Job and life satisfaction among remote physicians in Taiwan.

To determine the nature and current level of job and life satisfaction among remote physicians in Taiwan, 115 physicians practicing in 31 aboriginal townships and on 3 offshore islands were interviewed through a mail survey. Out of 95 respondents, 93% were male. The average age was 46.0 years, and 82% of the physicians practiced only primary care. About half of the respondents had not received any residency training prior to their beginning practice. Physicians aboriginal areas and on offshore islands appear to be moderately satisfied with their jobs and with their lives in general. In aggregate, the areas of greatest job satisfaction included their contacts with other physicians and their relationships with other health care workers. Areas of least satisfaction included physicians' salary/income and their opportunities for promotion in the future. Most respondents felt that the greatest causes of work stress were the realities of medical practice and the time pressures. Areas of least stress included clinical competence/interpersonal relations and anxieties about the future. In aggregate, the areas of lowest life satisfaction included the physicians' incomes and the lack of leisure activities. It is suggested that a family practice residency training course prior to practice and access to continuing medical education programs are urgently needed for remote physicians in Taiwan. On the other hand, economic incentives seem to be the best strategy to increase the job and life satisfaction of these physicians.

Factors related to adolescents' perceptions of treatment outcomes in an adolescent health clinic.

To determine factors related to adolescents' perceived treatment outcomes of their health problems in an adolescent health clinic located at a college hospital, 246 adolescent patients between the ages of 11 and 21 who visited the clinic twice or more during the period January 1994 to December 1995 were included in this study. Information concerning adolescents' sociodemographic characteristics, family function, office visits and health problems of first visits was collected by reviewing subjects' medical and other clinic-related records. In addition, a structured questionnaire was mailed to assess subjects' satisfaction with physicians and the environment and services provided by the clinic as well as their perceived treatment outcomes. 148 patients completed the questionnaire, a response rate of 60.2%. Most of the respondents were in late-stage adolescence (71.0%) and were in school (71.0%). About half of respondents had normal family function, while the other half had moderate or severe family dysfunction. Most of the health problems of respondents were acute (64.2%) and were biological (76.4%) conditions. Most of the respondents were satisfied with the various characteristics of physicians except confidentiality emphasized by the physicians, while many fewer respondents were satisfied with the environment and services provided by the clinic. Family function, physicians' respect toward the adolescents, and the adolescents' satisfaction with the services provided in general were the factors significantly related to adolescents' perceived treatment outcomes based on a stepwise, multiple logistic regression analysis. We conclude that efforts to provided could result in better adolescent perceived treatment outcomes.

Job and life satisfaction among rural physicians. Results of a survey.

Results of a survey of approximately half of Minnesota's rural physicians show that these physicians appear to be well-satisfied with their jobs (average rating of 2.5 on a five-point scale with 2 = very satisfied and 3 = moderately satisfied). In aggregate, areas of greatest job satisfaction are the diversity of patients physicians see, physicians' contact with others, and their ability to derive personal gratification from patient care. Salary/income was not a source of dissatisfaction. Areas of least satisfaction are physicians' opportunities for promotion, their ability to remain knowledgeable, and their role in making organizational and administrative decisions. Rural Minnesota physicians feel least work stress about their feelings of clinical competence/interpersonal relations at work and anxieties about the future. Areas of greatest stress focus on time pressures and realities of medical practice, i.e., being reimbursed by third-party payers and meeting the need for certainty when medical knowledge only allows for approximation. These physicians are reasonably happy with their lives in general (5.4 on a seven-point scale with 7 = delighted, 1 = terrible). In aggregate, areas of lowest life satisfaction are physicians' social relations, leisure activities, and finances. Examination of subgroups shows that women are statistically less satisfied with their living situations; younger physicians are less satisfied with their work, their living situations, and their leisure activities; physicians who spend more than 10 hours per week on administrative duties are less satisfied with their living and social situations; and physicians who see more than 100 patients per week are less satisfied with their social relations.

Demonstrating the characteristics of family practice through the family medicine clinic located at a college hospital.

During its development, family practice in Taiwan has been housed at the university/college hospitals, and different settings have served as the main bases for service and teaching. To demonstrate the progress made in the family medicine clinic at the Chung Shan Medical College Hospital and to evaluate the appropriateness of this kind of family practice setting, our patient population of 616 was investigated. There were 5177 patient encounters during the period from September 1987 to August 1989. Of 616 patients, 52.3% were male, the average age was 38.5 years, 85.1% lived in Taichung, where the hospital is located, and 60.1% were insured. A total of 117 families, containing 310 members, made up 50.3% of the patient population. Most patients (64.0%) visited us after introductions by their relatives or friends. There was an average of 4.2 visits per patient per year, and only 6.3% of patients were lost to follow-up after their first visits. The three leading causes for visits to the Family Medicine Clinic were general medical examination (14.5%), acute upper respiratory tract infection (13.6%), and peptic ulcer diseases (8.0%): these comprised 36.1% of all patients' problems. The average referral rate among the 5177 patient encounters was 2.9%. Patient education about treatment of disease, immunization against hepatitis B, and screening for liver cirrhosis/hepatoma in hepatitis B antigen carriers were the most common preventative encounters in our clinic. In conclusion, university/college hospitals are certainly not the best site for service and teaching of family practice, since they are not based on ambulatory care.(ABSTRACT TRUNCATED AT 250 WORDS)

[Effects of family medicine education on medical students' attitudes].

Undergraduate education is considered to be one of the main contributory factors for the development of family medicine through increasing the number of medical graduates opting for a career in family practice. To evaluate the effects of family medicine education on student's attitudes, 140 fifth year medical students were asked in 1989 to fill in a questionnaire both before and after their curricula. The average age of the 123 students who completed the questionnaire on both occasions was 24.9 years; 106 were males; 17 were tuition free and 26 took additional family medicine clerkships. On aggregate, the students' disposition toward family medicine before their curricula appeared to be uncertain. Mean scores on the attitude scale did not significantly differ between socioeconomic subgroups before the curricula. After the curricula, students' attitudes were significantly altered, especially toward the future development of family medicine in Taiwan. However, their disposition toward family practice as a career changed the least. The degree of alteration in students' attitude toward family medicine before and after the curricula was related to the intensity of the course and to their socioeconomic backgrounds.

The development of general practice in China.

The concepts and principles of general practice are consistent with Chinese cultural values; the leading authorities at the General Practice Training Centre are extremely enthusiastic about the general practice movement; the Ministry of Public Health is totally supportive of the general practice training; the medical/allied health professionals are eager to participate in general practice activities; and general practice certainly is responsive to public expectations. General practice will be flourishing and prosperous in China; however, there may be times when the specialty of general practice in China experiences growing pains with obstacles. The experiences gained from the development of general practice training programmes in Taiwan and other countries to handle the obstacles are of tremendous value to the development of general practice in China. It is expected that communication and exchange between the general practice educators of Taiwan and China will play an important role in the further development of general practice in China.

[Evaluation of the effects of a general medical course for non-medical university students].

In order to evaluate the effects of a general medical course on students' related attitudes and knowledge, 186 students who took the general medical course in the National Chung-Hsing University or the Private Fung-Chia University were asked to fill in a structured questionnaire both before and after their course during February, 1993 and January, 1994. The average age of the 177 students who completed the questionnaire on both occasions was 21.9 years; 109 were males and 68 were females. Two thirds of the students indicated that they would like to learn more about health and medical sciences as the main reason for taking the course. Before the class, the leading two perceptions of health given by students were no biopsychological problem (54.2%) and no biomedical problem (18.6%), while no biopsychological problem (55.4%) and no biopsychosocial problem (23.7%) were the leading two perceptions afterwards. After the course, about 21% of students counted health as the greatest concern in their lives, while only 16% did before the class. At first only 18.6% of students considered life style as the most important contributing factor to human health, but the frequency increased to 28.2% at the end of the class. Regarding knowledge on health and medical care, mean scores in all five domains of knowledge were significantly higher after than before the course. The general medical curriculum was welcomed and highly valued by students based on their evaluations after the class. We concluded that university students' attitudes toward and knowledge on health and medical care can be significantly increased by a general medical curriculum.

Acute paronychia heralding the exacerbation of pemphigus vulgaris.

Acute paronychia, the suppurative inflammation involving the paronychium of the nails, is usually caused by bacterial or fungal infection and has been rarely reported as a presentation of pemphigus vulgaris (PV). We report a woman with PV who presented with suppurative paronychia of multiple fingernails and toenails, which preceded the exacerbation of other mucocutaneous lesions. A biopsy specimen of the paronychium revealed suprabasal vesicles due to acantholysis. Systemic corticosteroids and adjuvant immunosuppressants were effective in treating mucocutaneous lesions as well as nail disease. We conclude that in patients with PV, acute paronychia could be a manifestation of the disease per se, rather than an infectious process. Only the precise diagnosis with adequate immunosuppressive treatment can lead to good control of disease activity.

Brain glucose metabolic changes associated with neuropsychological improvements after 4 months of treatment in patients with obsessive-compulsive disorder.

OBJECTIVE: The study was designed to elucidate regional brain metabolic changes according to a treatment and their relationship with neuropsychological performance changes in obsessive-compulsive disorder (OCD). METHOD: Cerebral glucose metabolic rates were repeatedly measured before and after treatment in 10 patients with OCD using [18F]-2-fluoro-deoxyglucose positron emission tomography (PET). They were compared on a voxel-basis, and the correlations were counted between the regional metabolic changes and the degree to improvement on the neuropsychological assessments. RESULTS: After treatment, the patients showed significant (P < 0.005, two-tailed) regional metabolic changes in multiple brain areas involving frontal-subcortical circuits and parietal-cerebellar networks. Especially, the metabolic changes of the putamen, the cerebellum, and the hippocampus were significantly correlated with the improvement of the immediate- and delayed-recall scores of the Rey-Osterrieth Complex Figure Test (RCFT). CONCLUSION: These results suggest a possibility that metabolic changes of frontal-subcortical and parietal-cerebellar circuit changes may underlie cognitive improvements in patients with OCD.