Patients' and physicians' attitudes regarding the physician's professional appearance.

Although physician appearance has been a topic of interest to medical historians for more than two centuries, little objective investigation has been made into patients' and physicians' attitudes toward the physician's appearance. This study analyzed responses from 404 patients, residents, and staff physicians regarding their attitudes toward various aspects of the male and female physician's professional appearance. Positive responses from all participants were associated with traditional items of dress such as the dress, shirt and tie, dress shoes, and nylons, and for physician-identifying items such as a white coat and a name tag. Negative responses were associated with casual items such as blue jeans, scrub suits, athletic shoes, clogs, and sport socks. Negative ratings were also associated with overly feminine items such as prominent ruffles and female dangling earrings and such temporarily fashionable items as long hair on men, male earrings, and patterned hose on women. Overall, patients were less discriminating in their attitude toward physician appearance than physicians. Patients rated traditional items less positively and casual items less negatively. This study confirms the importance of the physician's appearance in physician-patient communication.

Barriers to the health maintenance organization for the over 65's.

What are the barriers that impede and prevent those over age 65 from considering a health maintenance organization (HMO) as an alternative to traditional Medicare-supplementary insurance? In an attempt to answer this question, structured interviews were conducted with 260 elderly people. The barriers examined include knowledge deficits lack of exposure to information, general resistance to change, the difficulties of integrating the 'new' with old insurance patterns, and value stances that may limit the adoption of HMOs by some elderly. Also discussed are educational strategies that may enhance the possibility of the elderly's consideration of the HMO as a viable option.

Patients' responses to short obstetrical hospital stays during a nurses' strike.

A 1984 St. Paul nurses' strike led to a reduction in the length of obstetrical hospital stays, and this effect persisted after the strike. The mean length of hospitalization for vaginal deliveries was 2.7 days before the strike, 1.6 days during the strike, and 2.4 days after the strike. Forty-nine women who delivered during the strike completed questionnaires investigating their attitudes about their length of hospital stay. Although the mean patient response to length of stay was slightly positive, several patients were dissatisfied with their short hospital stays. Patients who stayed for two days or longer were more positive about their length of stay than those who stayed for shorter periods of time. It was planned that most women with vaginal deliveries would be discharged within 24 hours; however, 11 of the 36 women with vaginal deliveries stayed two days or more. This study demonstrates the need to individualize discharge plans. Not all women with vaginal deliveries can be discharged within 24 hours, and one may expect some patient dissatisfaction when early discharge is mandated.

Medical examiners' attitudes toward organ procurement from child abuse/homicide victims.

Solid organ transplant provides lifesaving therapy for infants and children with otherwise terminal diseases, but it is severely limited by donor organ supply. Medical examiners perform a pivotal role in the organ procurement process by determining whether a "heartbeating cadaver" on life support is a medicolegally suitable donor. This descriptive questionnaire study assesses medical examiner practice and behavior regarding organ procurement from child abuse/homicide victims. Obtaining forensic evidence for judicial purposes and releasing organs to children awaiting transplantation are not necessarily conflicting values. Greater than 60% of medical examiners sampled would agree to release organs from abuse/homicide victims in the scenarios presented here if provided with requested information. Further confronting the origins of variable medical examiner practice in this area might result in the availability of additional solid organs for pediatric transplantation.