whereas the Dutch were more interested in the continuity of care. Effectiveness, knowledge, information, and patient-physician relationships were ranked higher in both nations than waiting time, autonomy, and efficiency. Respondents in both countries attributed the increase in healthcare cost primarily to the high cost of technology. Compared with their Dutch peers, Americans were less likely to attribute increases in the cost of healthcare to the public tendency to consume and to the decrease in informal care and were more likely to implicate defensive medicine and an increase in diagnostic procedures. CONCLUSIONS: As both nations experience pressures to reduce costs while maintaining and augmenting the quality of healthcare, planners and government officials should tailor their approaches to each nation's problems within the context of their public perspectives. Replication of such studies should help assess the impact of changing societal values on healthcare delivery. (+info)
Trends in negative defensive medicine within general practice.
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Negative defensive medical practice has adverse consequences both for individual patients and for public health. This paper reports the results from a survey conducted in 1999 in which certain features indicative of negative defensive practice were compared with an identical survey conducted five years previously. Responding general practitioners stated that they are now significantly more likely to undertake diagnostic testing, refer patients, and avoid the treatment of certain conditions. (+info)
Is consent in medicine a concept only of modern times?
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Although the issue of consent in medical practice has grown immensely in recent years, and it is generally believed that historical cases are unknown, our research amongst original ancient Greek and Byzantine historical sources reveals that it is a very old subject which ancient philosophers and physicians have addressed. Plato, in ancient Greece, connected consent with the quality of a free person and even before him, Hippocrates had advocated seeking the patient's cooperation in order to combat the disease. In Alexander the Great's era and later on in Byzantine times, not only was the consent of the patient necessary but physicians were asking for even more safeguards before undertaking a difficult operation. Our study has shown that from ancient times physicians have at least on occasion been driven to seek the consent of their patient either because of respect for the patient's autonomy or from fear of the consequences of their failure. (+info)
Medicolegal claims in vascular surgery.
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BACKGROUND: Knowledge about medicolegal claims is important for risk management and clinical practice. This study presents the first comprehensive collated data for vascular surgical practice. METHOD: Details of claims notified to the National Health Service Litigation Authority (NHSLA) since its inception in 1995, and to the Medical Defence Union (MDU) from 1990-1999 were analysed. RESULTS: A total of 424 claims were notified--170 NHSLA and 254 MDU (176 from surgeons who described themselves as 'vascular' and 248 from 'general surgeons'). Varicose veins were the commonest condition involved (244 claims) and nerve damage was the most frequent complaint (76), followed by incorrect or unsatisfactory surgery (35), and damage to the femoral vein (16) or artery (13). Arterial claims (174) against vascular surgeons comprised 88% in the NHS but only 39% in private practice: 45 related to aortic grafting, 28 to other bypass grafts, and 36 alleged failure to recognise or treat ischaemia. CONCLUSIONS: The likely cause of many of these claims was failure to advise patients about potential risks and expected benefits. Recognition of the areas of highest risk, with improvements in communication and record keeping, may limit future claims. (+info)
The Ionising Radiation (Medical Exposure) regulations (IRME) 2000--radiological considerations.
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1) IRME regulations apply to the trust and not to the individual clinician. 2) Each trust must have written regulations outlining how the IRME regulations are to be applied locally. 3) The IRME regulations and, almost certainly, the local directions, have the force of the law and breaches may be dealt with by both the criminal and the civil courts. 4) All radiological examinations using ionising radiation must be reported either by a radiologist or a clinician, and the report must be filed in the patient's case notes. 5) It is unlawful to request a radiological examination if it is not to be reported. 6) No regulation mentions the quality or timeliness of the radiological report. (+info)
Defensive practice among psychiatrists: a questionnaire survey.
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OBJECTIVE: There has been little research on the prevalence of defensive practice within hospital settings. The aim of this report was to examine the extent of defensiveness among psychiatrists and to examine the relationship between defensiveness and seniority, as well as the effect of previous experiences on the level of defensiveness. DESIGN: A postal questionnaire survey on defensive practice. SETTING: Northern Region of England. SUBJECTS: 154 psychiatrists in the region. RESULTS: 96 responses were received from 48 equivalent consultants, 18 specialist registrars, and 23 equivalent senior house officers. Overall, 75% of those who replied had taken defensive actions within the past month. In particular, 21% had admitted patients overcautiously and 29% had placed patients on higher levels of observations. Junior psychiatrists were particularly prone to practise defensively. Important contributing factors included previous experience of complaints (against colleague or self), critical incidents, and legal claims. CONCLUSION: Almost three quarters of the psychiatrists who responded had practised defensively within the past month. The higher propensity of junior trainees to practise defensively may be attributable to their lack of confidence and experience. Experience of complaints (colleague or self) and critical incidents were important factors for defensive practice. Better and more structured training might reduce the high level of defensive practice and the way complaints and investigations are handled should be improved to maintain a truly "no blame" environment conducive to learning from past experience. (+info)
How to avoid being sued in clinical practice.
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Challenges to clinical management are a fact of professional life. Every doctor must expect to become embroiled in complaints and claims from time to time and be prepared to justify why they managed a particular case in the way that they did. Good medical practice is defensible practice, which depends upon staying within the limits of your own expertise, keeping up to date and conducting audit, ensuring your administration is effective and that patients are not allowed to slip through the net, that you communicate effectively with patients, their carers and colleagues, and that medical records recall all salient facts relating to the patient. If things go wrong, be open, investigate the facts, explain the situation fully to the patient, and do not be afraid to apologise. (+info)
Chaperone use by family physicians during the collection of a Pap smear.
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BACKGROUND: We wanted to determine whether variations exist in use of a chaperone during the performance of a pelvic examination by family physicians. METHODS: A self-administered questionnaire was mailed to 5,000 randomly selected active members of the American Academy of Family Physicians. RESULTS: There were 3,551 survey responses (71% response rate) and 2,748 useable questionnaires. Most respondents (75.4%) reported routinely using a chaperone in the room during the collection of a Papanicolaou (Pap) smear. Significantly (P < .00001) more male physicians (84.1%) than female physicians (31.4%) reported using a chaperone. Physicians reporting routine use of a chaperone were significantly younger (P = .01) and did fewer Pap smears per month (P < .00001). Regional reporting of chaperone use varied significantly (P < .00001), with 71.6% reporting use in the Northeast, 89.0% in the South, 65.7% in the Midwest, and 72.4% in the West. CONCLUSION: Family physicians vary considerably in the reported use of a chaperone during the collection of a Pap smear. The variation could reflect different regional or local norms, efficiency or resource issues in high-volume clinical settings, or other interpersonal factors. These issues need to be explored in more depth. (+info)