[The most serious incident-Experiences of aggression and violence in ophthalmology]. / Der schwerwiegendste Vorfall ­ Erfahrungen von Aggressionen und Gewalt in der Augenheilkunde.

BACKGROUND: Experiences of aggression/violence influence job satisfaction and can have a long-term psychological and physical impact on employees. In the fall of 2018, the Professional Association of Ophthalmologists (BVA) and the German Ophthalmological Society (DOG) conducted a survey on experiences of aggression and violence. The first results were published in 2020. In the survey it was also possible to describe the most serious incident to date using free text fields, among others. METHOD: All 9411 members of the DOG and BVA were given the opportunity to complete a questionnaire online in 2018 regarding aggression and violence in ophthalmology. RESULTS: Overall, 253 of 1508 (16.8%) ophthalmologists participating in the survey reported their most serious incident, 46.8% of which were classified as moderate and 34.3% were related to verbal violence such as insults and threats. The most serious incident was experienced by 171 (67.6%) physicians in a practice setting, 71% were specialists at the time of the incident and 74.3% of the incidents occurred during regular working hours. The main causes were intercultural conflicts, long waiting times, problems with the allocation of appointments, excessive expectations, differences in treatment and basic aggressiveness. The offenders were male in 86.3% of cases, 15.8% of the incidents were reported to the police and 21 (8.3%) physicians issued a practice reprimand or house ban. DISCUSSION: The description of the most serious incidents illustrates situations that are sometimes hard to imagine and also which incidents were considered serious. There are large subjective variations in the assessment of the incidents. Protective measures in practices and clinics are essential.

["Responsiveness" in psychiatric outpatient care and in hostel management]. / "Responsiveness" in der psychiatrischen ambulanten Versorgung und in der Heimversorgung.

OBJECTIVE: Responsiveness is a concept developed by the World Health Organisation (WHO) to evaluate health system performance. It measures how well a health system meets its users' legitimate expectations in non-medical related service aspects. Responsiveness consists of the categories "patient orientation" and "respect for persons". It is operationalised by nine (8+1) domains. This project aims to explore the responsiveness concept as a possibility to evaluate the performance of mental health care. METHOD: Face to face interviews with users of outpatient and hostel mental health services by means of a standardised instrument, developed by WHO were carried out. RESULTS: Overall responsiveness in outpatient care was rated by a lower proportion of users negative than responsiveness in hostel care (15 vs. 20%). Socio-demographic characteristics were related only to responsiveness ratings in hostel care when legal guardianship was considered. Domains indicated as most important (attention, participation) in out-patient care did not perform well there. In hostel care the domains attention and respect were rated as most important. These domains performed well. DISCUSSION AND CONCLUSIONS: The results are in line with the literature and adequately reflect the realities in mental health care. The responsiveness concept offers a systematic approach for considering the categories "patient orientation" and "respect for persons" as quality criteria in mental health care. Evaluating mental health service provision using the concept of responsiveness, indicates where to launch reforms in health care.

[Experiences of aggression and violence against ophthalmologists]. / Erfahrungen von Aggression und Gewalt gegen Augenärztinnen und Augenärzte.

BACKGROUND: The media have reported an increased willingness of patients and relatives to use violence against medical personnel. So far a few studies have been carried out on this topic and the data situation is correspondingly weak. Ophthalmologists in particular have close contact with patients at the slit lamp and are often alone with patients. METHODS: A questionnaire was developed based on the perception of prevalence of aggression scale (POPAS) questionnaire and the survey on aggression and violence among general practitioners. In autumn 2018, all members of the German Ophthalmological Society (DOG) and the Professional Association of Ophthalmologists (BVA) received an invitation by e­mail to complete the questionnaire online. RESULTS: Of the 9411 ophthalmologists contacted a total of 1508 (age 49 ± 12 years) took part in the survey (16%). Of the respondents 806 (53.7%) were female and 1139 (75.5%) participants worked in practices. A total of 1264 (83.3%) ophthalmologists had experienced aggression/violence in their work, 986 (65%) respondents had already experienced verbal assaults without threats, 363 (24.1%) doctors reported experiences with threats of physical violence and 30 (2%) participants had received medical treatment for severe physical violence. Sexual intimidation/harassment was affirmed by 322 (21.4%) of respondents, of whom 243 (75.5%) were female and 533 (47.9%) doctors felt that aggressive/violent behavior had increased in the last 5 years. CONCLUSION: The high number of participants indicates the high relevance of the topic. The survey produced astonishing results, which should lead to further discussion and action to improve the safety of employees.

[Variability of physician judgements in school entry examinations]. / Variabilität von Arzturteilen in Schuleingangsuntersuchungen.

AIM: Data from school entry examinations were used for studying the variability of judgements between physicians performing the examinations. Two diagnoses were subject to examination: 1) Obesity, because an external criterion was available for this one. The medical classifications were compared with automated classifications using an external criterion. 2) Language anomalies, because these are the most frequent diagnoses. No external criterion had been available, thus differences within the group of examining physicians were considered. MATERIAL AND METHODS: Data from all school entry examinations performed in the city of Hannover between 1998 and 2001 were used. Altogether 14 physicians were involved, but due to low case numbers the data of two had to be omitted. The analyses are based on 18,303 datasets. For obesity the agreement rates between physicians' and automatically generated diagnoses were ascertained by calculating sensitivity and specificity. Comparisons of differences between physicians with respect to chances of getting a diagnosis were performed using logistic regression. RESULTS: The sensitivity of classifying body weights above the 75 (th) percentile correctly was 0.64 over all years of observation. The respective sensitivity of classifying children with body weights above the 97 (th) percentile was 0.70. Considerable differences over the four years of observation occurred. For performing logistic regressions, the diagnoses of the physician with the smallest difference from an external criterion were used as standard of comparison. The diagnoses of the physician with the largest difference yielded an OR=0.08. The overall variability within the group of examining physicians was large. With respect to language anomalies, although considerable, the within-group differences were smaller. The largest odds ratio in this case was OR=0.40. CONCLUSION: Diagnoses from school entry examinations vary according to the physicians involved. Thus the data should not be used for epidemiological studies. In order to improve data quality, the involved physicians should be extensively trained in using the instruments, and their instructions should be formulated more clearly in order to facilitate their application.

Wishes and expectations of alcoholic patients concerning their therapy.

AIM: To assess the wishes and expectations of alcoholic patients concerning their therapy. METHODS: 227 alcohol-dependent patients from three sites in two cities in Germany completed a questionnaire about their aspirations for the outcome (20 items) and their expectations about the elements (23 items) of treatment. RESULTS: Some components of treatment were equally important to men and women (a life without alcohol, individual sessions during therapy). Women attached more importance than men to 'strengthening of self-esteem' and 'an environment of tranquillity and security'. Most patients in this study were aware of their alcohol dependence, which limits the generalizability of these results to patients at earlier stages of recovery. CONCLUSION: Patients request individual, patient-oriented treatment. Some differences in expectations between men and women suggest that a gendered approach in treatment could mean an increase in patients' satisfaction, and thus a decrease in drop-outs.