A descriptive study of the effect of a disciplinary proceeding decision on medical practitioners' practice behaviour in the context of providing a hydrocortisone and lignocaine injection.

INTRODUCTION: We conducted a descriptive study to evaluate any changes in practice behaviour regarding the provision of hydrocortisone and lignocaine (H&L) injections among doctors and how an H&L injection is priced following a disciplinary proceeding decision. A doctor had been fined SGD 100,000 for failing to obtain informed consent before an H&L injection. METHODS: We performed a survey shortly after the disciplinary decision to ascertain: (a) the category of the respondent; (b) whether the respondent provided H&L injections and how much he charged before the decision; and (c) after the decision. All members of the Singapore Medical Association and College of Family Physicians Singapore are doctors and were invited to participate. RESULTS: 1,927 doctors responded to the survey. Prior to the decision, 804 doctors did not perform H&L injections; this increased by 20.4% to 968 after the decision. The number of doctors who gave H&L injections decreased by 164 (14.6%), from the previous 1,123. Pre-decision, doctors who determined their own price for H&L injections charged a median pricing ≤ SGD 100. Post-decision, the median charge rose to > SGD 100 to SGD 200. At higher price bands, the number of doctors who charged > SGD 1,000 increased eight-fold, from eight to 65. CONCLUSION: The study demonstrated how a disciplinary decision can affect practice behaviour, and specifically how doctors may choose to not offer a service, an example of defensive medicine through avoidance behaviour. It also showed how prices for a service can rise following such a decision, which demonstrates the concept of negative general deterrence in sentencing.

Applying principles of self-management to facilitate workers to return to or remain at work with a chronic musculoskeletal condition.

It is incumbent on health care professionals to support patients with chronic musculoskeletal conditions to manage the impact of the condition on their life. Work is a positive health behaviour for which self-management skills are essential. In this paper, self-management is defined and the role of clinicians in promoting self-management for return to work is outlined with examples and tips on how the clinician can incorporate self-management into practice. The clinician is ideally placed to assist individuals with chronic musculoskeletal conditions manage to remain at work or return to work. This can be achieved through such activities as the promotion of the core self-management skills of problem-solving, decision making, resource utilisation, developing a cooperative partnership between clinician and patient and making an action plan.

"Habits of employees": smoking, spies, and shopfloor culture at Hammermill Paper Company.

As cigarette smoking expanded dramatically during the early twentieth century, it brought more and more workers into conflict with the policies and demands of the manufacturers who employed them. As this paper shows, addiction to nicotine ignited daily struggles over workers' shopfloor rights and the ability of employers to set rules, establish discipline, and monitor behavior. A specific set of records from the archives of the Hammermill Paper Company, a paper manufacturer once based in Erie, Pennsylvania, provide a unique opportunity to explore the impact of cigarette consumption on labor relations during the era of mass production, as two nosy factory spies probed and documented worker actions and attitudes in the summer of 1915. As a result of their intelligence gathering, the spies discovered a factory-wide work culture rooted in the addictive pleasure of cigarette smoke. This discovery worried them. Worker-smokers needed to dampen their hunger for nicotine with frequent, and often clandestine, breaks from work, typically in defiance of "no-smoking" rules, employer designations for the uses of factory space, and bosses' demands for continuous production. Highlighting the intersections of the histories of labor, smoking, and addiction, this paper argues that cigarettes were a key battleground in workers' and managers' intensifying struggles over who really controlled the industrial shopfloor during the early 1900s.

Impaired nurses: a cost analysis.

Although the literature reflects a continuing concern about impaired practice and its associated costs, no attempt has yet been made to examine those costs in a comprehensive manner. This analysis was undertaken to determine the specific economic impact of impaired nursing practice on the employing agency, the individual nurse, and the state regulatory body. It will provide valuable data for policy development and for planning cost-effective approaches to early recognition and intervention.