Intention for healthy eating among southern Appalachian teens.

OBJECTIVE: To describe the intention for healthy eating and its correlates among southern Appalachian teens. METHODS: Four hundred sixteen adolescents 14- to 16-years-old were surveyed with self-administered questionnaires. RESULTS: About 30% of the adolescents surveyed had definite intentions to eat healthfully during the next 2 weeks. The scales for perceived behavior control, attitude, perceived eating habits of significant others, and social support were shown to be fairly reliable (Cronbach's alpha=0.60 to 0.88). Perceived behavior control and attitude were positively associated with the intention for healthy eating. CONCLUSIONS: Better behavior control and more positive attitude may lead to a stronger intention for healthy eating.

Observations on burnout in family medicine and psychiatry residents.

OBJECTIVE: To investigate the relationship between burnout, work environment, and a variety of personal variables, including age, gender, marital, parental and acculturation status within a population of family medicine and psychiatry resident physicians. METHODS: Between 2002 and 2005, 155 residents in family medicine and psychiatry at East Tennessee State University College of Medicine were surveyed at intervals using the Maslach Burnout Inventory and Work Environment Scale, form R, to assess their current state of emotional health and job satisfaction. RESULTS: Female residents had lower scores on the Depersonalization scale of the Maslach Burnout Inventory (t=3.37, p=0.001). Parenting was associated with lower Depersonalization (t=3.98, p<0.001) and Emotional Exhaustion (t=2.59, p=0.011). Residents from the United States culture reported higher Depersonalization and Emotional Exhaustion (t=-3.64, p<0.001; t=-3.85, p<0.001). On the Work Environment Scale, residents from United States culture reported less Task Orientation and Control but higher Work Pressure (t=2.89, p=0.005; t=2.24, p=0.027; t=-2.79, p=0.006). Psychiatry residents reported less burnout than family medicine residents on the Depersonalization and Emotional Exhaustion scales (t=2.49, p=0.014: t=2.05, p=0.042) and higher Physical Comfort on the Work Environment Scale (t=-2.60, p=0.011); while family medicine residents reported higher Peer Cohesion, Supervisor Support, and Autonomy (t=3.41, p=0.001; t=2.38, p=0.019; t=2.27, p=0.025). CONCLUSION: This study design, using well established, standard, and valid measures, identified important issues for further exploration: the relationship between acculturation to burnout, the potential role of parenting as a protective factor from burnout, and the recognition that women residents may not be as vulnerable to burnout as previously reported.

Patients prefer the method of "tell back-collaborative inquiry" to assess understanding of medical information.

PURPOSE: The goal of this study was to determine which approach to assessing understanding of medical information patients most prefer and perceive to be most effective. METHODS: Two videos were shown to participants: (1) a physician explaining a medical condition and its treatment and (2) a physician inquiring about patient understanding of the medical information the patient had been given using 3 different types of inquiry: Yes-No, Tell Back-Collaborative, and Tell Back-Directive. RESULTS: The Tell Back-Collaborative inquiry was significantly preferred over the other 2 approaches. CONCLUSIONS: Patients strongly prefer the Tell Back-Collaborative inquiry when assessing their understanding. We recommend that physicians ask patients to restate what they understand using their own words and that they use a patient-centered approach.

Eating habits among adolescents in rural Southern Appalachia.

A survey of 274 adolescents aged 14-16 years in rural Appalachia showed that unhealthy eating habits were prevalent. A few adolescents were teased about weight whereas 20.1% witnessed weight teasing almost everyday. Perception of parents' healthy eating and better social support for healthy eating were associated with healthier eating habits.

Patients with worry: presentation of concerns and expectations for response.

Patients with the same underlying concern express this with different styles that predict preference for physician responses. One hundred primary care patients imagined having chest pain and selected from a videotape, the most likely response which they would tell their physician: (1) symptoms only--no disclosure of underlying concern; (2) symptoms and a "Clue" to an underlying concern; or (3) symptom with an explicit concern. Depending on their preferred expression, they were presented videotaped doctors responses to that disclosure and ranked their response preferences. Patients stating they would present with symptoms only (17%) preferred a biomedical question response; patients selecting a symptom and a clue (43%) were equally comfortable with a biomedical question, facilitation or, an exploration of the clue. Of patients presenting with an explicit concern (40%), most wanted the physician to acknowledge and explore the origins of that concern.

Sequenced questioning to elicit the patient's perspective on illness: effects on information disclosure, patient satisfaction, and time expenditure.

BACKGROUND: During the medical interview, clinicians frequently overlook the patient's perspective on illness (PPI), ie, the patient's explanations and concerns about the presenting symptoms and expectations for the encounter. Without special efforts, the PPI surfaces spontaneously in only about one fourth of medical interviews. We determined whether asking the patient a series of sequenced questions would elicit the PPI and what effect such questioning would have on patient and physician satisfaction and on the length of the clinical encounter. METHODS: Fifty-five interviews in a family practice clinic setting were studied by videotape and post-interview debriefings. On a random basis, 29 patients were asked sequenced questions at the end of the history, while 26 experienced usual medical interviews. Measures of patient and physician satisfaction were compared by descriptive statistics and the Mann-Whitney test for ordinal data. RESULTS: In response to sequenced questioning, 44% of patients revealed specific, significant concerns that had not been otherwise disclosed. Among patients without prior contact with their provider, satisfaction with the encounter was significantly higher when the sequenced questions were used than when they were not; perception of time spent in discussion with the physician was also higher. Paradoxically, resident physicians expressed lower confidence that they had helped the patient when the sequenced questions were used to elicit the PPI. CONCLUSIONS: Use of sequenced questions to elicit the PPI results in significant sharing of new information and increased patient satisfaction and requires only a modest investment of time.

Responding effectively to patient anger directed at the physician.

BACKGROUND AND OBJECTIVES: Patient anger because of a long wait is a common occurrence, but few studies have looked at how the anger should be addressed. This study determined patient levels of satisfaction, rating of importance, and preference for a variety of approaches for addressing anger being directed toward a physician. METHODS: A video trigger tape of an angry patient and 12 physician responses to the angry patient were shown to 130 participants who then rated the physician responses based on four approaches, alone or in combination (apology, explanation, self disclosure, and acknowledgment) for satisfaction and importance of the response. Participants also evaluated four physician follow-up questions. RESULTS: An apology combined with an explanation was rated highest in satisfaction and importance and individually ranked as the best approaches for physicians to use. "I apologize for your long wait" was rated significantly higher than "I am sorry you have been kept waiting." Although gender and prior high anger with clinicians affected the ratings of some responses, participants consistently preferred an apology and/or an apology combined with explanation as the best response. Participants also preferred physician follow-up questions that facilitated segue to the medical interview rather than questions that explored patient feelings. CONCLUSIONS: Participants clearly indicated that they would like a physician to apologize, explain the reason for the delay, and then quickly move along with the interview.