Pharma Websites and "Professionals-Only" Information: The Implications for Patient Trust and Autonomy.

BACKGROUND: Access to information is critical to a patient's valid exercise of autonomy. One increasingly important source of medical information is the Internet. Individuals often turn to drug company ("pharma") websites to look for drug information. OBJECTIVE: The objective of this study was to determine whether there is information on pharma websites that is embargoed: Is there information that is hidden from the patient unless she attests to being a health care provider? We discuss the implications of our findings for health care ethics. METHODS: We reviewed a convenience sample of 40 pharma websites for "professionals-only" areas and determined whether access to those areas was restricted, requiring attestation that the user is a health care professional in the United States. RESULTS: Of the 40 websites reviewed, 38 had information that was labeled for health care professionals-only. Of these, 24 required the user to certify their status as a health care provider before they were able to access this "hidden" information. CONCLUSIONS: Many pharma websites include information in a "professionals-only" section. Of these, the majority require attestation that the user is a health care professional before they can access the information. This leaves patients with two bad choices: (1) not accessing the information or (2) lying about being a health care professional. Both of these outcomes are unacceptable. In the first instance, the patient's access to information is limited, potentially impairing their health and their ability to make reasonable and well-informed decisions. In the second instance, they may be induced to lie in a medical setting. "Teaching" patients to lie may have adverse consequences for the provider-patient relationship.

Get your paws off of my pixels: personal identity and avatars as self.

There is an astounding silence in the peer-reviewed literature regarding what rights a person ought to expect to retain when being represented by an avatar rather than a biological body. Before one can have meaningful ethical discussions about informed consent in virtual worlds, avatar bodily integrity, and so on, the status of avatars vis-à-vis the self must first be decided. We argue that as another manifestation of the individual, an individual's avatar should have rights analogous to those of a biological body. Our strategy will be to show that (1) possessing a physical body is not a necessary condition for possessing rights; (2) rights are already extended to representations of a person to which no biological consciousness is attached; and (3) when imbued with intentionality, some prostheses become "self." We will then argue that avatars meet all of the conditions necessary to be protected by rights similar to those enjoyed by a biological body. The structure of our argument will take the form of a conditional. We will argue that if a user considers an avatar an extension of the self, then the avatar has rights analogous to the rights of the user. Finally, we will discuss and resolve some of the objections to our position including conflicts that may arise when more than one individual considers an avatar to be part of the self.

Preparatory graduate professional training in general practice by using the 'experiential learning' framework.

BACKGROUND: General practitioners (GPs) in Indonesia are medical doctors without formal graduate professional training. Only recently, graduate general practice (GP) is being introduced to Indonesia. Therefore, it is important to provide a framework to prepare a residency training in general practice part of which is to equip GP graduate doctors to deliver person-centered, comprehensive care in general practice. Experiential learning theory is often used to design workplace-based learning in medical education. The aim of this study was to evaluate a graduate professional training program in general practice based on the 'experiential learning' framework. METHODS: This was a pre-posttest study. The participants were 159 GPs who have been practicing for a minimum of 5 years, without formal graduate professional training, from two urban cities of Indonesia (Yogyakarta and Jakarta). A 40-week curriculum called the 'weekly clinical updates on primary care medicine' (WCU) was designed, where GPs met with clinical consultants weekly in a class. The participant's knowledge was assessed with pre-posttests involving 100 written clinical cases in line with each topic in the curriculum. Learning continued with a series of group discussions to gain reflection to reinforce learning. RESULTS: Participants' knowledge regarding clinical problems in general practice was moderately increased (p < 0.05) after the training from a mean score of 50.64-72.77 (Yogyakarta's doctors) and 39.37-51.81 (Jakarta's doctors). Participants were able to reflect on the principles of general practice patient-care. Participants reported satisfaction during the course, and expressed a desire for a formal residency training. CONCLUSIONS: A graduate educational framework for GP based on the 'experiential learning' framework in this study could be used to prepare a graduate GP training; it is effective at increasing the comprehension of general practitioners towards better primary care practice.

Physician's self-perceived abilities at primary care settings in Indonesia.

BACKGROUND: Southeast Asian countries with better-skilled primary care physicians have been shown to have better health outcomes. However, in Indonesia, there has been a large number of inappropriate referrals, leading to suboptimal health outcomes. This study aimed to examine the reasons underlying the unnecessary referrals as related to Indonesian physicians' standard of abilities. MATERIALS AND METHODS: This was a multiple-case study that explored physicians' self-evaluation of their abilities. Self-evaluation questionnaires were constructed from the Indonesian Standards of Physicians Competences of 2006-2012 (ISPC), which is a list of 155 diseases. This study was undertaken in three cities, three towns, and one "border-less developed" area during 2011-2014. The study involved 184 physicians in those seven districts. Data were collected using one-on-one, in-depth interviews, focus group discussions (FGDs), and clinical observations. RESULTS: This study found that primary care physicians in Indonesia felt that they were competent to handle less than one-third of "typical" primary care cases. The reasons were limited understanding of person-centered care principles and limited patient care services to diagnosis and treatment of common biomedical problems. Additionally, physical facilities in primary care settings are lacking. DISCUSSIONS AND CONCLUSIONS: Strengthening primary health care in Indonesia requires upscaling doctors' abilities in managing health problems through more structured graduate education in family medicine, which emphasizes the bio-psycho-socio-cultural background of persons; secondly, standardizing primary care facilities to support physicians' performance is critical. Finally, a strong national health policy that recognizes the essential role of primary care physicians in health outcomes is an urgent need.