RESUMO
BACKGROUND: The role of rural family physicians continues to evolve to accommodate the comprehensive care needs of aging societies. For older individuals in rural areas, rehabilitation is vital to ensure that they can continue to perform activities of daily living. In this population, a smooth discharge following periods of hospitalization is essential and requires management of multimorbidity, and rehabilitation therapists may require support from family physicians to achieve optimal outcomes. Therefore, this study aimed to investigate changes in the roles of rural family physicians in patient rehabilitation. METHODS: An ethnographic analysis was conducted with rural family physicians and rehabilitation therapists at a rural Japanese hospital. A constructivist grounded theory approach was applied as a qualitative research method. Data were collected from the participants via field notes and semi-structured interviews. RESULTS: Using a grounded theory approach, the following three themes were developed regarding the establishment of effective interprofessional collaboration between family physicians and therapists in the rehabilitation of older patients in rural communities: 1) establishment of mutual understanding and the perception of psychological safety; 2) improvement of relationships between healthcare professionals and their patients; and 3) creation of new roles in rural family medicine to meet evolving needs. CONCLUSION: Ensuring continual dialogue between family medicine and rehabilitation departments helped to establish understanding, enhance knowledge, and heighten mutual respect among healthcare workers, making the work more enjoyable. Continuous collaboration between departments also improved relationships between professionals and their patients, establishing trust in collaborative treatment paradigms and supporting patient-centered approaches to family medicine. Within this framework, understanding the capabilities of family physicians can lead to the establishment of new roles for them in rural hospitals. Family medicine plays a vital role in geriatric care in community hospitals, especially in rural primary care settings. The role of family medicine in hospitals should be investigated in other settings to improve geriatric care and promote mutual learning and improvement among healthcare professionals.
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Teoria Fundamentada , Hospitais Comunitários , Hospitais Rurais , Médicos de Família , Pesquisa Qualitativa , Humanos , Feminino , Masculino , Médicos de Família/psicologia , Hospitais Comunitários/organização & administração , Hospitais Rurais/organização & administração , Japão , Comportamento Cooperativo , Papel do Médico/psicologia , Idoso , Fisioterapeutas/psicologia , Relações Interprofissionais , Pessoa de Meia-IdadeRESUMO
Psychiatrists play a crucial role in evaluating requests and treatment indications for individuals experiencing gender incongruence, while also providing support throughout the transition process. Their work involves addressing both the psychological and somatic aspects of this journey, facilitating the profound identity changes it entails.
Les psychiatres psychothérapeutes jouent un rôle essentiel pour évaluer les demandes et les indications au traitement des personnes souffrant d'incongruence de genre, et les accompagner dans leur parcours de transition. Leur travail permet d'intégrer les enjeux psychologiques et somatiques de ce cheminement et de soutenir les remaniements identitaires profonds qu'il implique.
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Psiquiatria , Humanos , Psiquiatria/métodos , Feminino , Masculino , Pessoas Transgênero/psicologia , Papel do Médico/psicologia , Identidade de Gênero , PsiquiatrasRESUMO
INTRODUCTION: Despite the increasing importance of teamwork in healthcare, medical education still puts great emphasis on individual achievements. The purpose of this study is to examine medical students' team role preferences, including the association with gender and specialty; and to provide implications for policy makers and medical educators. METHODS: We used an exploratory methodology, following a cross-sectional design. Data was collected from first year master students in medicine (n = 2293) during five consecutive years (2016-2020). The Belbin Team Role Self Perception Inventory (BTRSPI) was used to measure medical students' self-perceptions of their team role. RESULTS: The Team Worker was the most preferred team role among medical students (35.8%), regardless of gender or specialty. Female and male students had similar team role patterns, although female students scored higher on Team Worker (40.4% vs. 29.1%, P < .001) and Completer-Finisher (14.0% vs. 8.0%, P < .001). With regard to specialties, the Team Worker role was more often chosen by general practitioners than by person-centered and technique-oriented specialties (47.1% vs. 41.8% vs. 29.1%, P < .001). CONCLUSIONS: Our findings contribute to an increased scientific understanding of how medical students perceive their own team role, and how this is related to gender and specialty. This is valuable due to the increased importance of interdisciplinary teamwork in healthcare. Medical schools should prioritize stimulating teamwork skills through the implementation of different interventions at all stages (i.e. from the admission process to curricula to residency) and all levels (i.e. explicit and implicit curricula).
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Equipe de Assistência ao Paciente , Papel do Médico , Estudantes de Medicina , Estudos Transversais , Educação de Pós-Graduação em Medicina , Feminino , Humanos , Masculino , Papel do Médico/psicologia , Especialização , Estudantes de Medicina/psicologia , Estudantes de Medicina/estatística & dados numéricosRESUMO
OBJECTIVES: Moral elevation is the underlying emotion that arises when witnessing admirable acts, and it is theorized to be the psychological mechanism driving the impact that positive clinical role models have on medical students' professional identity formation (eg, growth in professional virtues, higher sense of meaning, and well-being). This proof-of-concept study explores the development of the Moral Elevation Scale in Medicine by testing the association of moral elevation with various markers of professional identity formation. METHODS: A secondary data analysis of two nationally representative samples of 960 medical students and 2000 physicians was performed. Respondents completed validated measures of moral elevation as well as markers of professional identity formation, including patient-centered virtues (empathic compassion, interpersonal generosity, mindfulness) and measures of well-being (life meaning, life satisfaction, spirituality, burnout). RESULTS: The study obtained adjusted response rates of 56.2% (1047/1863, physician survey) and 48.7% (448/919, student survey). The national estimates for mean moral elevation in medical students and physicians are 4.34/5.00 and 4.22/5.00, respectively. In medical students and physicians, high moral elevation was associated with higher empathic compassion (student odds ratio [OR] 1.30, 95% confidence interval [CI] 1.02-1.67; physician OR 1.22, 95% CI 1.23-1.65) and, similarly, generosity. In addition, higher moral elevation in the physician cohort was associated with greater life meaning (OR 2.03, 95% CI 1.25-3.32) and similarly spirituality. CONCLUSIONS: In medical students and practicing physicians, self-reported experiences of high moral elevation with physician role models were associated with higher self-reported measures of patient-centered virtues, spirituality, and life meaning. Our Moral Elevation Scale in Medicine demonstrates preliminary promise as a measure to assess environmental precursors needed for virtue development in professional identity formation, but further reliability and validity testing of this measure is needed.
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Papel do Médico/psicologia , Médicos/psicologia , Profissionalismo/tendências , Identificação Social , Adulto , Esgotamento Profissional/prevenção & controle , Esgotamento Profissional/psicologia , Feminino , Humanos , Masculino , Mentores/psicologia , Mentores/estatística & dados numéricos , Princípios Morais , Médicos/tendências , Autorrelato , Inquéritos e QuestionáriosAssuntos
COVID-19/epidemiologia , Cuidados Críticos , Administração dos Cuidados ao Paciente , Papel do Médico/psicologia , Condições Sociais/tendências , Ferimentos e Lesões/cirurgia , Cuidados Críticos/ética , Cuidados Críticos/organização & administração , Cuidados Críticos/psicologia , Serviços Médicos de Emergência/tendências , Humanos , Modelos Organizacionais , Administração dos Cuidados ao Paciente/ética , Administração dos Cuidados ao Paciente/organização & administração , Administração dos Cuidados ao Paciente/tendências , Equipe de Assistência ao Paciente/ética , Equipe de Assistência ao Paciente/tendências , SARS-CoV-2 , Responsabilidade Social , Fatores Socioeconômicos , Estados Unidos , ViolênciaAssuntos
COVID-19 , Pandemias , SARS-CoV-2 , Confiança , COVID-19/epidemiologia , COVID-19/psicologia , Criança , Desinformação , Humanos , Pediatras/psicologia , Pediatria , Papel do Médico/psicologia , Confiança/psicologiaRESUMO
INTRODUCTION: This study explores general practitioners' (GPs') and medical specialists' perceptions of role distribution and collaboration in the care of patients with chronic conditions, exemplified by spinal cord injury. METHODS: Semi-structured interviews with GPs and medical specialists caring for individuals with spinal cord injury in Switzerland. The physicians we interviewed were recruited as part of an intervention study. We used a hybrid framework of inductive and deductive coding to analyse the qualitative data. RESULTS: Six GPs and six medical specialists agreed to be interviewed. GPs and specialists perceived the role of specialists similarly, namely as an expert and support role for GPs in the case of specialised questions. Specialists' expectations of GP services and what GPs provide differed. Specialists saw the GPs' role as complementary to their own responsibilities, namely as the first contact for patients and gatekeepers to specialised services. GPs saw themselves as care managers and guides with a holistic view of patients, connecting several healthcare professionals. GPs were looking for relations and recognition by getting to know specialists better. Specialists viewed collaboration as somewhat distant and focused on processes and patient pathways. Challenges in collaboration were related to unclear roles and responsibilities in patient care. CONCLUSION: The expectations for role distribution and responsibilities differ among physicians. Different goals of GPs and specialists for collaboration may jeopardise shared care models. The role distribution should be aligned according to patients' holistic needs to improve collaboration and provide appropriate patient care.
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Atitude do Pessoal de Saúde , Clínicos Gerais , Relações Interprofissionais , Papel do Médico , Especialização , Traumatismos da Medula Espinal , Humanos , Doença Crônica/terapia , Clínicos Gerais/psicologia , Assistência de Longa Duração , Papel do Médico/psicologia , Pesquisa Qualitativa , Serviços de Saúde Rural , Traumatismos da Medula Espinal/terapia , SuíçaAssuntos
Médicos Graduados Estrangeiros/estatística & dados numéricos , Gastroenterologia/estatística & dados numéricos , Disparidades em Assistência à Saúde/etnologia , Papel do Médico/psicologia , Diversidade Cultural , Educação de Pós-Graduação em Medicina/normas , Médicos Graduados Estrangeiros/provisão & distribuição , Mão de Obra em Saúde/estatística & dados numéricos , Mão de Obra em Saúde/tendências , Humanos , Área Carente de Assistência MédicaAssuntos
Esgotamento Profissional , Cardiologistas , Cardiologia/normas , Etnicidade , Negro ou Afro-Americano , Asiático , Atitude do Pessoal de Saúde , Feminino , Hispânico ou Latino , Humanos , Satisfação no Emprego , Masculino , Mentores , Pediatria , Papel do Médico/psicologia , Padrões de Prática Médica , Papel Profissional/psicologia , Inquéritos e Questionários , Estados Unidos , População BrancaRESUMO
Importance: In recent years, casual physician attire (fleece jackets and softshell jackets) has become increasingly popular, but to our knowledge, public perceptions of these garments have not been studied. Furthermore, gender biases may result in differing expectations and perceptions of female and male physicians and may be associated with patient rapport and trust building. Objective: To characterize public perceptions of casual physician attire and implicit gender biases in public assessment of physicians' professional attire. Design, Setting, and Participants: This survey study used a population-based survey administered via Amazon Mechanical Turk from May to June 2020 among individuals aged 18 years or older who were US residents and for whom English was the primary language. Intervention: Survey featuring photographs of a male or female model wearing various types of physician attire (white coat, business attire, and scrubs). Main Outcomes and Measures: Respondents' ratings of professionalism, experience, and friendliness of the male and female models in various attire and perceptions of the models' most likely health care profession. Preference scores for various outfits were calculated as the difference between the preference score for an outfit and the mean preference score for the outfit-role pairing. Results: Of 522 surveys completed, 487 were included for analysis; the mean (SD) age of respondents was 36.2 (12.4) years, 260 (53.4%) were female, and 372 (76.4%) were White individuals. Respondents perceived models of health care professionals wearing white coats vs those wearing fleece or softshell jackets as significantly more experienced (mean [SD] experience score: white coat, 4.9 [1.5]; fleece, 3.1 [1.5]; softshell, 3.1 [1.5]; P < .001) and professional (mean [SD] professionalism score: white coat, 4.9 [1.6]; fleece, 3.2 [1.5]; softshell, 3.3 [1.5]; P < .001). A white coat with scrubs attire was most preferred for surgeons (mean [SD] preference index: 1.3 [2.3]), whereas a white coat with business attire was preferred for family physicians and dermatologists (mean [SD] preference indexes, 1.6 [2.3] and 1.2 [2.3], respectively; P < .001). Regardless of outerwear, female models in business attire as inner wear were rated as less professional than male counterparts (mean [SD] professionalism score: male, 65.8 [25.4]; female, 56.2 [20.2]; P < .001). Both the male and the female model were identified by the greater number of respondents as a physician or surgeon; however, the female model vs the male model was mistaken by more respondents as a medical technician (39 [8.0] vs 16 [3.3%]; P < .005), physician assistant (56 [11.5%] vs 11 [2.3%]; P < .001), or nurse (161 [33.1%] vs 133 [27.3%]; P = .050). Conclusions and Relevance: In this survey study, survey respondents rated physicians wearing casual attire as less professional and experienced than those wearing a white coat. Gender biases were found in impressions of professionalism, with female physicians' roles being more frequently misidentified. Understanding disparate public perceptions of physician apparel may inform interventions to address professional role confusion and cumulative career disadvantages for women in medicine.
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Vestuário/psicologia , Pessoal de Saúde/psicologia , Papel do Médico/psicologia , Médicos/psicologia , Profissionalismo , Adulto , Feminino , Humanos , Masculino , Relações Médico-Paciente , Médicas/psicologia , Opinião Pública , Sexismo/psicologia , Confiança , Estados UnidosRESUMO
INTRODUCTION/AIMS: Since 2016, six states have legalized physician-hastened death (PHD). Neuromuscular disorders, including amyotrophic lateral sclerosis (ALS), are common diagnoses for patients who use PHD, but how patients with ALS view PHD in California has not been systematically studied. We aimed to quantify how many patients with ALS and their caregivers have considered PHD and to assess reasons to consider using or not using it. METHODS: This is a cross-sectional study at one ALS center surveying patients with ALS and their caregivers. Data on disease characteristics, demographics, quality of life, and depression were also collected. Descriptive statistics were used to analyze the data. Qualitative data were also collected and analyzed. Patients were followed up longitudinally to assess if they died or if they used PHD. RESULTS: A small majority of ALS patients surveyed had considered or would consider using PHD (16/30). Patients most commonly described having intolerable symptoms, being a burden on their loved ones, and losing independence as reasons to consider using PHD. Many patients shared that "their life has purpose" and "they are making the most of their lives" as to why they are not considering PHD. Considering PHD was not related to disease severity or depression. On longitudinal follow-up, 10 of the 30 patients have died, and none have used PHD. DISCUSSION: Pursuing PHD is a personal decision for each individual patient. This study shows that considering PHD is relatively common in ALS patients, independent of disease severity or presence of depression.
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Esclerose Lateral Amiotrófica/psicologia , Cuidadores/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Participação do Paciente/psicologia , Papel do Médico/psicologia , Suicídio Assistido/psicologia , Adaptação Psicológica/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Esclerose Lateral Amiotrófica/epidemiologia , Esclerose Lateral Amiotrófica/terapia , California/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Participação do Paciente/métodosRESUMO
BACKGROUND: Preoperative anxiety is prevalent and has harmful effects on postoperative outcomes. However, to date, it is still unclear (i) to what extent patients perceive preoperative anxiety as emotionally distressful, (ii) whether patients would welcome support from anesthesiologists in coping with their anxiety, and (iii) whether anxiety scores are useful for everyday clinical practice to determine patients' need for support. METHODS: 1082 patients scheduled to undergo elective procedures under general anesthesia were eligible for this cross-sectional study carried out at a university hospital. Preoperative anxiety, resulting in emotional distress, and patients' desire for anesthesiologists' support in coping with their anxiety were assessed dichotomously (no vs. yes) and analyzed descriptively. The intensity of anxiety was evaluated using the Amsterdam Preoperative Anxiety and Information Scale (range 4-20). Associations between the intensity of anxiety and the resulting desire for support were analyzed using logistic regression. Receiver operating characteristic analyses were performed to identify anxiety levels that best predict desire for support. RESULTS: Among the 1000 (537 female; M (SD) 57 (18) years) subjects evaluated, 493 (318 (65 %) female) reported anxiety. Anxiety was associated with emotional distress in 320 (65 %) and desire for support in 291 (59 %) patients. Increased preoperative anxiety levels were associated with higher rates of desire for support (B= 0.270; odds ratio 1.31 [95 % CI 1.22-1.41]). An anxiety score > 9 was best to predict a desire for support (sensitivity 0.861, specificity 0.724). However, desire for support was even present in some patients with lowest anxiety scores (5 or 6). CONCLUSIONS: All patients undergoing surgery should be screened for preoperative anxiety and the resulting desire for support to be able to determine who would welcome support. Anxiety scoring tools do not seem to be useful to identify these patients. By helping patients experience less preoperative anxiety, anesthesiologists may not only reduce patients' emotional distress but also have a positive impact on postoperative outcome. TRIAL REGISTRATION: German Clinical Trials Register (DRKS 00013319, 23 November 2017).