Stress and coping of the African-American physician.

The purpose of this qualitative study was to examine the nature of work-related stress and coping experienced by African-American family physicians. Ten African-American family physicians across the state of Ohio were interviewed using a standardized open-ended format. Interview data were analyzed through an "editing" technique and QSR Nud*ist, a qualitative software program. Patterns and themes common to the interviews were identified. Stressors presented by research participants included experiences with racism in medicine, doubt, and a strong desire to prove oneself in the medical environment. Distinctive coping strategies involved spirituality, kinship, and the development of strength and perseverance in the face of adversity. Responses to general questions on stress and coping indicated difficulties with the shift toward managed care and use of "time for self, away from medicine" types of coping strategies. Results underscored the importance of culture and race in stress and coping processes, and suggested that programs and policies addressing the specific pressures faced by African-American physicians in training and practice need to be developed.

Quality of care and black American patients.

Even with major advancements in medical knowledge and significant improvements in health sciences technology, evidence still exists that blacks do not enjoy as full a measure of health as do other racial and ethnic groups. To attempt a better understanding of this situation, literature was reviewed to consider relationships between being black and issues related to quality of health care. It was determined that these relationships have not been studied to any great extent, either in quantity or quality. When such studies have been undertaken, they have been limited to mostly qualitative designs, and appropriate controls for confounding variables have been minimal. The psychiatric literature reports most of the studies with very few studies found in the literature of other specialties. A conceptual model is presented regarding race-related research. It is argued that a first step might be to study whether the quality of care differs when the physician and the patient are members of different racial groups compared with when the physician and patient are members of the same racial group. In all race-related research, it is necessary to carefully consider specific variables that may confound results, eg, diagnostic errors, age, sex, socioeconomic status, level of education, geographic locale, and method of payment for health-care services.

Surgical practice and perceived training needs of selected Ohio family physicians.

This study was performed to determine, relative to Ohio, what percentage of family physicians are actively involved in providing surgical care, what types of surgical care are provided, and what variations exist in opinions and practices regarding surgery related to previous training and practice location. Data were collected from active members of the Ohio Academy of Family Physicians; usable returns were secured from 76 percent of the members. Several conclusions were made. Overwhelming percentages of family physicians in Ohio are actively involved in providing surgical care. A considerably greater percentage of family physicians are actively involved in performing minor surgery compared with major surgery, although they perform a wide range of minor and major surgical procedures at relatively high frequencies. Over the years, however, there has been a decrease in performance of major surgery on the part of family physicians in Ohio. Issues related to surgery in family practice are more positively influenced by being in a rural practice rather than an urban or suburban practice, having had more surgical training, and having had family practice residency training. Family physicians in Ohio definitely think that surgical training should be included in family practice training programs, and they think that the surgical training should be balanced between a curriculum standardized for all residents and one individualized to the anticipated future practices of the residents.