Gender differences in job satisfaction, mental health and work environments of hospital internists in Japan / 日本プライマリ・ケア連合学会誌

OBJECTIVE: To describe gender differences in job satisfaction, mental health and work conditions of Japanese hospital internists <br>METHODS: A self-administered, mailed survey was conducted among hospital internists throughout Japan. The survey included questions such as job satisfaction, time allotted for an ambulatory patient, and work environments. <br>RESULTS: Two hundred thirty-four hospital internists were eligible (59 women). Female internists allotted more time for each patient in an ambulatory care setting than their male colleagues (new patient/consultation: P<0.01, routine follow ups: P=0.046). Female internists worked continuously for as long as their male colleagues when they were on night duty (average: 31.1 hours), but their replies indicated that they were not able to maintain continuous high-quality care for as long as the male internists (-4 hours, P=0.02). <br>CONCLUSIONS: Female internists allotted more time for each ambulatory patient, and their replies showed that they were able to maintain quality care continuously for less time than were the males.

Medical Interview Skills and Patient Satisfaction Levels in a Setting Utilizing Electronic Medical Records / General Medicine

<b>BACKGROUND</b> : Electronic medical records (EMRs) were first introduced in the 1960s, and in Japan they are starting to become popular. Recognizing the need to adapt to a new clinical setting with EMRs, we aimed to explore which interviewing skills were associated with patient satisfaction in this era of EMR use.<br><b>METHODS</b> : A prospective observational study was conducted to evaluate interviewing skills among medical residents and to collate data on patients' satisfaction levels at an outpatient general medicine walk-in clinic at a teaching hospital in Japan. Five trained raters reviewed the video recordings of these interviews and assessed them based on a predetermined set of criteria for medical interview skills developed specifically for an outpatient EMR setting. The relationships between these assessment scores and patient satisfaction levels were analyzed.<br><b>RESULTS</b> : Significant skills that were associated with higher scores of patient satisfaction included : employed appropriate eye contact (P=0.021) ; and, invited patients directly without using a microphone (P=0.008). In addition, the degree of keyboard typing during interviews was not associated with patient satisfaction.<br><b>CONCLUSIONS</b> : In an outpatient setting with EMR, using good non-verbal communication skills to build trustful relationships with patients is more likely to influence patient satisfaction levels. Even when physicians are typing on a keyboard, if they keep appropriate eye contact during medical interviews, patient satisfaction can be improved.

Physicians' Use of Local Dialects during Communication with Patients / General Medicine

OBJECTIVE: To investigate Japanese physicians' use of dialects related to geographic areas and to elucidate how physicians respond to dialect-using patients.<BR>METHODS: We conducted a web-based open survey, to which 170 anonymous physicians reported. We examined the following 1) whether dialects are used during communication with patients; 2) how to communicate with patients using dialects; and, 3) reasons for having difficulty in communicating with patients who regularly use dialects. Geographical areas were divided into the following 8 areas Hokkaido-Tohoku, Kanto, Koshinetsu-Hokuriku, Tokai, Kinki, Chugoku, Shikoku and Kyushu-Okinawa.<BR>RESULTS: Of 170 physicians, 61.2% (95% CI: 53.4-68.5%) reported using dialects. These proportions differed by geographic area (F= 8.141; p<0.001) . Physicians practicing in Shikoku and Chugoku used dialects most frequently, while those practicing in Kanto and Hokkaido-Tohoku used dialects least frequently. Many dialect-using physicians thought that physicians should use the same dialect as dialect-using patients. In addition, dialect-using physicians were more likely to think that a physician-related factor was responsible for having difficulty in garnering clinical information.<BR>CONCLUSIONS: Use of dialects by Japanese physicians during communication with patients seems common and may differ by geographic areas. Physicians' use of dialects could be a useful tool for effective clinical communication.

Patient Safety: Residents' Viewpoints for Reducing Errors in Teaching Hospitals / 医学教育

Japan introduced a mandatory residency program in 2004. Teaching hospitals are now responsible for improving patient safety and the overall teaching environment. Questionnaires were sent to teaching hospitals in Kyushu to evaluate residents' work environments and to ask them about improving patient safety. Questionnaires asked about the work environment, experience with medical errors and adverse events, self-reported work conditions, personal anxiety levels about medical errors, and personal suggestions for decreasing medical errors. One hundred eight questionnaires were mailed, and 76 (70.3%) were returned complete and were analyzed. Most residents in Japan work long hours, feel extremely busy, and are anxious about medical errors; many of them reported personal involvement in medical errors or adverse events. Their suggestions to improve patient safety included improvement of the work environment, establishment of a resident support system, and better organization of medical charts and equipment. Considering residents' viewpoints for patient safety is important to help reduce errors in teaching hospitals.