Surgeons’ non-transparent facemasks challenge the physician–patient relationship in the orthopedic outpatient clinic of a tertiary university hospital during the COVID-19 pandemic: a prospective cohort study of 285 patients

Background and purpose — Facemasks play a role in preventing the respiratory spread of SARS-CoV-2, but their impact on the physician–patient relationship in the orthopedic outpatient clinic is unclear. We investigated whether the type of surgeons’ facemask impacts patients’ perception of the physician–patient relationship, influences their understanding of what the surgeon said, or affects their perceived empathy. Patients and methods — All patients with an appointment in the orthopedic outpatient clinic of a tertiary university hospital during the 2-week study period were included. During consultations, all surgeons wore a non-transparent (first study week) or transparent facemask (second study week). Results of 285 of 407 eligible patients were available for analysis. The doctor–patient relationship was evaluated using the standardized Patient Reactions Assessment (PRA) and a 10-point Likert-scale questionnaire ranging from 0 (strongly disagree) to 10 (strongly agree). Results — A non-transparent facemask led to more restrictions in the physician–patient communication and a worse understanding of what the surgeon said. Patients’ understanding improved with a transparent facemask with greatest improvements reported by patients aged 65 years and older (non-transparent: 6 [IQR 5–10] vs. transparent: 10 [IQR 9–10], p < 0.001) and by patients with a self-reported hearing impairment (non-transparent: 7 [IQR 3–7] vs. transparent: 9 [IQR 9–10], p < 0.001). The median PRA score was higher when surgeons wore a transparent facemask (p= 0.003). Interpretation — Surgeons’ non-transparent facemasks pose a new communication barrier that can negatively affect the physician–patient relationship. While emotional factors like affectivity and empathy seem to be less affected overall, the physician–patient communication and patients’ understanding of what the surgeon said seem to be negatively affected.

Iatrogenic depression: the case of Frederic Chopin

Psychological disorders caused by the doctor’s rash words are as common as the side effects of drug. Iatrogenic depression caused by ethical and psychological mistakes of doctors will never go away. Their frequency can be reduced only by improving the physicians’ skills in the fields of medical ethics and psychology. A clinical case analysis based on a famous person’s history of the disease is an effective pedagogical tool. The study aims to present the case of the famous Polish composer Frederic Chopin. The A comparative analysis of doctors’ objective actions and patients’ subjective evaluations of their actions were made based on a study of Chopin’s and Sand’s letters as well as the works of composer’s biographers. This approach provides a valuable opportunity to see doctors through the patient’s eyes. In the fall of 1838, during his rest in Majorca, the local doctors diagnosed pulmonary tuberculosis in Chopin. The Majorcan doctors made a serious ethical mistake. They ignored the patient’s anamnesis vitae indicating his phthisiophobia and informed Chopin about the diagnosis of pulmonary tuberculosis and a poor prognosis in a very cynical manner. Chopin wrote: ‘One (doctor) said I had died the second that I am dying, the 3rd that I shall die’. Chopin perceived the diagnosis of tuberculosis as a ‘death sentence’, as a result of which he developed iatrogenic depression. All previous and subsequent Chopin’s doctors used other tactics: they prescribed the correct treatment, but the diagnosis was not voiced. The analysis shows the effectiveness of this tactic: Chopin lived another 10 years after the Majorcan episode. Chopin’s case shows typical doctors’ ethical and psychological issues in informing the patient about the dangerous diagnosis and poor prognosis as well as tactics for building a good physician‑patient relationship.

The Digital Way to Intercept Psoriatic Arthritis

Psoriasis (PsO) and Psoriatic Arthritis (PsA) are chronic, immune-mediated diseases that share common etiopathogenetic pathways. Up to 30% of PsO patient may later develop PsA. In nearly 75% of cases, skin psoriatic lesions precede arthritic symptoms, typically 10 years prior to the onset of joint symptoms, while PsO diagnosis occurring after the onset of arthritis is described only in 15% of cases. Therefore, skin involvement offers to the rheumatologist a unique opportunity to study PsA in a very early phase, having a cohort of psoriatic “risk patients” that may develop the disease and may benefit from preventive treatment. Progression from PsO to PsA is often characterized by non-specific musculoskeletal symptoms, subclinical synovio-entheseal inflammation, and occasionally asymptomatic digital swelling such as painless toe dactylitis, that frequently go unnoticed, leading to diagnostic delay. The early diagnosis of PsA is crucial for initiating a treatment prior the development of significant and permanent joint damage. With the ongoing development of pharmacological treatments, early interception of PsA has become a priority, but many obstacles have been reported in daily routine. The introduction of digital technology in rheumatology may fill the gap in the physician-patient relationship, allowing more targeted monitoring of PsO patients. Digital technology includes telemedicine, virtual visits, electronic health record, wearable technology, mobile health, artificial intelligence, and machine learning. Overall, this digital revolution could lead to earlier PsA diagnosis, improved follow-up and disease control as well as maximizing the referral capacity of rheumatic centers.

How do patients respond to safety problems in ambulatory care? Results of a retrospective cross-sectional telephone survey

ObjectivesPatients in German ambulatory care frequently report patient safety problems (PSP). It is unclear whether patients report PSP back to their general practitioner (GP) or specialist in charge. This study reports on how patients respond to experienced PSP.DesignRetrospective cross-sectional study.SettingComputer-assisted telephone interviews (CATI) with randomly recruited citizens aged ≥40 years in Germany.Participants10 037 citizens ≥40 years. About 52% of the interviewees were female, 38% were between 60 and 79 years old and about 47% reported that they were chronically ill. A total of 2589 PSPs was reported.Primary and secondary measures/ResultsAccording to the respondents (n=1422, 77%, 95% CI: 74.7 to 79.1), 72% (95% CI: 70.2 to 73.7) of PSP were reported back to the GP in charge or to another GP/specialist. Further reactions were taken by 65% (95% CI: 62.5 to 67.5) of the interviewees: around 63% (95% CI: 62.5 to 66.2) of the reported PSP led to a loss of faith in the physician or to complaints. χ2 and binary logistic regression analyses show significant associations between the (a) reporting and (b) reaction behaviour and determinants like ‘medical treatment area’ ((a) χ2=17.13, p=0.009/(b) χ2=97.58, p=0.000), ‘PSP with/without harm’ ((a) χ2=111.84, p=0.000/(b) χ2=265.39, p=0.000) and sociodemographic characteristics when respondents are aged between 40 and 59 years ((a) OR 2.57/(b) OR 2.60) or have chronic illnesses ((a) OR 2.16/(b) OR 2.14).ConclusionThe data suggest that PSPs are frequently reported back to the GP or specialist in charge and have a significant serious impact on the physician–patient relationship. Much could be learnt from the patient reporting and reacting behaviour to prevent PSPs in ambulatory care.

New Insights into Antihypertensive Adherence from Illness Perception and the Physician-Patient Relationship: A Mixed Methods Study

Low treatment adherence is the most important cause of uncontrolled hypertension. Given the limited evidence in the literature, this study investigated how illness perception and the physician-patient relationship influence medication and lifestyle modification adherence in essential hypertension. In this explanatory mixed methods study, we collected and analyzed quantitative data from 112 patients, and then revealed qualitative themes from the collected data of 3 patients identified based on statistical results. Explaining quantitative results, mixed methods inferences provided preliminary evidence for professionals and future studies regarding the role of illness perception and the physician-patient relationship as modifiable factors in fearless behavior change intervention.