Perceptions of Practicing Physicians and Members of the Public on the Attributes of a “Good Doctor”

Since physician–patient relationships are a central part of the medical practice, it is essential to understand whether physicians and the general public share the same perspective on traits defining a “good doctor”. Our study compared the perceptions of physicians and members of the public on the essential traits of a “good doctor.” We conducted parallel surveys of 1000 practicing specialist-physicians, and 500 members of the public in Israel. Respondents were asked about the two most important attributes of a “good doctor” and whether they thought the physicians’ role was to reduce health disparities. Many physicians (56%) and members of the public (48%) reported that the role of physicians includes helping to reduce health disparities. Physicians emphasized the importance of non-technical skills such as humaneness and concern for patients as important traits of a “good doctor,” while the public emphasized professional and technical skills. Internal medicine physicians were more likely than surgeons to emphasize humaneness, empathy, and professionalism. Future research should focus on actionable approaches to bridge the gap in the perceptions between the groups, and that may support the formation of caring physicians embedded in a complex array of relationships within clinical and community contexts.

An international survey on the use of intrapleural tPA/DNase therapy for pleural infection

IntroductionIntrapleural tissue plasminogen activator (tPA) combined with human recombinant DNase (DNase) could be an effective alternative to surgery in managing pleural infection as demonstrated in the Multi-centre Intrapleural Sepsis Trial (MIST)-2. However, the optimal delivery regime is still unknown. The aim of this survey is to identify the current practice of tPA/DNase use by physicians with published interests in pleural infection, and their opinions on dose de-escalation of tPA/DNase therapy.MethodsPotential participants were identified using four search strategies. Only practicing physicians who are managing patients with pleural infections and are either actively involved in pleural research and publications, or members of relevant pleural disease guideline panels at the time of survey were included.ResultsAn invitation email with the questionnaire was sent to 102 participants of which 49 (48%) responded. Most respondents (90%, n=44) have used tPA/DNase to manage pleural infection but the dosing and delivery regimens employed varied. Many (86%, n=38/44) respondents have used 10 mg tPA, while 73% (n=32), 16%, (n=7) and 9% (n=4) have used 5 mg, 2.5 mg and 1 mg doses respectively. Most respondents instilled tPA/DNase concurrently (61%, n=27) and routinely administered 6 doses of tPA/DNase (52%, n=23) twice daily (82%, n=36). Respondents would consider using a lower starting dose of tPA (with the possibility of escalation if clinically needed) if 80% [IQR 50–80] of patients could be successfully treated at that dose.ConclusionThis survey observed a large variation in the current treatment protocol of intrapleural tPA/DNase therapy worldwide and the need for more data on this subject.

Virtual and Augmented Reality Changing Horizons in Dentistry

Augmented and virtual reality (AR-VR) is a fast developing technology that has been used in the field of medicine for a long time. It has also found its way in dentistry and the preliminary assessments so far have shown promising results. Aim: The presented scoping review was conducted with an aim of identifying the current applications of AR-VR in the field of dental training and education. The paper also highlights the presently available dental simulators, their features and areas of use. Result: It was found that AR-VR is not restricted to teaching of upcoming dentists but also helps practicing physicians to return to basics and refine their skills. Inclusion of haptics provides a realistic experience by simulating the tactile sensations. Instant feedback feature act as a source of motivation to cover the missed bases. Conclusion: AR-VR technology has numerous advantages in dental education and training. However, the currently available systems require imports and are bulky to be transported in difficult terrains. Thereby it is important that indigenous systems be developed that have enhanced feasibility to be used for training of Armed Forces for managing trauma cases encountered in the field.

Knowledge and perceptions towards candidate COVID-19 vaccines among practicing physicians of Tamil Nadu: a cross-sectional pilot study

Background: The world is in the midst of a COVID-19 pandemic and WHO is working in collaboration with scientists, business and global health organizations to speed up the pandemic response and they are racing to find a vaccine. COVAX the largest and most diverse COVID-19 vaccine portfolio in the world launched by WHO. There are currently over 189 COVID-19 vaccine candidates under development, with 40 of these in the human trial phase. This study was done to assess the knowledge and perceptions towards candidate COVID-19 vaccines among practicing physicians.Methods: A cross-sectional study were done among 129 practicing physicians using a semi-structured, validated, questionnaire through online Google forms after obtaining the informed consent. The data was analyzed using SPSS version 20.Results: The study was done among 129 practicing physicians of which 65 (50.4%) were males and 64 (49.6%) were females and majority of them in the age group of 21-40 years (77.5%) with a mean age of 34.89±9.906 years. 82.2% of the participants were working with the clinical specialty of which 95 (73.6%) with 10 years of professional experience and 23 (17.8%) had 10-20 years of professional experience. Majority of the practicing physicians 92 (72.3%) have average knowledge towards COVID-19 vaccines. Overall, the physicians showed positive attitude towards COVID-19 vaccines and 107 (82.9%) said that COVID-19 vaccine was really needed to control the pandemic.Conclusions: The study recommends promoting all precautionary and preventive measures of COVID-19 with a comprehensive training program for the practicing physicians before the implementation of COVID-19 vaccines which will support public engagement strategies and help to build preparedness for potential vaccine introduction.

Teaching EndoFLIP Impedance Planimetry to Practicing Endoscopists: An “Into the Fire” Approach to Simulation

Background. There are growing interests from practicing endoscopists to implement the functional lumen imaging probe (FLIP) impedance planimetry system. We present a simulation-based curriculum using an “into the fire” approach with hands-on pre- and post-tests to teach the use of this technology. Methods. The curriculum consists of a series of pre-tests, didactic content, mentored hands-on instructions, and post-tests. Pre- and post-testing included a knowledge-based written test, a confidence survey, and an assessment form specific to the hands-on performance of FLIP. Result. Twenty-two practicing physicians completed the curriculum. After course completion, participants had improved knowledge-based written test scores from 6.8±1.7 to 8.9±0.9 ( P<0.001), confidence scores from 10.0±5.9 to 22.1±2.6 ( P<0.001), and hands-on performance score from 11.4±3.4 to 23.1±2.0 ( P<0.001) with significant improvement in all components of the hands-on skills. Conclusion. Our simulation curriculum is effective in improving confidence, knowledge, and technical proficiency when teaching the use of FLIP to practicing physicians.

Clinical profile of isolated systolic hypertension in elderly

Isolated systolic hypertension is the most common hemodynamic form of hypertension in the elderly. With a rapidly aging population, the prevalence of hypertension, particularly isolated systolic hypertension, is increasing steadily. Isolated systolic hypertension is associated with substantial mortality and morbidity, particularly of cerebrovascular disease. It is a rapidly growing public health concern and its management continues to remain a challenge to practicing physicians. Recent studies like the Systolic Blood Pressure Intervention Trial (SPRINT) and Heart Outcomes Prevention Evaluation (HOPE)-3 have implications for antihypertensive therapy in general and for the management of isolated systolic hypertension in particular.

Dual Agency in Hospitals: What Strategies Do Managers and Physicians Apply to Reconcile Dilemmas Between Clinical and Economic Considerations?

Background: Hospital professionals are "dual agents" who may face dilemmas between their commitment to patients’ clinical needs and hospitals’ financial sustainability. This study examines whether and how hospital professionals balance or reconcile clinical and economic considerations in their decision-making in two countries with activity-based payment systems. Methods: We conducted 46 semi-structured interviews with hospital managers, chief physicians and practicing physicians in five German and five Israeli hospitals in 2018/2019. We used thematic analysis to identify common topics and patterns of meaning. Results: Hospital professionals report many situations in which activity-based payment incentivizes proper treatment, and clinical and economic considerations are aligned. This is the case when efficiency can be improved, eg, by curbing unnecessary expenditures or specializing in certain procedures. When considerations are misaligned, hospital professionals have developed a range of strategies that may contribute to balancing competing considerations. These include ‘reshaping management,’ such as better planning of the entire course of treatment and improvement of the coding; and ‘reframing decision-making,’ which involves working with averages and developing tool-kits for decision-making. Conclusion: Misalignment of economic and clinical considerations does not necessarily have negative implications, if professionals manage to balance and reconcile them. Context is important in determining if considerations can be reconciled or not. Reconciling strategies are fragile and can be easily disrupted depending on context. Creating tool-kits for better decision-making, planning the treatment course in advance, working with averages, and having interdisciplinary teams to think together about ways to improve efficiency can help mitigate dilemmas of hospital professionals.

Regional Population-Based Workforce Shortages in General Surgery by Practicing Surgeon and Resident Trainee

Background The physician shortage in the United States (US) continues to become more apparent. We aimed to evaluate the relationship between the US physician distribution from 2012-2019 by specialty at the state/regional level relative to the corresponding population growth. Methods US matched residents and practicing physicians from 2012-2019 were extracted from the National Resident Matching Program and Association of American Medical College databases, respectively. Residents and practicing physicians were divided by geographic regions (West, Midwest, South, Northeast), states, and specialties (anesthesiology, emergency medicine, family medicine, general surgery (GS), internal medicine, obstetrics/gynecology and pediatrics). Results Entering residents and physicians increased across 7 specialties from 2012-2019 with the exception of GS, which showed .2% decrease in practicing physicians. GS experienced decreases in entering residents in all US regions except the South. All specialties showed a decrease in the people-per-physician (PPP) except GS and pediatrics, which had a 4.1% and 71.3% increase, respectively. EM showed the largest growth overall, both in entering residents and overall workforce. Conclusion GS experienced slow growth of residents, decreases in practicing physicians and workforce overall, and an increase in PPP from 2012-2019. Our findings suggest that current population growth rate is exceeding the rate of physicians entering the field of GS and highlights the need for interventions to promote the recruitment of GS residents and retainment of attending physicians, particularly for rural areas. Future research to measure surgeon distribution in relation to patient outcomes and the efficacy of recent policy to address shortages can help define additional interventions to address physician shortages moving forward.