Medical professionalism: Navigating modern challenges

Medical professionalism is an evolving entity, requiring continual development according to shifting societal priorities. The public trust that underpins the medical profession is imperative for maintaining effective partnerships with patients, their families and the wider community. This article provides an overview of what constitutes medical professionalism, including the current protocols and assessments for general practice training. The aim is to improve understanding of the current issues surrounding professionalism in primary care. Fictional case scenarios are used to illustrate modern professional dilemmas and to promote reflection on the complex interacting factors that influence professional practice and clinical decision-making.

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Impact of the COVID-19 pandemic on the core functions of primary care: will the cure be worse than the disease? A qualitative interview study in Flemish GPs

BMJ Open ◽

10.1136/bmjopen-2020-039674 ◽

2020 ◽

Vol 10 (6) ◽

pp. e039674 ◽

Cited By ~ 11

Author(s):

Veronique Verhoeven ◽

Giannoula Tsakitzidis ◽

Hilde Philips ◽

Paul Van Royen

Keyword(s):

Primary Care ◽

General Practice ◽

Clinical Decision Making ◽

Core Competencies ◽

Well Being ◽

Clinical Decision ◽

Framework Analysis ◽

Profound Impact ◽

The Core ◽

Qualitative Interview Study

ObjectivesThe current COVID-19 pandemic, as well as the measures taken to control it, have a profound impact on healthcare. This study was set up to gain insights into the consequences of the COVID-19 outbreak on the core competencies of general practice, as they are experienced by general practitioners (GPs) on the frontline.Design, setting, participantsWe performed a descriptive study using semistructured interviews with 132 GPs in Flanders, using a topic list based on the WONCA definition of core competencies in general practice. Data were analysed qualitatively using framework analysis.ResultsChanges in practice management and in consultation strategies were quickly adopted. There was a major switch towards telephone triage and consults, for covid-related as well as for non-covid related problems. Patient-centred care is still a major objective. Clinical decision-making is largely focused on respiratory assessment and triage, and GPs feel that acute care is compromised, both by their own changed focus and by the fact that patients consult less frequently for non-covid problems. Chronic care is mostly postponed, and this will have consequences that will extend and become visible after the corona crisis. Through the holistic eyes of primary care, the current outbreak—as well as the measures taken to control it—will have a profound impact on psychological and socioeconomic well-being. This impact is already visible in vulnerable people and will continue to become clear in the medium and long terms. GPs think that they are at high risk of getting infected. Dropping out and being unable to contribute their part or becoming virus transmitters are reported to be greater concerns than getting ill themselves.ConclusionsThe current times have a profound impact on the core competences of primary care. Although the vast increase in patients soliciting medical help and the necessary separate covid and non-covid flows have been dealt with, GPs are worried about the continuity of regular care and the consequences of the anticovid measures. These may become a threat for the general health of the population and for the provision of primary healthcare in the near and distant future.

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BRIEF COMMUNICATION: Evaluating the presentation and management of upper respiratory tract infection in primary care clinics in Saudi Arabia: biomedical factors do not govern clinical decision making

Journal of Evaluation in Clinical Practice ◽

10.1046/j.1365-2753.1999.00149.x ◽

1999 ◽

Vol 5 (1) ◽

pp. 65-71 ◽

Cited By ~ 1

Author(s):

Sulaiman A. Al-Shammari ◽

Hamza Abdul Ghani

Keyword(s):

Primary Care ◽

Decision Making ◽

Saudi Arabia ◽

Tract Infection ◽

Respiratory Tract ◽

Clinical Decision Making ◽

Clinical Decision ◽

Upper Respiratory Tract ◽

Primary Care Clinics ◽

Upper Respiratory

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Primary Care Physicians' Perceptions of the Effect of Insurance Status on Clinical Decision Making

The Annals of Family Medicine ◽

10.1370/afm.574 ◽

2006 ◽

Vol 4 (5) ◽

pp. 399-402 ◽

Cited By ~ 17

Author(s):

D. S. Meyers

Keyword(s):

Primary Care ◽

Decision Making ◽

Primary Care Physicians ◽

Clinical Decision Making ◽

Clinical Decision ◽

Insurance Status

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Consensus for a primary care clinical decision-making tool for assessing, diagnosing, and managing shoulder pain in Alberta, Canada

BMC Family Practice ◽

10.1186/s12875-021-01544-3 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Breda H. F. Eubank ◽

Sebastian W. Lackey ◽

Mel Slomp ◽

Jason R. Werle ◽

Colleen Kuntze ◽

...

Keyword(s):

Primary Care ◽

Decision Making ◽

Shoulder Pain ◽

Clinical Decision Making ◽

Clinical Decision ◽

Primary Care Providers ◽

Rapid Review ◽

Diagnosis And Management ◽

Joint Health ◽

Decision Making Tool

Abstract Background Shoulder pain is a highly prevalent condition and a significant cause of morbidity and functional disability. Current data suggests that many patients presenting with shoulder pain at the primary care level are not receiving high quality care. Primary care decision-making is complex and has the potential to influence the quality of care provided and patient outcomes. The aim of this study was to develop a clinical decision-making tool that standardizes care and minimizes uncertainty in assessment, diagnosis, and management. Methods First a rapid review was conducted to identify existing tools and evidence that could support a comprehensive clinical decision-making tool for shoulder pain. Secondly, provincial consensus was established for the assessment, diagnosis, and management of patients presenting to primary care with shoulder pain in Alberta, Canada using a three-step modified Delphi approach. This project was a highly collaborative effort between Alberta Health Services’ Bone and Joint Health Strategic Clinical Network (BJH SCN) and the Alberta Bone and Joint Health Institute (ABJHI). Results A clinical decision-making tool for shoulder pain was developed and reached consensus by a province-wide expert panel representing various health disciplines and geographical regions. This tool consists of a clinical examination algorithm for assessing, diagnosis, and managing shoulder pain; recommendations for history-taking and identification of red flags or additional concerns; recommendations for physical examination and neurological screening; recommendations for the differential diagnosis; and care pathways for managing patients presenting with rotator cuff disease, biceps pathology, superior labral tear, adhesive capsulitis, osteoarthritis, and instability. Conclusions This clinical decision-making tool will help to standardize care, provide guidance on the diagnosis and management of shoulder pain, and assist in clinical decision-making for primary care providers in both public and private sectors.

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A Comparison of Physicians' and Nurse Practitioners' Use of Race in Clinical Decision-Making

Ethnicity & Disease ◽

10.18865/ed.29.1.1 ◽

2019 ◽

Vol 29 (1) ◽

pp. 1-8

Author(s):

Khadijah E. Abdallah ◽

Kathleen A. Calzone ◽

Jean F. Jenkins ◽

Melissa E. Moss ◽

Sherrill L. Sellers ◽

...

Keyword(s):

Internal Medicine ◽

Primary Care ◽

Decision Making ◽

Genetic Variation ◽

Nurse Practitioners ◽

Clinical Decision Making ◽

Clinical Decision ◽

Primary Care Providers ◽

Care Providers ◽

General Internal

Objective: The debate over use of race as a proxy for genetic risk of disease continues, but little is known about how primary care providers (nurse practitioners and general internal medicine physicians) currently use race in their clinical practice. Our study investigates primary care providers’ use of race in clinical practice.Methods: Survey data from three cross-sectional parent studies were used. A total of 178 nurse practitioners (NPs) and 759 general internal medicine physicians were included. The outcome of interest was the Racial Attributes in Clinical Evaluation (RACE) scale, which measures explicit use of race in clinical decision-making. Predictor variables included the Genetic Variation Knowledge Assessment Index (GKAI), which measures the providers’ knowledge of human genetic variation.Results: In the final multivariable model, NPs had an average RACE score that was 1.60 points higher than the physicians’ score (P=.03). The GKAI score was not significantly associated with the RACE outcome in the final model (P=.67).Conclusions: Physicians had more knowledge of genetic variation and used patients’ race less in the clinical decision-making process than NPs. We speculate that these differences may be related to differences in discipline-specific clinical training and approaches to clinical care. Further exploration of these differences is needed, including examination of physicians’ and NPs’ beliefs about race, how they use race in disease screening and treatment, and if the use of race is contributing to health care disparities.Ethn Dis.2019;29(1):1-8; doi:10.18865/ ed.29.1.1.

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