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Introduction: Patients admitted to the hospital will receive various drugs, each carrying the risk of error. Medication errors concern our healthcare system, especially considering the relatively high number of patients admitted to hospitals. Assuming that each patient receives at least two medications twice a day, the likelihood of a medication error is considerable. Therefore, therapeutic drug monitoring (TDM) focuses on measuring blood medication levels and plays a crucial role in medication safety. Aims: This study aimed to determine the effect of TDM in ensuring the safety of medications in many Taif hospitals. Also, to enhance the safety and quality of drug use and reflect physician perception and practice regarding TDM. Methodology: A prospective cross-sectional study consisting of questionnaires was conducted to physicians at many of Taif's governmental hospitals between March and May 2021. Questionnaires evaluated three parts: physician demographics, physician perception about TDM, and physician practices regarding TDM. The collected data were processed using the Excel program. Results: More than 80% of the interviewed physicians agreed that TDM is a tool that can guide the clinician to provide effective and safe drug therapy in the individual patient. Approximately 77% agreed that TDM is a team of decision-making groups. Around 25% of physicians performed TDM weekly, 22% monthly, and 10% daily. The medications that participating physicians ordered TDM were digoxin (30%), carbamazepine (21%), and gentamycin (17%). The participants had a limited understanding of the advantages of TDM in terms of drug safety and welfare. Conclusion: The number of actual drug errors occurs in the healthcare systems. Therefore, must establishment of TDM in hospitals. Medical administration and physicians must cooperate with the clinical pharmacist. Also, establish workshops for health practitioners to educate them about the role of TDM and pharmacokinetic laboratories in controlling the therapeutic process.

Background Patient satisfaction is a proxy for quality clinical care. Understanding the factors that drive patient satisfaction scores is important because they are publicly reported, may be used in determining hospital and physician compensation, and may allow patients to preselect physicians. Objective This single-center survey study of adult patients at the Michigan Medicine outpatient dermatology clinics aimed to investigate how patients respond differently to theoretical dermatologic scenarios with varying dermatologist gender. Methods Each questionnaire contained one of four clinical scenarios illustrating overall positive or negative encounters with a male or female dermatologist, followed by questions derived from the Press Ganey survey to assess patient satisfaction. Results A total of 452 completed questionnaires were collected. There were statistically significant differences in overall patient satisfaction scores between positive versus negative female and positive versus negative male dermatologists, but there were no differences in scores between positive female and positive male dermatologists or between negative female and negative male dermatologists. There were also no differences in overall scores after controlling for patient demographic characteristics or patient–dermatologist gender concordance. Conclusion Previous studies have suggested that male physicians receive better patient satisfaction scores compared to female physicians. However, our study found that, in response to hypothetical scenarios of positive and negative dermatology encounters, dermatologist gender did not affect any domain of patient satisfaction scores. Limitations include the use of hypothetical patient–dermatologist encounters and possible lack of generalizability because the study was conducted at one academic center in southeast Michigan with a predominantly Caucasian patient population.

The influence of historical cultural norms is evident when analyzing the physician demographics in the United States. To this day, there exists a paucity in diversity as it pertains to gender balance and ethnicity. This phenomenon is particularly concerning when studies support the notion that race and gender concordance are associated with improved outcomes. The literature presented in this article identifies potential targets for interventions on how to attract, train, and retain minority physicians.

To determine preferences of clinicians and surgeons regarding radiology reporting of liver observations in patients at risk for hepatocellular carcinoma (HCC). Members of the American College of Radiology Liver Imaging and Data Reporting System (LI-RADS) Outreach & Education Group (30 members) as well as Society of Abdominal Radiology Disease-Focused Panel on HCC diagnosis (27 members) created and distributed an 18-question survey to clinicians and surgeons, with focus on preferences regarding radiology reporting of liver observations in patients. The survey questions were directed to physician demographics, current use of LI-RADS by their local radiologists, their opinions about current LI-RADS and potential improvements. A total of 152 physicians responded, 66.4% (101/152) from North America, including 42 surgeons, 81 physicians and 29 interventional radiologists. Participants were predominantly from academic centers 83% (126/152), while 13.8% (21/152) worked in private/community centers and 3.2% (5/152) worked in a hybrid practice. Almost 90% (136/152) of participants preferred the use of LI-RADS (compared to nothing or other standardized reporting systems; OPTN and AASLD) to communicate liver-related observations. However, only 28.5% (43/152) of participants input was sought at the time of implementing LI-RADS in their institutions. Fifty-eight percent (88/152) of all participants found standardized LI-RADS management recommendations in radiology reports to be clinically helpful. However, a subgroup analysis of surgeons in academic centers showed that 61.8% (21/34) prefer not to receive standardized LI-RADS recommendations. Most participants preferred the use LI-RADS in reporting CT and MRI examination. When considering inclusion of management recommendations, radiologists should consult with their referring physicians, as preference may differ.

Press Ganey patient satisfaction scores are increasingly being used as a physician quality metric. In this retrospective review of over 25,000 patient surveys for 61 ophthalmologists, pediatric ophthalmologists and neuro-ophthalmologists received significantly lower patient satisfaction scores than their peers, suggesting that the problem for which a patient seeks care may affect whether he or she is satisfied with the care received. These findings should be taken into account when considering the validity of Press Ganey scores as an equitable, modifiable measure of physician performance, especially when considering factoring these scores into physician evaluation and reimbursement.

OBJECTIVES/HYPOTHESIS Patient satisfaction is increasingly emphasized and measured in healthcare delivery. However, patient satisfaction is multifactorial and difficult to comprehensively assess. The objective of this study was to assess for correlation between patient satisfaction measured by Press Ganey surveys (PGS) and physician demographics of gender, years in practice, academic rank, and specialty in academic otolaryngology. STUDY DESIGN Review of publicly available PGS scores in academic otolaryngology practice. METHODS Public websites of academic otolaryngology departments were assessed for inclusion of PGS scores. Individual physician profiles were queried for years in practice, academic rank, and specialty. Gender was determined by picture or profile pronouns. Univariate and multivariate analyses compared PGS scores with studied variables. RESULTS Forty-seven of 113 (42.8%) academic practices publicly reported physician PGS score. Of 1,360 affiliated otolaryngologists, 742 (54.6%,592 male:150 female) revealed PGS scores. Average PGS score for male and female providers was equivalent (PGS = 4.73, P = .84). There was no significant difference in PGS scores by academic rank (P = .28). A weak statistically significant decrease in mean PGS scores was associated with longer duration of practice (r = -0.11, P = .018). Head and neck oncologic surgeons had higher mean PGS score in comparison to other specialties (PGS = 4.81, P

OBJECTIVEThe purpose of this study was to assess the impact of certain demographics, social media usage, and physician review website variables for spine surgeons across Healthgrades.com (Healthgrades), Vitals.com (Vitals), and Google.com (Google).METHODSThrough a directory of registered North American Spine Society (NASS) physicians, we identified spine surgeons practicing in Texas (107 neurosurgery trained, 192 orthopedic trained). Three physician rating websites (Healthgrades, Vitals, Google) were accessed to obtain surgeon demographics, training history, practice setting, number of ratings/reviews, and overall score (January 2, 2018–January 16, 2018). Using only the first 10 search results from Google.com, we then identified whether the surgeon had a website presence or an accessible social media account on Facebook, Twitter, and/or Instagram.RESULTSPhysicians with either a personal or institutional website had a higher overall rating on Healthgrades compared to those who did not have a website (p < 0.01). Nearly all spine surgeons had a personal or institutional website (90.3%), and at least 1 accessible social media account was recorded for 43.5% of the spine surgeons in our study cohort (39.5% Facebook, 10.4% Twitter, 2.7% Instagram). Social media presence was not significantly associated with overall ratings across all 3 sites, but it did significantly correlate with more comments on Healthgrades. In multivariable analysis, increasing surgeon age was significantly associated with a lower overall rating across all 3 review sites (p < 0.05). Neurosurgeons had higher overall ratings on Vitals (p = 0.04). Longer wait times were significantly associated with a lower overall rating on Healthgrades (p < 0.0001). Overall ratings from all 3 websites correlated significantly with each other, indicating agreement between physician ratings across different platforms.CONCLUSIONSLonger wait times, increasing physician age, and the absence of a website are indicative of lower online review scores for spine surgeons. Neurosurgery training correlated with a higher overall review score on Vitals. Having an accessible social media account does not appear to influence scores, but it is correlated with increased patient feedback on Healthgrades. Identification of ways to optimize patients’ perception of care are important in the future of performance-based medicine.

Objectives: This study compares hospital-generated online ratings to patient-generated online ratings in academic otolaryngology and evaluates physician factors influencing these results. Methods: Websites of academic otolaryngologists were assessed for inclusion of hospital-generated Press Ganey surveys. Corresponding scores on Healthgrades and Vitals.com were identified via internet search. Hospital ratings were compared with patient-generated ratings, including score, demographics, and number of ratings. All data was collected between July 15th 2019 and August 22nd 2019. Results: 742 academic otolaryngologists with hospital-generated ratings were identified. Mean hospital-generated rating was significantly higher ((4.70, 95% CI 4.69-4.72) than patient-generated rating (Vitals:4.26, 95% CI 4.18-4.34, and Healthgrades:4.02, 95% CI 3.87-4.18; P 20) was associated with male gender, professor ranking, and >30 years in practice ( P 30+ years in practice ( P = .023). Across all platforms, comprehensive otolaryngologists and neurotologists/otologists were rated lower in comparison to other specialties (PGS: P Conclusion: Hospital-generated ratings yield higher mean scores than patient-generated platforms. Between sources, Healthgrades.com scores were lower than those of Vitals.com . Professors with >30 years of practice generated more reviews in patient-generated ratings, and these physicians were generally rated lower. Access to patient-generated ratings is universal and physicians should be aware of variability between online rating platforms as scores may affect referrals and practice patterns.

Background: The literature suggests that medical oncologists differ on how they use the Oncotype DX (ODX) genomic assay for making decisions about systemic therapy in breast cancer patients. Given the emergence of data supporting the use of genomic profiling for the prognosis and predicting benefit of chemotherapy, we surveyed medical oncologists in Canada to assess their usage and perception of the ODX assay. Methods: A 34-item survey was distributed to Canadian medical oncologists via the Canadian Association of Medical Oncologists. Data was collected on physician demographics, ODX usage patterns, and physicians’ perception of the impact clinical and pathologic characteristics make on ODX utilization. Results: Response rate was 20.6% with 47 responses received from 228 survey sent. Forty-five responses were eligible for analysis. Sixty-two percent (28/45) of respondents treated predominantly breast cancer, and 60% (27/45) have been in practice for at least 10 years. The most cited reason for using ODX was to avoid giving patients unnecessary chemotherapy (64%, 29/45). Sixty-seven percent (30/45) deferred making treatment decisions until ODX testing was completed. Factors most strongly impacting ODX utilization included: patient request, medical comorbidities and tumor grade. In clinical scenarios, ODX was more frequently selected for patients aged 40–65 (vs. &lt, 40 or &gt, 65), grade 2 tumors (vs. grade 1 or 3), and Ki-67 index of 10–20% (vs. &lt, 10% or &gt, 20%). Conclusions: This survey demonstrated that Canadian medical oncologists are preferentially using ODX to avoid giving patients unnecessary chemotherapy. The utilization of ODX is mainly in patients with intermediate clinical and pathologic features.

This Viewpoint challenges US hospital claims that government funding to train physicians is necessary to offset costs, maintain physician supply, and keep costs

The lack of gender diversity in cardiology has long been considered a workforce problem, yet data were lacking. The past 5 years have seen the publication of a series of cardiology-specific papers on physician demographics, inequities, and barriers to recruitment ([1–5][1]), alongside a robust and

We aim to determine what variables may influence physician decision-making about transfer of pediatric patients from a Level III Trauma Center (L3TC) to a Pediatric Trauma Center (PTC).Emergency L3TC physicians and PTC emergency physicians/TTLs were surveyed with clinical scenarios of children presenting to a L3TC with 5 injury parameters: age, hemodynamic status, GCS, intra-abdominal injury, femur/ pelvic fracture, and asked if the patient should be transferred to a PTC. Associations between parameters and physician demographics in the decision to transfer were examined.One hundred seven and 94 surveys were completed at L3TCs and PTCs, respectively. Parameters associated with decision to transfer: pelvic and GI tract injuries, GCS 12, and age 4 years. L3TCs were significantly less likely vs. PTCs to recommend transfer with femur fracture, solid organ / GI injury, or a GCS of13. Increasing town size, access to an experienced surgeon, and formal training in emergency medicine among L3TC physicians were associated with a decision not to transfer.Injuries requiring potential surgery or critical care influenced the decision to transfer. For cases with lesser severity or older ages, input of L3TCs on developing triage criteria is vital to allow families to stay in their home communities while ensuring optimal clinical outcomes.Prospective Cross Sectional Survey.Level III.

Physician recommendation is a strong predictor of vaccine uptake, however their perceived barriers may prevent vaccination. Therefore, we determined the association between physicians' perceived barriers to HPV vaccination and vaccination initiation. We surveyed pediatricians in a large network of clinics in Houston, Texas to assess their perceived barriers to vaccinating adolescents. We combined survey data with electronic medical records to determine HPV vaccination initiation over a 12-month study period (July 2014–June 2015). Patients were 11–18 year olds who had not begun the vaccination series, had a physician visit during the study period, and whose physician completed the survey. We conducted a multilevel model clustered by physician controlling for patient and physician demographics to calculate the association between physician-reported barriers and HPV vaccination initiation. Among 36,827 patients seen by 134 pediatricians, 18.6% initiated HPV vaccination. The relative risk of initiating HPV vaccination were lower for patients whose physician reported concerns about HPV vaccine safety (RR: 0.75, 95% CI: 0.58–0.97), efficacy (RR: 0.73, 95% CI: 0.54–0.99), and the financial burden of the vaccine on patients (RR: 0.72, 95% CI: 0.58–0.88). After controlling for patient and physician characteristics, physician concern about the financial burden on patients was significantly associated with lower relative risk of initiating HPV vaccination (RR: 0.76, 95% CI: 0.64–0.90). In this large study we observed that physician-reported barriers are associated with HPV vaccination initiation. Interventions should be implemented to educate physicians on vaccine safety, efficacy, and that there is no patient cost for CDC-recommended vaccines.

Objective To evaluate the effect of state continuing medical education (CME) requirements on physician clinical knowledge. Data Sources Secondary data for 19,563 general internists who took the Internal Medicine Maintenance of Certification (MOC) examination between 2006 and 2013. Study Design We took advantage of a natural experiment resulting from variations in CME requirements across states over time and applied a difference-in-differences methodology to measure associations between changes in CME requirements and physician clinical knowledge. We measured changes in clinical knowledge by comparing initial and MOC examination performance 10 years apart. We constructed difference-in-differences estimates by regressing examination performance changes against physician demographics, county and year fixed effects, trend–state indicators, and state CME change indicators. Data Collection Physician data were compiled by the American Board of Internal Medicine. State CME policies were compiled from American Medical Association reports. Principal Findings More rigorous CME credit-hour requirements (mostly implementing a new requirement) were associated with an increase in examination performance equivalent to a shift in examination score from the 50th to 54th percentile. Conclusions Among physicians required to engage in a summative assessment of their clinical knowledge, CME requirements were associated with an improvement in physician clinical knowledge.

Background Advanced Practice Providers (APPs), including nurse practitioners and physician assistants, provide high quality medical care in multiple specialties by extending the physician workforce. However, within the Infectious Disease (ID) specialty, their demographics, areas of practice, and experience are not well described. To better understand this key group, we examined APP years of experience in ID, primary practice settings, and perceived practice barriers from the APP perspective. Methods We created a survey using REDCap which was distributed between 12/1/2019-1/31/2020 to APPs practicing in ID by social media, direct emails to key stakeholders, and online Infectious Disease Society of America (IDSA) community forums. Results Ninety-three APPs responded to the posted survey from across the US (figure 1). Most respondents (45 [49%]) had between 2-9 years of overall experience as an APP, while 14 (15%) between 10-15 years, and 24 (26%) had >16 years of experience. Experience specifically as an ID APP varied, with the majority (56%) having 2-9 years of experience and 25% reporting >16 years of experience as an APP. Although over half of the respondents worked in an outpatient adult ID clinic, they also practiced in diverse settings and within multiple ID sub-specialties (figure 2). The other most common areas of practice included inpatient adult ID, HIV care, and outpatient parental antimicrobial therapy programs. Limited formalized ID education and misconceptions about APP scope of practice were perceived barriers to practicing in ID (figure 3). Lack of recognition as a peer amongst physician colleagues was also identified as a practice barrier. Advanced Practice Provider Survey Response by Region Advanced Practice Provider ID Practice Areas Perceived Advanced Practice Provider Barriers Conclusion Our survey results demonstrate that the APP ID workforce is an experienced provider group, both in terms of total years as an APP and years exclusively in ID, working in a large variety of ID settings in a number of geographic locations. Creation of specific and directed ID educational opportunities, along with collaborating physician support and inclusion, are identified as significant areas of improvement. The establishment of APP-specific training programs and educational courses will create more opportunities for APPs and further expand the ID workforce. Disclosures Steven A. Pergam, MD, MPH, Chimerix, Inc (Scientific Research Study Investigator)Global Life Technologies, Inc. (Research Grant or Support)Merck & Co. (Scientific Research Study Investigator)Sanofi-Aventis (Other Financial or Material Support, Participate in clinical trial sponsored by NIAID (U01-AI132004); vaccines for this trial are provided by Sanofi-Aventis)

This cross-sectional study uses data from the American Medical Association Physician Masterfile to examine physician density by specialty type across metropolitan and rural US counties from 2010 to 2017.

PURPOSE We examined the perspectives of family physicians (FPs) on opioid prescribing and management of chronic pain to better understand the barriers to safer prescribing in primary care and differences in perspectives that may be potential drivers of practice variation. METHODS We used an exploratory qualitative study design. Semistructured interviews were conducted in June and July 2017 with 22 FPs in Ontario and coded inductively. Thematic analysis was used to identify themes, and a framework analysis explored the influence of physician demographics on prescribing experience. RESULTS Three key themes emerged: the discrepancy between FPs’ training and current practice, the tension between the FP’s role and patient and system expectations, and the influence of length of time in practice and strength of therapeutic relationships on perspectives on opioid prescribing. There was an overarching sentiment among participants that FPs are unsupported in their efforts to manage chronic pain. More years in practice (≥15 years) seems to influence practice patterns by increasing trust in therapeutic relationships and decreasing reliance on emergent guidelines (vs clinical experience). CONCLUSION Number of years in practice influences FPs’ response to emergent evidence, requiring initiatives to include strategies tailored to individual beliefs. Initiatives must move beyond dissemination and education to equip FPs with the skills they need to navigate emotionally charged conversations. External pressures and misaligned system and patient expectations place FPs at the center of a challenging situation, which may result in a higher risk of burnout compared with that of their specialist colleagues.

Background Systemic sclerosis (SSc) is an uncommon, complex and heterogeneous condition, making it challenging to manage. Individual rheumatologists see relatively few cases and patient surveys identify numerous gaps in clinical care. There are no published data on the educational needs of rheumatologists caring for patients with SSc. We aimed to determine rheumatologists’ self-rated knowledge and learning needs. Methods Survey questions were adapted from the EULAR Recommendations for the Treatment of SSc with reference to patient-identified care gaps. The survey was conducted on paper and on SurveyMonkey (a cloud-based online survey development software program). The target audience was Ontario rheumatologists, serving a population of 13.6 million. We sought to explore self-reported knowledge, experience, attitudes and perceived barriers in caring for SSc patients. Physician demographics and preferred educational methods were also collected. Gaps between perceived and desired knowledge were calculated to identify the greatest unmet learning needs. Results One hundred and eighteen responses were received with a response rate of 54%. The greatest unmet learning needs were seen in the management of sexual dysfunction (average gap of 1.4 on a 5-point scale), pulmonary hypertension (1.1), interstitial lung disease (1.0) and gastrointestinal manifestations of the disease (1.0). The smallest learning gap concerned screening recommendations (0.7). 19% of rheumatologists agreed with the statement “Scleroderma is an untreatable disease.” Agreement with this statement was highest (33%) among rheumatologists who treat relatively small numbers1–10 of scleroderma patients. Conclusions We have identified several unmet learning needs regarding the management of SSc among rheumatologists. These can be used to inform future educational resources and programs for rheumatologists regarding SSc and to direct further research into their needs. Disclosure of Interest None declared

BACKGROUND The Accreditation Council for Graduate Medical Education (ACGME) has established the requirement for residency programs to assess trainees' competencies in 6 core domains (patient care, medical knowledge, practice-based learning, interpersonal skills, professionalism, and systems-based practice). As attending rounds serve as a primary means for educating trainees at academic medical centers, our study aimed to identify current rounding practices and attending physician perceived capacity of different rounding models to promote teaching within the ACGME core competencies. METHODS We disseminated a 24-question survey electronically using educational and hospital medicine leadership mailing lists. We assessed attending physician demographics and the frequency with which they used various rounding models, as defined by the location of the discussion of the patient and care plan: bedside rounds (BR), hallway rounds (HR), and card-flipping rounds (CFR). Using the ACGME framework, we assessed the perceived educational value of each model. RESULTS We received 153 completed surveys from attending physicians representing 34 institutions. HR was used most frequently for both new and established patients (61% and 43%), followed by CFR for established patients (36%) and BR for new patients (22%). Most attending physicians indicated that BR and HR were superior to CFR in promoting the following ACGME competencies: patient care, systems-based practice, professionalism, and interpersonal skills. CONCLUSIONS HR is the most commonly employed rounding model. BR and HR are perceived to be valuable for teaching patient care, systems-based practice, professionalism, and interpersonal skills. CFR remains prevalent despite its perceived inferiority in promoting teaching across most of the ACGME core competencies. Journal of Hospital Medicine 2014;9:239–243. © 2014 Society of Hospital Medicine

The authors examined the responses of 63 primary care physicians to diabetes clinical protocols (DCPs) for the management of type II diabetes (T2DM). We measured physician demographics, current diabetes patient loads, and responses to DCPs (physician attitudes, physician familiarity, and physician recommendation of DCPs) using a 20-question electronic survey. Results of the survey indicate that primary care physicians may be unfamiliar with the benefits of diabetes clinical protocols for the self-management of T2DM. Given the importance of diabetes self-management education in controlling T2DM, those interested in implementing DCPs should address the beliefs and attitudes of primary care physicians.

Literature suggests early post-percutaneous endoscopic gastrostomy (PEG) feeding is as safe as delayed feeding. No consensus exists regarding feeding initiation after PEG placement. We performed a national survey to assess current practice regarding feeding initiation after PEG placement as well as clinical and practitioner based factors associated with early or delayed feeding.A survey assessing feeding initiation in general ward and intensive care unit patients, current literature knowledge, motility agent use, number of PEG placed per year, along with physician demographics was emailed to 5256 gastroenterologists. Statistical analysis was done using SAS software (V.9).28% of gastroenterologists responded. Amongst respondents, 59% were private consultants, 25% academic physicians and 16% trainees. Private gastroenterologists initiated feeding earlier (≤12 h) compared to academic gastroenterologists in general ward and intensive care unit patients (p0.0001). Amongst respondents, 41% of physicians were aware of current literature on post-PEG feeding times. Physicians aware of current literature started feeding earlier (12h) compared to those not aware in general ward and intensive care unit patients (p=0.0002). Male physicians instituted feeding earlier than females (p0.0001).Feeding initiation after PEG placement varies amongst gastroenterologists. Further studies are required to explore obstacles in standardizing post-PEG feeding practices.

Background and Purpose— Past studies consistently show an inverse relationship between physicians’ surgical procedures/diagnoses volume and cost. There is little information available on this aspect of stroke care. We used nationwide population-based data to explore the association between physician case volume and costs per discharge for patients with stroke. Methods— Data on all 83 748 hospitalizations for stroke in 2004, treated by 3757 physicians in Taiwan, from Taiwan’s National Health Insurance Research Database, was analyzed using hierarchical linear regression modeling to explore associations between costs per discharge and physician case volume (one to 44 cases=low volume, 44 to 135=medium volume, ≥136 cases=high volume) adjusting for patient’s age, gender, comorbidities, and stroke type; hospital ownership, teaching status, and geographic region; and physician demographics. Results— Unadjusted mean cost per discharge was highest for patients treated by low-volume physicians, at NT $79 993 compared with NT $78 588 for medium-volume physicians and NT $43 942 for high-volume physicians ( P P =0.001) and NT $7761 higher than medium-volume physicians ( P =0.027). Conclusions— Our data confirm an inverse volume–cost relationship for stroke care in Taiwan. After adjusting for patient, hospital, and physician characteristics, the potential cost savings if all patients were treated or supervised by high-volume physicians could be 41.0% of the mean treatment cost incurred by low-volume physicians.

We analyze the claims database of a large malpractice insurer covering more than 8,000 physicians and 9,300 claims. Applying empirical Bayes methods in a regression setting, we construct a predictor of each physician's underlying propensity to incur malpractice claims. Our explanatory factors are physician demographics (age, sex, specialty, training) and physician practice pattern characteristics (practice setting, procedures performed, practice intensity, special risk factors, and characteristics of hospital(s) on staff of). We divide physicians into medical and surgical/ancillary specialty categories and fit separate models to each. In the surgical/ancillary specialty group, physician characteristics can effectively distinguish between more and less claims-prone physicians. Physician characteristics have somewhat less predictive power in the medical specialty group. As measured by predictive information, physician characteristics are superior to 10 years of claims history. Insofar as medical malpractice claims can be thought of as extreme indicators of poor-quality care, this finding suggests that easily gathered physician characteristics can be helpful in designing targeted quality of care improvement policies.

In focusing on individual and physician demographics and system characteristics that lead to hysterectomy rate variations, researchers overlook the impact of culturally mediated meanings women assign to their bodies, hysterectomy, and other treatments. In this study I sought to provide a fuller description of this decision-making process by examining the role of meaning making in women’s decision not to have a hysterectomy. Using a descriptive qualitative approach, nine women diagnosed with menstrual disorders in Halifax, Nova Scotia, Canada each took part in a semi-structured interview. Factors deemed “irrational” in biomedical understandings of informed choice played a significant role in participants’ decisions not to have a hysterectomy. When these factors are hidden, they cannot be properly addressed during the treatment selection process. By shifting the approach to informed choice to incorporate a holistic view of the body and knowledge, requirements for informed choice may be more likely to be met. Keywords: Menstrual Disorders, Treatment Decision-Making, Women’s Health, Descriptive Qualitative Research

In this study we sought to better understand how EMR systems are actually being used by family physicians and what they perceive to be the performance outcomes for themselves and their medical practices. To achieve our objectives, we conducted a survey of family physicians in Quebec, Canada and obtained responses from 331 user physicians. Key findings reveal that EMR systems "as-used" vary from one physician to another in terms of the EMR capabilities that are actually mobilized by them. Two user profiles were identified, that is, Meaningful and Basic users. Significant differences between the two groups were found in terms of physician demographics and system characteristics. In terms of perceived outcomes, physicians were clustered under three profiles that could be clearly distinguished from one another, namely Highly Impacted, Slightly Impacted and Non Impacted users. Findings show that Highly Impacted physicians are those who are the most experienced with EMRs and those who make the most wide-ranging use of their system capabilities. Practical and research implications of this study are discussed.

Little is known about how physicians' knowledge of and attitudes to practice guidelines for stable angina may influence their implementation.To explore the association between physicians' demographics, their knowledge, and opinions about stable angina and their self-reported adherence to guideline recommendations.Questionnaire-based survey.We surveyed 1228 Quebec physicians using a questionnaire based on the 'awareness-to-adherence' conceptual framework to measure their adherence with recommendations for the pharmacological treatment of stable angina. Independent predictors of adherence with the targeted recommendations were determined by stepwise linear regression analysis.We received 877 (71.4%) responses from the 1228 eligible physicians. More than 90% of respondents were aware of and agreed with the targeted recommendations. However, the adoption rate varied, even among physicians who generally agreed with the guidelines. Factor analysis indicated that most physicians agreed with recommendations concerning ASA. More negative attitudes were expressed toward beta-blockers and hypolipaemic drugs. Respondents trusted the recommendations of a variety of scientific and professional organizations. Awareness, agreement, and adoption were the strongest predictors of adherence for the three recommendations. Physician demographics and practice characteristics did not predict adherence.Physicians were aware of and agreed with the recommendations, so additional large-scale dissemination of the guidelines would be unlikely to improve prescription patterns. However, negative attitudes about beta-blockers and hypolipaemic therapy affected adherence to recommendations for these drugs. Continuing medical education interventions involving local opinion leaders might address some of the obstacles identified.