scholarly journals Balancing altruism and self-interest: GP and patient implications

2019 ◽  
Vol 37 (1) ◽  
pp. 1-15 ◽  
Author(s):  
Chris O’Riordan
Keyword(s):  
Patient Care ◽  
General Practitioners ◽  
Best Interests ◽  
Professional Values ◽  
Incentive Systems ◽  
Dominant Motivation ◽  
Self Interest ◽  
Business Needs ◽  
Designing Incentive

Abstract This paper explores how general practitioners (GPs) address potentially opposing motivations stemming from being altruistic and self-interested, and the implications for patients and GPs. The author finds that GPs address dual goals of patient care and profit generation. This can be challenging, while professional values (altruism) encourage a patient focus, business realities (self-interest) mandate other priorities. Viewing clinicians as altruistic in isolation of business needs is unrealistic, as is the notion that profit is the dominant motivation. A blending of interests occurs, pursuing reasonable self-interest, patients’ best interests are ultimately met. GPs need a profit focus to sustain/improve the practice, benefitting patients through continued availability and capacity for enhancement. Therefore, it is argued that GPs behave in a manner that is ‘part altruistic, part self-interested’ and mutually beneficial. These insights should be considered in designing incentive systems for GPs, raising compelling questions about contemporary understanding of the nature of professionals.

scholarly journals Professional values and behaviours of younger and older general practitioners in Scotland: a cross-sectional survey

BMJ Leader ◽  
2020 ◽  
Vol 4 (2) ◽  
pp. 57-63
Author(s):  
Trudy Lynn Foster ◽  
Paul Bowie
Keyword(s):  
Data Analysis ◽  
Quality Management ◽  
Patient Care ◽  
General Practitioners ◽  
Questionnaire Survey ◽  
Home Visits ◽  
Professional Values ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Suboptimal Care

AimProfessionalism has been linked with improved patient care and reduced complaints. Our goal was to define what, if any, differences exist in the professional values and behaviours of younger general practitioners (GPs), those aged 34 years and under, compared with their older colleagues, those being aged 55 years and over.MethodAn online cross-sectional questionnaire survey of GPs in Scotland was undertaken during 2018 using a modified version of the Nijmegen Professionalism Scale, which comprises 4 domains: professionalism towards patients, towards colleagues, towards society and towards oneself. Descriptive and inferential data analysis was undertaken between responses from both GP groups.Results273 responses were obtained. Of these, 106 respondents were classed as either younger GPs (n=55; 51.9%) or older (n=51; 48.1%). The greatest number of differences were found in the Professional Distance subsection of professionalism towards patients. The greatest single disparity in responses was to distinguish between personal and professional interests in negotiations (p<0.0001). Younger GPs also reported they were less likely to bear the consequences of their own actions (p<0.02) and to be more likely to give others the blame or responsibility (p<0.006). Younger GPs report being less skilled in quality management, being less able to signal suboptimal care (p<0.006) and justify indications for making home visits (p<0.001).ConclusionWhile there were areas of similarity in relation to collaborating with colleagues, reflection on learning and dealing with emotions, differences were identified in relation to the 5 other subsections. Some differences may be explained by lack of exposure and experience, but this may not account for all the differences reported.

The mediating role of medical professionalism on financial self-interest GPs

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X697193
Author(s):  
David McCaffrey ◽  
Chris O’Riordan ◽  
Felicity Kelliher
Keyword(s):  
General Practitioners ◽  
Financial Resources ◽  
Medical Professionalism ◽  
Fiscal Constraints ◽  
Policy Initiatives ◽  
Mediating Role ◽  
Documentary Analysis ◽  
Self Interest ◽  
Fluid Interpretation

BackgroundWhile no normative definition exists, medical professionalism emphasises a set of values, behaviours and relationships that underpin public trust in a physician. The empirical setting for this study is the Irish health care system where GPs receive income through a unique mix of private fee income and state funded capitation. GPs’ income per patient has fallen by 33% under state schemes between 2008 and 2013 due to changes in health policy and national fiscal constraints.AimThis paper examines how general practitioners conceptualise and operationalise medical professionalism and financial self-interest in the Irish healthcare system.MethodTo address this research aim, a historical documentary analysis (2009–2016) of national and medical newspapers was used to investigate GPs’ expressions of medical professionalism and financial self-interest.ResultsThe vagueness of language in differing definitions of medical professionalism may lead to a GP having a fluid interpretation depending on the situation. While general practitioners expressed core humanistic values, such as empathy and compassion, the expression of altruistic values were limited when practitioners indicated there was constraint on the financial resources of a practice.ConclusionCentral to the analysis of a medical practitioner’s treatment of patients and receipt of fee income is the tension between medical professionalism and financial self-interest. Developing an understanding of this tension has implications for those undertaking healthcare policy initiatives and the recruitment and retention of general practitioners in primary care.

scholarly journals Attitudes to and experience of disease management programs in primary care—an exploratory survey of general practitioners in Germany

2021 ◽  
Author(s):  
Julian Wangler ◽  
Michael Jansky
Keyword(s):  
Primary Care ◽  
Disease Management ◽  
Patient Care ◽  
General Practitioners ◽  
Linear Regression Analysis ◽  
Chronically Ill ◽  
Disease Management Programs ◽  
Federal States ◽  
Set Up ◽  
Chronically Ill Patients

Summary Background Disease management programs (DMPs) were set up in Germany in 2003 to improve outpatient care of chronically ill patients. The present study looks at the attitudes and experiences of general practitioners (GPs) in relation to DMPs, how they rate them almost 20 years after their introduction and where they see a need for improvement. Methods A total of 1504 GPs in the Federal States of Rhineland Palatinate, Saarland and Hesse were surveyed between December 2019 and March 2020 using a written questionnaire. Results In total, 58% of respondents rate DMPs positively and regard them as making a useful contribution to primary care. The guarantee of regular, structured patient care and greater compliance are regarded as particularly positive aspects. It was also established that diagnostic and therapeutic knowledge was expanded through participation in DMPs. 57% essentially follow the DMP recommendations for (drug) treatment. Despite positive experiences of DMPs in patient care, the GPs surveyed mention various challenges (documentation requirements, frequent changes to the programmes, inflexibility). Univariant linear regression analysis revealed factors influencing the satisfaction with DMPs, such as improvement of compliance and clearly defined procedures in medical care. Conclusion Most of the GPs surveyed consider the combination of continuous patient care and evidence-based diagnosis and treatment to be a great advantage. To better adapt DMPs to the conditions of primary care, it makes sense to simplify the documentation requirements, to regulate cooperation with other healthcare levels more clearly and to give GPs more decision-making flexibility. Increased inclusion of GP experience in the process of developing and refining DMPs can be helpful.

Somatoform disorders: A help or hindrance to good patient care?

2004 ◽  
Vol 184 (6) ◽  
pp. 465-467 ◽  
Author(s):  
Michael Sharpe ◽  
Richard Mayou
Keyword(s):  
Primary Care ◽  
Patient Care ◽  
General Practitioners ◽  
Somatoform Disorders ◽  
Somatoform Disorder ◽  
Good Patient ◽  
Specific Category ◽  
Good Patient Care ◽  
Almost All ◽  
Issue Reports

The paper by de Waal and colleagues (2004, this issue) reports on the prevalence of somatoform disorders in Dutch primary care. They found that at least one out of six patients seen by general practitioners could be regarded as having a somatoform disorder, almost all in the non-specific category of undifferentiated somatoform disorder. The prevalence of the condition has major implications for medical services but what does this diagnosis mean? Is receiving a diagnosis of somatoform disorder of any benefit to the patient? Does it help the doctor to provide treatment?

scholarly journals In Machines We Trust: Are Robo-Advisers More Trustworthy Than Human Financial Advisers?

2019 ◽  
pp. 129-141 ◽  
Author(s):  
Hui Xian Chia
Keyword(s):  
Deep Learning ◽  
Black Box ◽  
Best Interests ◽  
Decision Making Process ◽  
Learning Technology ◽  
Technical Expertise ◽  
Learning Agents ◽  
The People ◽  
Self Interest ◽  
Deep Learning Model

This article examines the use of artificial intelligence (AI) and deep learning, specifically, to create financial robo-advisers. These machines have the potential to be perfectly honest fiduciaries, acting in their client’s best interests without conflicting self-interest or greed, unlike their human counterparts. However, the application of AI technology to create financial robo-advisers is not without risk. This article will focus on the unique risks posed by deep learning technology. One of the main fears regarding deep learning is that it is a “black box”, its decision-making process is opaque and not open to scrutiny even by the people who developed it. This poses a significant challenge to financial regulators, whom would not be able to examine the underlying rationale and rules of the robo-adviser to determine its safety for public use. The rise of deep learning has been met with calls for ‘explainability’ of how deep learning agents make their decisions. This paper argues that greater explainability can be achieved by describing the ‘personality’ of deep learning robo-advisers, and further proposes a framework for describing the parameters of the deep learning model using concepts that can be readily understood by people without technical expertise. This regards whether the robo-adviser is ‘greedy’, ‘selfish’ or ‘prudent’. Greater understanding will enable regulators and consumers to better judge the safety and suitability of deep learning financial robo-advisers.

scholarly journals Physician's Burnout and the COVID-19 Pandemic—A Nationwide Cross-Sectional Study in Austria

2021 ◽  
Vol 12 ◽  
Author(s):  
Ilsemarie Kurzthaler ◽  
Georg Kemmler ◽  
Bernhard Holzner ◽  
Alex Hofer
Keyword(s):  
Psychological Distress ◽  
Patient Care ◽  
General Practitioners ◽  
Statistical Significance ◽  
Demographic Data ◽  
Brief Symptom Inventory ◽  
Stress Factors ◽  
Financial Problems ◽  
Cross Sectional ◽  
Self Reporting Questionnaire

Background: The current study assesses the prevalence of burnout and psychological distress among general practitioners and physicians of various specialities, who are not working in a hospital, during the COVID-19 pandemic. Additionally in this context, contributing factors are registered.Materials and Methods: Burnout and psychological distress were assessed with the Copenhagen Burnout Inventory (CBI) and the Brief Symptom Inventory (BSI-18). A newly developed self-reporting questionnaire was used to evaluate demographic data and pandemic-associated stress factors.Results: 252 general practitioners and 229 private practice physicians provided sufficient responses to the outcome variables for analysis. The prevalence of clinically relevant psychological distress was comparable between groups (12.4 vs. 9.2%). A larger proportion of general practitioners than specialists had intermediate (43.8 vs. 39.9%) or high burnout (26.9 vs. 22.0%) without reaching statistical significance for either category. When combining study participants with intermediate and high levels of burnout, the group difference attained significance (70.7 % vs. 61.9%).Conclusion: Our findings provide evidence that practicing physicians are at high risk of burnout in the context of the pandemic. Being single (standardized beta = 0.134), financial problems (beta = 0.136), and facing violence in patient care (beta = 0.135) were identified as significant predictors for psychological distress. Burnout was predicted by being single (beta = 0.112), financial problems (beta= 0.136), facing violence in patient care (beta = 0.093), stigmatization because of treatment of SARS-CoV-2-positive patients (beta = 0.150), and longer working hours during the pandemic (beta = 0.098).

scholarly journals Pilot study to build capacity for family medicine with abbreviated, low-cost training programme with minimal impact on patient care for a cohort of 84 general practitioners caring for Palestinian refugees in Jordan

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e028240 ◽  
Author(s):  
Amjad Al Shdaifat ◽  
Therese Zink
Keyword(s):  
Primary Care ◽  
Patient Care ◽  
General Practitioners ◽  
Clinical Skills ◽  
Low Cost ◽  
Training Programme ◽  
Ambulatory Setting ◽  
Secondary Outcome ◽  
Intervention Programme ◽  
Minimal Impact

PurposeStudies document that primary care improves health outcomes and controls costs. In regions of the world where primary care is underdeveloped, building capacity is essential. Most capacity building programmes are expensive and take physicians away from their clinical settings. We describe a programme created, delivered and evaluated from 2013 to 2014 in Jordan.DesignCohort study.SettingPhysicians providing primary care in the United Nations Relief and Works Agency for Palestine Refugees clinics in Jordan.ParticipantsEighty-four general practitioners (GPs) were invited to participate and completed the training and evaluation. GPs are physicians who have a license to practice medicine after completing medical school and a 1 year hospital-based rotating internship. Although GPs provide care in the ambulatory setting, their hospital-based education provides little preparation for delivering ambulatory primary care.Intervention/ProgrammeThis three-stage programme included needs assessment, didactics and on-the-job coaching. First, the learning needs and baseline knowledge of the trainees were assessed and the findings guided curriculum development. During the second stage, 48 hours of didactics covered topics such as communications skills and disease management. The third stage was delivered one on one in the trainee’s clinical setting for a 4 to 6-hour block. The first, middle and final patient interactions were evaluated.Primary and secondary outcome measuresPreknowledge and postknowledge assessments were compared. The clinical checklist, developed for the programme, assessed eight domains of clinical skills such as communication and history taking on a five-point Likert scale during the patient interaction.ResultsPreknowledge and postknowledge assessments demonstrated significantly improved scores, 46% to 81% (p<0.0001). Trainee’s clinical checklist scores improved over the assessment intervals. Satisfaction with the training was high.ConclusionThis programme is a potential model for building primary care capacity at low cost and with little impact on patient care that addresses both knowledge and clinical skills on the job.

scholarly journals Out-patient care for people with learning disability and epilepsy: evaluating the audit process

1995 ◽  
Vol 19 (11) ◽  
pp. 686-688 ◽  
Author(s):  
Helen Chubb ◽  
Michael Kerr ◽  
Joseph Joyce
Keyword(s):  
Patient Care ◽  
Learning Disability ◽  
General Practitioners ◽  
Seizure Frequency ◽  
Seizure Type ◽  
Medical Audit ◽  
Audit Process ◽  
Audit Standards

The notes of 24 individuals attending a clinic for people with learning disability and epilepsy were reviewed for all visits in the year preceding and following the Implementation of medical audit standards for out-patient review. There was no deterioration in any standard. A significant improvement was seen in recording of seizure frequency by seizure type, legibility of signatures, regular letters to general practitioners and the recording of seizure type and frequency in these. Medical audit can improve standards in epilepsy care, though its influence on outcome is not known.

scholarly journals Through the Looking Glass: Mediator Conceptions of Philosophy, Process and Power

1969 ◽  
pp. 819 ◽  
Author(s):  
Colleen M. Hanycz
Keyword(s):  
Qualitative Study ◽  
Civil Procedure ◽  
Best Interests ◽  
Mediation Process ◽  
Mediation Program ◽  
Self Interest ◽  
Looking Glass

While a number of civil reforms using mediation emerged across Canada in recent years, of particular interest is the Ontario Mandatory Mediation Program Mediation Program that was first piloted in 1999, deemed successful and then made a permanent feature of the Rules of Civil Procedure in 2001. This article suggests that before we can evaluate the outcomes of mandatory mediation, we must first look more closely at the process being implemented by the mediators in this context. With that in mind, this article considers the ways in which the mediators themselves perceive of the mediation process. It reports on a qualitative study that examined the nature of mediator views on the topics of, inter alia, settlement orientation and mediator power. This article advances the claim that mediator power Is, in fact, far greater than that held by the disputants or their advocates. This article suggests that this power, in the context of a mandatory mediation scheme, creates mediator self-interest in achieving high rates of settlement, regardless of whether or not settlement is in the best interests of the disputants in every situation.

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