Chinese Calligraphy and the Art of Writing.

The popularity of portraits of clinicians during the COVID-19 pandemic suggested the importance of visual representation of what mass illness demands of us all-and particularly those on the front lines of health care. In addition to surges in variants of the SARS-CoV-2 virus, persons of Asian descent have endured waves of bigotry and violence. With the myriad of natural and man-made threats confronting the world today, an ancient Confucian proverb on the common good prompts us to recognize humanity's shared future. Although text-based, calligraphy is visually engaging and reminds us of the importance and poignancy of words that are well chosen and beautifully rendered. This article displays and describes Chinese calligraphies by Terry Zhizhong Yuan, commissioned by the AMA Journal of Ethics, to commemorate the American Medical Association's 175th anniversary and the extraordinary times in which we live.

What Is Represented "Worthily" in Luke Fildes' The Doctor?

One of the most recognized paintings of Western medicine, Luke Fildes' The Doctor aimed to represent a caring physician in a humble setting during an era when people living with poverty rarely had access to health care and nearly all physicians were White men. The Doctor challenges us to think about what good doctoring is.

Motivational Mechanisms Underlying Physicians' Occupational Health: A Self-Determination Theory Perspective.

Numerous studies have documented deteriorating occupational health among practicing physicians. This trend poses a serious risk not only for physicians but also for the many patients under their care. Past research finds that one protective factor involves the quality of physicians' motivation. When physicians are more autonomously motivated, they tend to experience better occupational health. However, few studies have identified antecedent factors that support physicians' autonomous work motivation. To identify and model potential root causes of physicians' autonomous work motivation and occupational health, the current study assessed physicians' intrinsic aspirations and need satisfaction at work. Hypotheses were tested in a sample of 2,116 U.S. practicing physicians. Structural equation modeling showed that physicians who endorsed intrinsic aspirations more strongly reported better occupational health, and that this association was mediated by physicians' need satisfaction and autonomous work motivation. Implications for designing more effective individual- and system-level interventions to improve physician occupational health are discussed.

Public Attitudes Regarding Hospitals and Physicians Encouraging Donations From Grateful Patients.

Importance: Philanthropy is an increasingly important source of support for health care institutions. There is little empirical evidence to inform ethical guidelines. Objective: To assess public attitudes regarding specific practices used by health care institutions to encourage philanthropic donations from grateful patients. Design, Setting, and Participants: Using the Ipsos KnowledgePanel, a probability-based sample representative of the US population, a survey solicited opinions from a primary cohort representing the general population and 3 supplemental cohorts (with high income, cancer, and with heart disease, respectively). Exposures: Web-based questionnaire. Main Outcomes and Measures: Descriptive analyses (with percentages weighted to make the sample demographically representative of the US population) evaluated respondents' attitudes regarding the acceptability of strategies hospitals may use to identify, solicit, and thank donors; perceptions of the effect of physicians discussing donations with their patients; and opinions regarding gift use and stewardship. Results: Of 831 individuals targeted for the general population sample, 513 (62%) completed surveys, of whom 246 (48.0%) were women and 345 (67.3%) non-Hispanic white. In the weighted sample, 47.0% (95% CI, 42.3%-51.7%) responded that physicians giving patient names to hospital fundraising staff after asking patients' permission was definitely or probably acceptable; 8.5% (95% CI, 5.7%-11.2%) endorsed referring without asking permission. Of the participants, 79.5% (95% CI, 75.6%-83.4%) reported it acceptable for physicians to talk to patients about donating if patients have brought it up; 14.2% (95% CI, 10.9%-17.6%) reported it acceptable when patients have not brought it up; 9.9% (95% CI, 7.1%-12.8%) accepted hospital development staff performing wealth screening using publicly available data to identify patients capable of large donations. Of the participants, 83.2% (95% CI, 79.5%-86.9%) agreed that physicians talking with their patients about donating may interfere with the patient-physician relationship. For a hypothetical patient who donated $1 million, 50.1% (95% CI, 45.4%-54.7%) indicated it would be acceptable for the hospital to show thanks by providing nicer hospital rooms, 26.0% (95% CI, 21.9%-30.1%) by providing expedited appointments, and 19.8% (95% CI, 16.1%-23.5%) by providing physicians' cell phone numbers. Conclusions and Relevance: In this survey study of participants drawn from the general US population, a substantial proportion did not endorse legally allowable approaches for identifying, engaging, and thanking patient-donors.

US Physicians' Work Motivation and Their Occupational Health: A National Survey of Practicing Physicians.

BACKGROUND: Poor occupational health among physicians poses a serious risk both to physicians themselves and the patients under their care. Prior research has found that occupational health among nonphysicians is associated with both degree and type of work motivation. OBJECTIVE: The main purpose of this article was to assess the association between physician work motivation and their occupational health. RESEARCH DESIGN: This study was a national survey of practicing physicians. A split-sample method was used to validate a measure of work motivation adapted for physicians. SUBJECTS: In total, 3589 physicians were selected from the American Medical Association Physician Masterfile among whom 2247 physicians completed a survey (response rate of 62.6%). MEASURES: Eight-item measure adapted from the Work Extrinsic and Intrinsic Motivation Scale. Grounded in self-determination theory, this measure includes 2 superordinate subscales of autonomous and controlled work motivation (characterized by feeling free and volitional versus pressured or compelled, respectively). Indicators of physicians' occupational health included single-item measures of general health, burnout, job satisfaction, intention to leave their practice, and intention to leave medicine, and a 2-item measure of depression risk. RESULTS: Confirmatory factor analyses found that an 8-item, 2 superordinate (4 subordinate subscale) measure had good factor structure [χ(14, n=500)=35.62, P<0.001; χ(14, n=1747)=108.85, P<0.001]. Autonomous work motivation was found to be positively related to all 6 indicators of physicians' occupational health. Controlled work motivation was negatively related to 3 of 6 occupational health indicators. CONCLUSIONS: Physicians who are more autonomously motivated at work reported having better occupational health. Fostering a health care work environment that supports autonomous motivation may benefit the well-being of physicians and their patients.

Physician Perception of Pay Fairness and its Association with Work Satisfaction, Intent to Leave Practice, and Personal Health.

BACKGROUND: Primary care physicians generally earn less than specialists. Studies of other occupations have identified perception of pay fairness as a predictor of work- and life-related outcomes. We evaluated whether physicians' pay fairness perceptions were associated with their work satisfaction, turnover intention, and personal health. METHODS: Three thousand five hundred eighty-nine physicians were surveyed. Agreement with "my total compensation is fair" was used to assess pay fairness perceptions. Total compensation was self-reported, and we used validated measures of work satisfaction, likelihood of leaving current practice, and health status. Hierarchical logistic regressions were used to assess the associations between pay fairness perceptions and work/life-related outcomes. RESULTS: A total of 2263 physicians completed surveys. Fifty-seven percent believed their compensation was fair; there was no difference between physicians in internal medicine and non-primary care specialties (P = 0.58). Eighty-three percent were satisfied at work, 70% reported low likelihood of leaving their practice, and 77% rated their health as very good or excellent. Higher compensation levels were associated with greater work satisfaction and lower turnover intention, but most associations became statistically non-significant after adjusting for pay fairness perceptions. Perceived pay fairness was associated with greater work satisfaction (OR, 4.90; 95% CI, 3.94-6.08; P < 0.001), lower turnover intention (OR, 2.46; 95% CI, 2.01-3.01; P < 0.001), and better health (OR, 1.33; 95% CI, 1.08-1.65; P < 0.01). DISCUSSION: Physicians who thought their pay was fair reported greater work satisfaction, lower likelihood of leaving their practice, and better overall health. Addressing pay fairness perceptions may be important for sustaining a satisfied and healthy physician workforce, which is necessary to deliver high-quality care.

Medical Students' Views of Medicine as a Calling and Selection of a Primary Care-Related Residency.

With the US health care system facing a primary care physician shortage, we evaluated whether medical students who saw medicine as a calling were more likely to enter a family medicine, internal medicine, or pediatrics residency program. Of the 591 4th-year medical students who responded to a survey item on medicine as a calling, 237 strongly agreed that the "practice of medicine is a calling." Students who strongly agreed that medicine was a calling had higher odds (P=.003) of selecting a primary care-related residency. Identifying with medicine as a calling may increase the likelihood of pursuing a primary care career.

Association Between Physician Burnout and Identification With Medicine as a Calling.

OBJECTIVE: To evaluate the association between degree of professional burnout and physicians' sense of calling. PARTICIPANTS AND METHODS: US physicians across all specialties were surveyed between October 24, 2014, and May 29, 2015. Professional burnout was assessed using a validated single-item measure. Sense of calling, defined as committing one's life to personally meaningful work that serves a prosocial purpose, was assessed using 6 validated true-false items. Associations between burnout and identification with calling items were assessed using multivariable logistic regressions. RESULTS: A total of 2263 physicians completed surveys (63.1% response rate). Among respondents, 28.5% (n=639) reported experiencing some degree of burnout. Compared with physicians who reported no burnout symptoms, those who were completely burned out had lower odds of finding their work rewarding (odds ratio [OR], 0.05; 95% CI, 0.02-0.10; P<.001), seeing their work as one of the most important things in their lives (OR, 0.38; 95% CI, 0.21-0.69; P<.001), or thinking their work makes the world a better place (OR, 0.38; 95% CI, 0.17-0.85; P=.02). Burnout was also associated with lower odds of enjoying talking about their work to others (OR, 0.23; 95% CI, 0.13-0.41; P<.001), choosing their work life again (OR, 0.11; 95% CI, 0.06-0.20; P<.001), or continuing with their current work even if they were no longer paid if they were financially stable (OR, 0.30; 95% CI, 0.15-0.59; P<.001). CONCLUSION: Physicians who experience more burnout are less likely to identify with medicine as a calling. Erosion of the sense that medicine is a calling may have adverse consequences for physicians as well as those for whom they care.

Effect of educational interventions and medical school policies on medical students' attitudes toward pharmaceutical marketing practices: a multi-institutional study.

PURPOSE: To determine the effect of educational interventions on medical students' attitudes toward pharmaceutical industry marketing practices and whether restrictive medical school policies governing medicine-industry interactions are associated with student support for banning such interactions. METHOD: Prospective cohort study involving the graduating classes of 2009 (intervention, n=474) and 2010 (control, n=459) at four U.S. medical schools. Intervention students experienced a former pharmaceutical representative's presentation, faculty debate, and a Web-based course. Both groups completed baseline and follow-up attitude surveys about pharmaceutical marketing. RESULTS: A total of 482 students (51.6%) completed both surveys. In regression analyses, intervention students were more likely than control students to think that physicians are strongly or moderately influenced by pharmaceutical marketing (OR, 2.29; 95% CI, 1.46-3.59) and believed they would be more likely to prescribe a company's drug if they accepted that company's gifts and food (OR, 1.68; 95% CI, 1.12-2.52). Intervention students were more likely to support banning interactions between pharmaceutical representatives and students (OR, 4.82; 95% CI, 3.02-7.68) and with physicians (OR, 6.88; 95% CI, 4.04-11.70). Students from schools with more restrictive policies were more likely to support banning interactions between pharmaceutical representatives and students (OR, 1.99; 95% CI, 1.26-3.16) and with physicians (OR, 3.44; 95% CI, 2.05-5.79). CONCLUSIONS: Education about pharmaceutical marketing practices and more restrictive policies governing medicine-industry interactions seem to increase medical students' skepticism about the appropriateness of such marketing practices and disapproval of pharmaceutical representatives in the learning environment.

Content analyses of oaths administered at U.S. medical schools in 2000.

PURPOSE: Oath taking is an important aspect of professionalization that all physicians share. The authors conducted a content analysis of the medical oaths administered at all allopathic and osteopathic medical schools in the United States to evaluate variations in ethical content. METHOD: The authors collected medical oaths administered at all accredited allopathic and osteopathic medical schools (122 and 19, respectively) in the year 2000. Using a modified conceptual framework developed by Baker, the oaths were analyzed for differences in their substantive content. Content differences based on schools' characteristics were also analyzed. RESULTS: Just over half (62 of 122) of the allopathic schools administered an oath other than the Hippocratic Oath or a modified version of it. Thirty allopathic schools administered an oath written by students and/or faculty, and 18 schools offered students more than one oath option. All 19 osteopathic schools used the Osteopathic Oath. Nearly all allopathic and osteopathic schools' oaths included content protecting patients' confidentiality (129 schools), but few cited the importance of avoiding sexual misconduct with patients (four schools). Although the Osteopathic Oath prohibits physician-assisted suicide or euthanasia, only six allopathic schools administered an oath with such a prohibition. One allopathic school's oath explicitly prohibited abortion. There were no major content differences in the oaths administered based on a school's ownership status, religious affiliation, or use of white coat ceremony. CONCLUSION: Many medical schools' oaths differ in substantive content. The impact of using a nonstandardized medical oath on physicians' professionalism and the inculcation of common ethical values and principles remains unknown.