Mortality and causes of death among Danish medical doctors 1973-1992.
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BACKGROUND: To examine the mortality pattern of Danish doctors for the period 1973-1992. METHODS: A historical prospective cohort study based on the membership register of the Danish Medical Association. The study population consisted of 21,943 medical doctors, 6012 of whom were women. The doctors' cause-specific mortality was compared with that of the general population. RESULTS: The study covered about 277,000 person-years. A total of 2387 deaths occurred from 1 January 1973 to 31 December 1992. The doctors' mortality was lower than that of the general population. Both sexes showed a standardized mortality ratio (SMR) below one for cancer, circulatory diseases and other natural causes. Mortality due to lung cancer was particularly low. The SMR for suicide was significantly increased, 1.6 for males (95% CI: 1.4-1.9) and 1.7 for females (95% CI: 1.1-2.5). The suicide rate was increased, in particular because of an increased number of suicides by poisoning. In addition female doctors displayed a relatively high mortality due to accidents and other types of violent death. CONCLUSIONS: Compared with the general population the doctors' mortality was low, but the mortality from external causes was increased, mainly due to an excess number of suicides. (+info)
Improving the letters we write: an exploration of doctor-doctor communication in cancer care.
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Referral and reply letters are common means by which doctors exchange information pertinent to patient care. Twenty-eight semi-structured interviews were conducted exploring the views of oncologists, referring surgeons and general practitioners. Twenty-seven categories of information in referral letters and 32 in reply letters after a consultation were defined. The letters to and from six medical oncologists relating to 20 consecutive new patients were copied, and their content analysed. Oncologists, surgeons and general practitioners Australia wide were surveyed using questionnaires developed on data obtained above. Only four of 27 categories of referral information appear regularly (in > 50%) in referral letters. Oncologists want most to receive information regarding the patient's medical status, the involvement of other doctors, and any special considerations. Referring surgeons and family doctors identified delay in receiving the consultant's reply letter as of greatest concern, and insufficient detail as relatively common problems. Reply letters include more information regarding patient history/background than the recipients would like. Referring surgeons and family doctors want information regarding the proposed treatment, expected outcomes, and any psychosocial concerns, yet these items are often omitted. Consultants and referring doctors need to review, and modify their letter writing practices. (+info)
Saskatchewan physicians' attitudes and knowledge regarding assessment of medical fitness to drive.
(35/3874)
BACKGROUND: Although legislation has been introduced in Saskatchewan for mandatory reporting by physicians of patients considered medically unfit to drive, little is known about physicians' attitudes, knowledge or resources with regard to evaluating medical fitness to drive. METHODS: The objective of this study was to determine Saskatchewan physicians' attitudes, knowledge, training, resources and current educational needs with regard to evaluating medical fitness to drive. A questionnaire survey of all physicians in the province who were identified as likely to be involved in determining medical fitness to drive was conducted between October and December 1996. RESULTS: Of the 1102 physicians who received a questionnaire, 690 (62.6%) responded, of whom 167 were excluded because they were not involved in assessing fitness to drive. Thus, 523 (55.9%) of the 935 eligible physicians surveyed completed the questionnaire. Most (57.6% [298/517]) of the respondents indicated that they do not hesitate to report patients medically unfit to drive; however, 59.5% (307/516) felt that the physician-patient relationship is negatively affected by reporting. Overall, 85.5% (444/519) of the respondents felt that restricted licensing is a fair alternative for people who might otherwise be denied a full licence. The availability of restricted licensing positively influenced the decision to report for 60.3% (313/519) of the respondents. Significantly more rural physicians than urban physicians believed that the need to drive was greater for rural residents than for urban dwellers (81.2% [95/117] v. 64.2% [257/400], p < 0.001). Physician knowledge regarding specific medical conditions and fitness to drive was generally poor. The resource most commonly used in determining medical fitness to drive was the Physicians' Guide to Driver Examination (71.1% [361/508] of respondents). The most useful continuing medical education methods indicated by physicians for assessing medical fitness to drive included conference presentations, workshops and journal articles. INTERPRETATION: Most of the Saskatchewan physicians surveyed supported restricted licensing, and the availability of restricted licensing made them more likely to report patients considered medically unfit to drive. The physician-patient relationship was felt to be negatively affected by reporting. (+info)
Assessment of physician performance in Alberta: the physician achievement review.
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The College of Physicians and Surgeons of Alberta, in collaboration with the Universities of Calgary and Alberta, has developed a program to routinely assess the performance of physicians, intended primarily for quality improvement in medical practice. The Physician Achievement Review (PAR) provides a multidimensional view of performance through structured feedback to physicians. The program will also provide a new mechanism for identifying physicians for whom more detailed assessment of practice performance or medical competence may be needed. Questionnaires were created to assess an array of performance attributes, and then appropriate assessors were designated--the physician himself or herself (self-evaluation), patients, medical peers, consultants and referring physicians, and non-physician coworkers. A pilot study with 308 physician volunteers was used to evaluate the psychometric and statistical properties of the questionnaires and to develop operating policies. The pilot surveys showed good statistical validity and technical reliability of the PAR questionnaires. For only 28 (9.1%) of the physicians were the PAR results more than one standard deviation from the peer group means for 3 or more of the 5 major domains of assessment (self, patients, peers, consultants and coworkers). In post-survey feedback, two-thirds of the physicians indicated that they were considering or had implemented changes to their medical practice on the basis of their PAR data. The estimated operating cost of the PAR program is approximately $200 per physician. In February 1999, on the basis of the operating experience and the results of the pilot survey, the College of Physicians and Surgeons of Alberta implemented this innovative program, in which all Alberta physicians will be required to participate every 5 years. (+info)
The influence of the obstetrician in the relationship between epidural analgesia and cesarean section for dystocia.
(37/3874)
BACKGROUND: The association between epidural analgesia for labor and the risk of cesarean section for dystocia remains controversial The authors hypothesized that if epidural analgesia were an important factor in determining cesarean section rates, then obstetricians with higher rates of utilization of epidural analgesia for labor would have higher rates of cesarean section for dystocia. METHODS: The frequency of use of epidural analgesia and frequency of occurrence of various patient risk factors for cesarean section were calculated for 110 obstetricians caring for > or = 50 low-risk parturients. These frequencies were compared by linear regression to obstetricians' rates of cesarean section for dystocia. Stepwise regression was used to attempt to predict obstetricians' cesarean rates from the incidence of various patient and provider risk factors. RESULTS: There was no relationship between frequency of epidural analgesia and rate of cesarean section for dystocia across practitioners (R2 = 0.019; P = 0.156). Weighting each obstetrician's data for the number of patients cared for during the study period did not change this result. Stepwise linear regression only modestly predicted obstetricians' cesarean section rates for dystocia, yielding a model containing 12 variables not including epidural analgesia (gestational age, induction of labor, maternal age, provider volume, nulliparity, and seven interactions; adjusted R2 = 0.312; P < 0.0001). CONCLUSIONS: The frequency of use of epidural analgesia does not predict obstetricians' rates of cesarean section for dystocia. After accounting for a number of known patient risk factors, obstetrical practice style appears to be a major determinant of rates of cesarean section. (+info)
The influence of an expert system for test ordering and interpretation on laboratory investigations.
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BACKGROUND: The Laboratory Advisory System (LAS) is an expert system interface that works interactively with clinicians to assist them with test selection and result interpretation throughout the laboratory investigation of a patient. METHODS: To study the influence of the LAS on laboratory investigations, a repeated-measures experiment using clinical vignettes was conducted. To collect baseline data on how laboratory investigations are currently conducted, clinicians investigated one-half of the vignettes using a conventional (noncomputer) approach. To determine the influence of the LAS on clinicians' behavior, the other half of the vignettes were investigated using the LAS. RESULTS: Clinicians using the LAS (compared with conventional practice) ordered fewer laboratory tests during the diagnostic process (mean, 17.8 vs 32.7), completed the diagnostic workup with fewer sample collections (mean, 5.8 vs 7.5), generated lower laboratory costs (mean, $194 vs $232), shortened the time required to reach a diagnosis (mean, 1 day vs 3.2 days), showed closer adherence to established clinical practice guidelines, and exhibited a more uniform and diagnostically successful investigation. CONCLUSION: The LAS enhances the outcome of the investigation and improves laboratory utilization. (+info)
Discordance between physicians and coders in assignment of diagnoses.
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OBJECTIVE: To measure concordance between physicians and medical record coders in their assignment of diagnoses. DESIGN: Prospective cohort series. SETTING: Five hundred and fifty-bed, tertiary-care, university teaching hospital. Study participants. In-patients who were discharged from either the Cardiac Sciences Program (n=125), the Renal Program (n=43), or the HIV-AIDS Program (n=25) during the period May 18-July 1, 1995. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Physicians and coders assigned diagnoses for individual in-patients based on their independent interpretations of the patient chart and discharge summary sheet. All assigned diagnoses were coded using the ICD-9-CM classification system. Concordance was measured for the most responsible diagnosis and for all assigned diagnoses. Difference in calculated resource intensity weights based on physicians' and coders' assignment of diagnoses was also calculated. RESULTS: Concordance rates for the most responsible diagnosis in each program were: Cardiac Sciences [27%; 95% confidence interval (CI)=20-36%], Renal Program (35%; 95% CI=21-53%), and HIV-AIDS Program (20%; 95% CI, 6-41%). Concordance rates for all diagnoses per chart were similar: Cardiac Sciences (20%; 95% CI, 14-25%), Renal Program (25%; 95% CI, 20-33%), and HIV-AIDS Program (29%; 95% CI, 25-44%). Resource intensity weights assigned by coders for the Cardiac Sciences and HIV-AIDS Program were significantly higher than those assigned by the physicians. (+info)
Survey of Japanese physicians' attitudes towards the care of adult patients in persistent vegetative state.
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OBJECTIVES: Ethical issues have recently been raised regarding the appropriate care of patients in persistent vegetative state (PVS) in Japan. The purpose of our study is to study the attitudes and beliefs of Japanese physicians who have experience caring for patients in PVS. DESIGN AND SETTING: A postal questionnaire was sent to all 317 representative members of the Japan Society of Apoplexy working at university hospitals or designated teaching hospitals by the Ministry of Health and Welfare. The questionnaire asked subjects what they would recommend for three hypothetical vignettes that varied with respect to a PVS patient's previous wishes and the wishes of the family. RESULTS: The response rate was 65%. In the case of a PVS patient who had no previous expressed wishes and no family, 3% of the respondents would withdraw artificial nutrition and hydration (ANH) when the patient did not require any other life-sustaining treatments, 4% would discontinue ANH, and 30% would withhold antibiotics when the patient developed pneumonia. Significantly more respondents (17%) would withdraw ANH in the case of a PVS patient whose previous wishes and family agreed that all life support be discontinued. Most respondents thought that a patient's written advance directives would influence their decisions. Forty per cent of the respondents would want to have ANH stopped and 31% would not want antibiotics administered if they were in PVS. CONCLUSIONS: Japanese physicians tend not to withdraw ANH from PVS patients. Patients' written advance directives, however, would affect their decisions. (+info)