Patient safety and practitioner identity: the move towards statutory self-regulation

BackgroundUnprecedented numbers of physicians are practicing past age 65. Unlike other safety-conscious industries, such as aviation, medicine lacks robust systems to ensure late-career physician (LCP) competence while promoting career longevity.ObjectiveTo describe the attitudes of key stakeholders about the oversight of LCPs and principles that might shape policy development.DesignThematic content analysis of interviews and focus groups.Participants40 representatives of stakeholder groups including state medical board leaders, institutional chief medical officers, senior physicians (>65 years old), patient advocates (patients or family members in advocacy roles), nurses and junior physicians. Participants represented a balanced sample from all US regions, surgical and non-surgical specialties, and both academic and non-academic institutions.ResultsStakeholders describe lax professional self-regulation of LCPs and believe this represents an important unsolved challenge. Patient safety and attention to physician well-being emerged as key organising principles for policy development. Stakeholders believe that healthcare institutions rather than state or certifying boards should lead implementation of policies related to LCPs, yet expressed concerns about resistance by physicians and the ability of institutions to address politically complex medical staff challenges. Respondents recommended a coaching and professional development framework, with environmental changes, to maximise safety and career longevity of physicians as they age.ConclusionsKey stakeholders express a desire for wider adoption of LCP standards, but foresee significant culture change and practical challenges ahead. Participants recommended that institutions lead this work, with support from regulatory stakeholders that endorse standards and create frameworks for policy adoption.

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Relation between illness representation and self-reported degree-of-worry in patients calling out-of-hours services: a mixed-methods study in Copenhagen, Denmark

BMJ Open ◽

10.1136/bmjopen-2017-020401 ◽

2018 ◽

Vol 8 (9) ◽

pp. e020401 ◽

Cited By ~ 3

Author(s):

Sita LeBlanc Thilsted ◽

Ingrid Egerod ◽

Freddy Knudsen Lippert ◽

Hejdi Gamst-Jensen

Keyword(s):

Patient Safety ◽

Mixed Methods ◽

Qualitative Data ◽

Self Regulation ◽

Illness Representation ◽

Telephone Triage ◽

Out Of Hours ◽

Illness Duration ◽

Safety Research ◽

Somatic Illness

ObjectivesTo examine the relation between patients’ illness representations, presented in telephone consultation to out-of-hours (OOH) services, and self-reported degree-of-worry (DOW), as a measure of self-evaluated urgency. If a clear relation is found, incorporating DOW during telephone triage could aid the triage process, potentially increasing patient safety.DesignA convergent parallel mixed methods design with quantitative data; DOW and qualitative data from recorded telephone consultations. Thematic analysis of the qualitative data was used to explore the content of the quantitatively scaled DOW, using the Common-Sense Model of Self-Regulation (CSM).SettingA convenience sampling of calls to the OOH services in Copenhagen, Denmark, during 3 days was included in the study.ParticipantsCalls from adults (≥15 years of age) concerning somatic illness during the data collection period were eligible for inclusion. Calls made on behalf of another person, calls concerning perceived life-threatening illness or calls regarding logistical/practical problems were excluded, resulting in analysis of 180 calls.ResultsAll five components of the CSM framework, regardless of DOW, were present in the data. All callers referred to identity and timeline and were least likely to refer to consequence (37%). Through qualitative analysis, themes were defined. Callers with a strong identity, illness duration of less than 24 hours, clear cause and solution for cure/control seemed to present a lower DOW. Callers with a medium identity, illness duration of more than 24 hours and a high consequence seemed to present a higher DOW.ConclusionThis study suggests a relation between a patient’s illness representation and self-evaluation of urgency. Incorporating a patient’s DOW during telephone triage could aid the triage process in determining urgency and type of healthcare needed, potentially increasing patient safety. Research on patient outcome after DOW-assisted triage is needed before implementation of the DOW scale is recommended.

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Comment: ‘The Problem Surgical Colleague’

Annals of The Royal College of Surgeons of England ◽

10.1308/003588407x202191 ◽

2007 ◽

Vol 89 (5) ◽

pp. 464-465

Author(s):

Irving Taylor

Keyword(s):

Patient Safety ◽

Self Regulation ◽

General Medical Council ◽

Medical Council ◽

Safety Risk ◽

Medical Case ◽

Investigative Process

The review of ‘The problem surgical colleague’ by Mr John Mosley is both timely and relevant. All surgeons are naturally concerned about the mechanisms in place, both locally and through the General Medical Council (GMC) to deal with fitness-to-practise issues. It is inevitable that criticisms, often unfounded, are voiced by the profession. Most surgeons welcome a fair and transparent system to deal with such matters whilst maintaining the principle of self-regulation. We must accept that there are a small number of surgeons whose practice is impaired to such a degree that they represent a serious patient-safety risk and they must be dealt with appropriately. As a GMC medical case examiner since 2003, and having dealt with over 600 fitness-to-practise cases, I wish to comment on some of the important issues raised by Mr Mosley, specifically in relation to the surgeon and his or her practice. In doing so, I will set out the investigative process to be followed when fitness-to-practise concerns are brought to the attention of the GMC.

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On the Road to Professionalism

Anesthesiology ◽

10.1097/aln.0000000000001545 ◽

2017 ◽

Vol 126 (5) ◽

pp. 780-786 ◽

Cited By ~ 8

Author(s):

David H. Chestnut

Keyword(s):

Patient Safety ◽

Lifelong Learning ◽

Self Regulation ◽

Well Being ◽

Personal Attributes ◽

Self Awareness ◽

The Road ◽

Practice Of Medicine ◽

Physician Leaders ◽

On The Road

Abstract Many observers have concluded that we have a crisis of professionalism in the practice of medicine. In this essay, the author identifies and discusses personal attributes and commitments important in the development and maintenance of physician professionalism: humility, servant leadership, self-awareness, kindness, altruism, attention to personal well-being, responsibility and concern for patient safety, lifelong learning, self-regulation, and honesty and integrity. Professionalism requires character, but character alone is not enough. We need others to help and encourage us. And in turn, as physician leaders, we help shape the culture of professionalism in our practice environment. Professionalism is not something we learn once, and no physician is perfectly professional at all times, in all circumstances. Professionalism is both a commitment and a skill—a competency—that we practice over a lifetime.

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Self-Regulation and the Writing Process: Enhancing the Performance of Students With Language and Learning Difficulties

Perspectives on Language Learning and Education ◽

10.1044/lle16.1.28 ◽

2009 ◽

Vol 16 (1) ◽

pp. 28-36 ◽

Cited By ~ 1

Author(s):

Gary A. Troia

Keyword(s):

Writing Process ◽

Self Regulation ◽

Learning Difficulties ◽

Evidence Based ◽

Struggling Learners ◽

Evidence Based Practices

Abstract This article first provides an overview of components of self-regulation in writing and specific examples of each component are given. The remainder of the article addresses common reasons why struggling learners experience trouble with revising, followed by evidence-based practices to help students revise their papers more effectively.

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