On practicing magicine, from wonder to care: A systematic review of studies that apply magic in healthcare.

RATIONALE: Magic, traditionally perceived as entertainment, has been increasingly employed in healthcare to enhance health and well-being. Despite its potential benefits across various dimensions of health, including biological, psychological, and social, a comprehensive review highlighting its broad applications in healthcare remains unexplored. OBJECTIVE: This study aims to explore the diverse uses of magic within healthcare, progressing from entertainment to integral medical care, termed "magicine." METHODS: This systematic review adopted a narrative synthesis approach, and an extensive database search was conducted including Embase Classic & Embase, MEDLINE (Ovid), Scopus, the Cochrane Collaboration Central Register of Controlled Clinical Trials, Cochrane Systematic Reviews, and CINAHL (EBSCOhost), from the earliest records to 22 June 2023. Potential applications of magic in healthcare were explored with an unrestricted search strategy. A quality assessment was conducted using the Mixed Methods Appraisal Tool. (Registration: PROSPERO number CRD42023417122.) RESULTS: This review identified 82 journal articles, including 11 randomized controlled trials, four quasi-experimental designs, 10 pre-experimental designs, five qualitative studies, three mixed methods studies, two observational studies, five review articles, and 42 commentaries. The review resulted in the conception of "magicine ennead" - nine diverse areas where magic can be applied in healthcare including physical rehabilitation, cognitive training, psychotherapy, humor therapy, distraction therapy, social skills, health education, doctor-patient relationships, and surgical techniques. These applications demonstrate the potential of magic to enhance health outcomes for the general population and improve the clinical practice of healthcare professionals. CONCLUSIONS: Magic in healthcare shows potential for varied applications, and a deeper understanding of these applications could lead to optimized and cost-efficient intervention programs. Given the heterogeneity and varied methodological quality of the current research, future studies necessitate the adoption of rigorous designs with active controls.

Influence of medical humanization on patients' attribution in negative medical situations with communication as the mediator: a questionnaire study.

Background: Patients' attribution in negative medical situations plays a vital role in reducing medical conflicts and developing high-quality healthcare. The purpose of this study was to investigate the triadic relations among patients' attribution, medical humanization and communication. Furthermore, the mediating effect of communication was tested. Methods: A cross-sectional study on the relationship between patients' attribution in negative medical situations and medical staff's humanization and communication was conducted, with 3,000 participants totally from 103 hospitals of three different levels in different regions. Results: There were significant positive correlations among medical staff's humanization, communication and patients' attributional styles (r = 0.112-0.236, p < 0.001 for all). Medical humanization had direct predictive effects on patients' attributional style in negative medical situations (ß = 0.14, p < 0.01). Mediation analysis also indicated the indirect predictive effect of medical humanization on patients' attributions through communication (ß = 0.02, p < 0.01). Conclusion: Patients' attribution in negative medical situations is predicted by patients' perception of medical staff's humanization in healthcare and physicians' communication skills. Medical humanization not only affects patients' attributions in negative situations directly, but also influences patients' attributions via communication indirectly. The humanistic care should be included in medical education for healthcare professionals, and professional training on medical staff's humanization and communication skills is strongly needed to establish healthy and harmonious doctor-patient relationship.

Gender Differences in Premenstrual Syndrome and Premenstrual Dysphoric Disorder Diagnosis and Treatment among Japanese Obstetricians and Gynecologists: A Cross-Sectional Study.

Premenstrual symptoms are characterized by unpleasant psychophysical symptoms that appear during the luteal phase before menstruation and interfere with a woman's quality of life. Premenstrual syndrome (PMS) is a pathological condition with premenstrual symptoms, of which premenstrual dysphoric disorder (PMDD) is a particularly severe psychological symptom. This study aimed to examine the gender differences in the diagnosis and treatment of PMS and PMDD among obstetricians and gynecologists (OB/GYNs) in Japan. Data were obtained from the survey conducted by the Japanese Society of Obstetrics and Gynecology. We used data from 1,257 of the 1,265 OB/GYNs who are engaged in PMS/PMDD practice and reported their gender. Multivariate regression analysis adjusted for propensity scores was performed. Female OB/GYNs were more frequently engaged in treating patients with PMS/PMDD than males [odds ratio (OR) 1.74; 95% confidence interval (CI) 1.36-2.21]. With regard to the diagnostic methods, more female OB/GYNs selected the two-cycle symptom diary than males (OR 2.88; 95% CI 1.80-4.60). Regarding treatment, fewer female OB/GYNs selected selective serotonin reuptake inhibitors as their first-line drug (OR 0.39; 95% CI 0.17-0.89). Gender differences were found in the selection of PMS/PMDD diagnosis and treatment methods among Japanese OB/GYNs.

Saberes intactos, saberes en contacto. Una revisión feminista del significado del contacto en los debates contemporáneos sobre las relaciones clínicas / From “intact knowledge” to “knowledge in contact”. A feminist review of the meaning of “contact” in contemporary debates about clinical relationships

En la última década, profesionales de la biomedicina han propuesto varios modelos que parecen plantear un papel renovado y esperanzador para las y los pacientes en las relaciones clínicas. Se trata del modelo de paciente inteligente (“smart patient”) y de otras propuestas procedentes de corrientes humanizadoras de la medicina. En este artículo analizo críticamente el modelo del “smart patient” como un ensamblaje histórico contemporáneo que refleja una tendencia aparentemente positiva en la biomedicina: la revalorización del “contacto” entre profesionales y pacientes, y el fomento de la participación y educación de estas últimas para estar mejor informadas y digitalizadas. Sin embargo, ¿implica esta puesta en valor del contacto una transformación de los saberes expertos? Tomando como guía esta pregunta, en este artículo analizo los límites de los modelos emergentes, y aporto una relectura basada en la perspectiva del contacto. Para ello contrasto dichos modelos, que mantienen los saberes profesionales epistémicamente intactos, con el enfoque de dos trabajos clásicos de la antropología feminista, publicados hace dos décadas, y que abordan críticamente la llamada “Evidence-Based Obstetrics” (Obstetricia Basada en la Evidencia), poniéndolos en diálogo con lecturas fenomenológicas que trascienden una visión del cuerpo basada en el binomio generizado cuerpo / mente. El objetivo es abordar la clínica como una zona de contacto que hay que entender en contextos (g)locales específicos. Este análisis presenta un valor crítico para el presente pues permite argumentar a favor de encuentros ‒entre profesionales, pacientes y organizaciones‒ asentados sobre reequilibrios epistémicos; yendo más allá de modelos de relación que excluyen los conocimientos y experiencias de quienes padecen y con la finalidad de preservar intacto el papel único de los saberes biomédicos.(AU)

In the last decade, medical professionals have proposed an apparently renewed and hopeful role for patients in their relationship with professionals, namely the “smart patient” model and other proposals coming from humanizing medical trends. In this article, I critically analyze the “smart patient” model as a contemporary historical assemblage that reflects an apparent trend in biomedicine: the revaluation of “contact”, between professionals and patients, and the promotion of patient participation and education to be better informed. However, does this enhancement of contact implies, within the relationship, a transformation of the consideration of biomedical expert knowledge? To answer this question, I analyze the limits of emerging models, and I provide a rereading of the contact perspective. I contrast this perspective with the approach of two classic works of feminist anthropology, published two decades ago, and which critically address the so-called “Evidence-Based Obstetrics”. I will put these works into dialogue with phenomenological readings that transcend a vision of the body based on the gendered binary body / mind. These dialogues will allow me to delve into the proposal to analyze the clinic as a space for the creation of “contact zones” in specific (g)local contexts. This analysis has a critical value for the present. It will also allow me to argue in favor of encounters ‒between transdisciplinary professional teams, patients and organizations- that look for an epistemic rebalancing that embraces the experiential knowledge of those who suffer. These encounters I am proposing do not leave medical knowledge intact.(AU)

Good conduct in a context of rationing: A case study of how frontline professionals deal with distributive dilemmas of novel gene therapies.

Classical dilemmas of how to distribute limited resources have been rekindled by the rise of advanced, high-cost therapies. Building on a case study of a novel gene therapy in neuropaediatric care, this article explores the dilemmas that explicit priority setting can create for frontline professionals and develops a typology of professionals' responses to these dilemmas. Despite political attempts to centralise priority setting and spare health professionals from having to consider treatment costs at the 'bedside', this study shows that concern for economic efficiency and budget control nonetheless need to be handled and balanced against other accountabilities in the daily work of frontline professionals. Contributing to the sociological debate on priority setting and rationing, this study develops an analytical perspective attuned to the relational aspects of frontline work and the challenges related to the balancing of diverging ideas of good conduct. Further, focussing on an empirical field at the forefront of genomic medicine, this study brings the sociological debate on priority setting and rationing up to date with current developments in precision medicine.

How is physicians' implicit prejudice against the obese and mentally ill moderated by specialty and experience?

BACKGROUND: Implicit prejudice can lead to disparities in treatment. The effects of specialty and experience on implicit obesity and mental illness prejudice had not been explored. The main objective was to examine how specializing in psychiatry/general medicine and years of experience moderated implicit obesity and mental illness prejudice among Swiss physicians. Secondary outcomes included examining the malleability of implicit bias via two video interventions and a condition of cognitive load, correlations of implicit bias with responses to a clinical vignette, and correlations with explicit prejudice. METHODS: In stage 1, participants completed an online questionnaire including a clinical vignette. In stage 2, implicit prejudice pre- and post- intervention was tested using a 4 × 4 between-subject design including a control group. In stage 3, explicit prejudice was tested with feeling thermometers and participants were debriefed. Participants were 133 psychiatrists and internists working in Geneva, hospital-based and private practice. Implicit prejudice was assessed using a Weight IAT (Implicit Association Test) and a Mental Illness IAT. Explicit feelings towards the obese and the mentally ill were measured using Feeling Thermometers. A clinical vignette assessed the level of concern felt for a fictional patient under four conditions: control, obese, depression, obese and depression. Linear regression was conducted to test for association of gender, experience, and specialty with responses to vignettes, pre-intervention IATs and explicit attitudes, and to test for association of interventions (or control) with post-intervention IATs and explicit attitudes. Reported effect sizes were computed using Cohen's d. Two-tailed p < 0.05 was selected as the significance threshold. RESULTS: Compared to internists, psychiatrists showed significantly less implicit bias against mentally vs. physically ill people than internists and warmer explicit feelings towards the mentally ill. More experienced physicians displayed warmer explicit feelings towards the mentally ill and a greater level of concern for the fictional patients in the vignette than the less experienced, except when the patient was described as obese. CONCLUSIONS: Specialty moderates both implicit and explicit mental illness prejudice. Experience moderates explicit mental illness bias and concern for patients. The effect of specialty on implicit prejudice seems to be based principally on self-selection.

O que estudantes nos contam sobre as entrevistas narrativas / What students tell us about narrative interviews

Romper com o modelo biomédico é necessário, e o ponto inicial pode vir com a compreensão da narrativa do usuário ou da usuária. Este estudo buscou avaliar a compreensão de estudantes de medicina das narrativas de adoecimento, utilizando a entrevista McGillIllness Narrative Interview (MINI). Trata-se de estudo exploratório, descritivo e qualitativo, realizado durante cinco semanas com 11 estudantes do quinto ano de uma universidade privada, no internato de Medicina de Família e Comunidade, que prestavam atendimento a 29 pessoas usuárias de unidades de saúde. Por meio de encontros individuais on-line, foram levantadas questões sobre essa experiência. Os relatos foram inseridos em núcleos argumentais, o que possibilitou o estabelecimento de relações com o referencial teórico da Medicina Narrativa, da Antropologia Médica e da Clínica Ampliada. Para os alunos e alunas houve uma nova experiência de entrevista clínica, uma valorização da narrativa e o desejo de incorporar uma abordagem mais ampliada à sua prática, embora não contemplem incorporar o MINI na sua forma integral, atribuindo a isso dificuldades na rotina médica. Acreditamos que o MINI pode colaborar com a aquisição de competências interpretativa e narrativa em estudantes, embora o ensino esteja ainda, emparte, vinculado ao modelo biomédico.

It is essential to break with the biomedical model. The starting point for that can come from the understanding of patients' narratives. This study sought to evaluate medical students' comprehension of illness narratives using the McGill Illness Narrative Interview (MINI). This is an exploratory, descriptive, and qualitative study, carried out with 11 fifth-year students at a private university in the internship of Family and Community Medicine, for five weeks, involving the care of 29 patients in health units. Through individual online meetings, questions were raised about the experience.The reports were inserted into categories, which allowed us to establish relationships among the theoretical referential elements of Narrative Medicine, Medical Anthropology, and Expanded Clinic. It was a new experience of clinical interviews for the students, with a new appreciation of narratives and a desire to incorporate a more extended approach to their practice, although they do not contemplate incorporating the MINI in its full form due to difficulties in the physician's routine. We believe that MINI can collaborate with the acquisition of interpretative and narrative competence in students, although teaching is still partly linked to the biomedical model.

Patient-centred care and patient autonomy: doctors' views in Chinese hospitals.

BACKGROUND: Patient-centred care and patient autonomy is one of the key factors to better quality of service provision, hence patient outcomes. It enables the development of patients' trusts which is an important element to a better doctor-patient relationship. Given the increasing number of patient disputes and conflicts between patients and doctors in Chinese public hospital, it is timely to ensure patient-centred care is fully and successfully implemented. However, limited studies have examined the views and practice in different aspects of patient-centred care among doctors in the Chinese public hospitals. METHODS: A quantitative approach was adopted by distributing paper-based questionnaires to doctors and patients in two hospitals (Level III and Level II) in Jinan, Shandong province, China. RESULTS: In total, 614 doctors from the surgical and internal medicine units of the two hospitals participated in the survey yielding 90% response rates. The study confirmed the inconsistent views among doctors in terms of their perception and practice in various aspects patient-centred care and patient autonomy regardless of the hospital where they work (category II or category III), their unit speciality (surgical or non-surgical), their gender or seniority. The high proportion of doctors (more than 20%) who did not perceive the importance of patient consultation prior to determining diagnostic and treatment procedure is alarming. This in in part due to the belief held by more than half of the doctors that patients were unable to make rational decisions and their involvement in treatment planning process did not necessarily lead to better treatment outcomes. CONCLUSION: The study calls for the development of system level policy and organisation wide strategies in encouraging and enabling the practice of patient-centred care and patient autonomy with the purposes of improving the quality of the service provided to patients by Chinese hospitals.

Terminations in Primary Care: a Retrospective Observational Study of 16 Primary Care Clinics.

BACKGROUND: The relationship between clinician and patient is the cornerstone of primary care. Breakdown and termination of this relationship are understudied yet important, undesirable outcomes. OBJECTIVE: To better understand the nature and extent of provider and clinic termination of the primary care relationship. DESIGN: Retrospective observational case-control study. SUBJECTS: Adult patients in Eastern Massachusetts who received primary care at hospital- and community-based clinics and health centers participating in a practice-based research network between January 2013 and June 2017. MAIN MEASURES: Formal termination by primary care physician (PCP), reasons for termination, independent predictors of termination based on mixed-effects logistic regression, and documentation of a new PCP after termination. KEY RESULTS: We identified 158,192 patients who received primary care from 182 PCPs across 16 clinics. We found 536 cases of formal termination. Clinics ranged from 4 to 119 terminations per 10,000 patients (intraclass correlation coefficient [ICC]=0.21; 95% CI: 0.18-0.24). Patient age, race/ethnicity, educational attainment, relationship status, employment status, and insurance type were independent predictors of termination (e.g., compared to patients employed full-time, patients unemployed due to disability were more likely to be terminated [adjusted OR:9.26; 95% CI: 6.74-12.74]). The most common cause for termination (38%) was appointment "no-shows" with some PCPs/clinics found to enforce a policy of dismissal following three no-shows. At the time of chart review, 201 patients (38%) had no documentation of a new PCP. Among patients who re-established care within the network, 134 (25%) had a primary care visit within 6 months of termination. CONCLUSIONS: Detailed chart review found that, unlike previous survey-based studies, dismissal was often for missed appointments based on enforcement of no-show policies. Many sociodemographic factors were associated with termination. Variability among clinics highlights the need for further research to better understand circumstances surrounding terminations, with the principal goals of improving patient-provider relationships and providing equitable care.

Physiological linkage during interactions between doctors and cancer patients.

INTRODUCTION: Doctors and patients influence each other when interacting and, as a result, can become similar to each other in affect and behavior. In the current work, we examine whether they also become similar to each other on a moment-to-moment basis in their physiological responses. Specifically, we examine physiological linkage-how much a doctor's (or patient's) physiological response predicts a patient's (or doctor's) response at a subsequent time interval-and whether this changes over the course of doctor-patient relationships (measured as the number of consultations held for each unique doctor-patient dyad). METHODS: We collected interbeat interval responses (IBI) continuously during consultations between oncologists and patients undergoing cancer treatment (N = 102 unique doctor-patient interactions) at a hospital in Austria. RESULTS: Physiological linkage varied by an interaction between role (doctor vs. patient) and relationship length (in a non-linear, quadratic pattern). Patients showed significant positive linkage to their doctors (i.e., doctors' physiological responses positively, significantly predicted patients' responses) in relationships that spanned three to eight consultations together. Patients were not linked to their doctors in shorter or longer relationships. Doctors were never significantly linked to their patients, meaning that patients' physiological responses never predicted doctors' responses. CONCLUSION: These results reveal that, by influencing patients' physiological responses on a moment-to-moment basis, doctors may have even more influence over patients' physiology than previously known.

Effective provider-patient communication of a rare disease diagnosis: A qualitative study of people diagnosed with schwannomatosis.

OBJECTIVE: To understand diagnostic communication preferences of patients with schwannomatosis, a rare disease. METHODS: Eighteen adults with schwannomatosis from across the United States participated in semi-structured phone interviews about their diagnostic experiences. Interview transcripts were inductively coded using thematic analysis. RESULTS: We identified three elements of effective diagnostic communication: education (particularly about etiology, prognosis, and treatment options); psychological support (to cope with the new diagnosis and any prior diagnostic harms); and efforts to develop therapeutic alliance (i.e. feelings of collaboration, trust, and social-emotional rapport). Poor communication was characterized by inadequate or jargon-heavy explanations, perceived disinterest in or disbelief of symptoms, and lack of partnership. Effective communication helped people feel informed and cope with their condition; poor communication could cause significant psychological distress. CONCLUSIONS: During diagnosis, patients need education and psychosocial support; the presence of therapeutic alliance between clinicians and patients facilitates this assistance. Diagnostic communication that includes these elements helps patients proactively engage in healthcare decision-making and connect with appropriate treatments. PRACTICE IMPLICATIONS: When disclosing a rare disease diagnosis, clinicians should meaningfully educate patients about the disorder and acknowledge diagnosis-related psychosocial stressors. Approaching diagnosis empathetically and collaboratively helps foster therapeutic alliance. Referrals for psychological and genetic counseling are often warranted.

Patient's perception of the communication of clinical doctors and surgeons in a university hospital / Percepção de pacientes sobre a comunicação de médicos clínicos e cirurgiões em hospital universitário

Abstract: Introduction: The way information is transmitted is of crucial importance in the doctor-patient relationship, as good communication reduces complaints about inadequate practices and patient concerns and improves treatment adherence and health recovery. However, patient dissatisfaction on this subject is not unusual. Objectives: The objective of this work was to evaluate the perception of patients admitted to a Hospital Complex about the communication of clinical doctors and surgeons during the hospitalization period. Method: Cross-sectional, descriptive, analytical inquiry study, with the application of a questionnaire with questions about physicians' general communication. The instrument was built by the researchers and was answered by 120 adult patients. The sample was defined by convenience and stratified by medical and surgical clinic. Frequency and statistical analyses were performed on the obtained results. Results: Of 120 patients, 53.33%(n=64) were admitted to the Surgical Clinic and 46.67%(n=56) to the Medical Clinic. Of this total, 57.5%(n=69) had high school to college/university education. Patients reported more negative than positive responses to the following questions: information about the side effects of medications (66%), advice on post-surgical procedures (68.75%) and information on health promotion and prevention in the hospital environment (63.33%). The surgical clinic had significantly lower proportions of positive responses for: The doctor said their name (p <0.01; crude OR: 0.33; 95% CI 0.15-0.76); The patient was informed about how their treatment would be conducted (p=0.02; crude OR: 0.38; 95% CI 0.17-0.87); and the patient was informed about the need to undergo tests (p=0.02; crude OR 0.40; 95% CI 0.18-0.90), which remained significant after adjustment for certain confounding factors. There were no significant differences regarding the other questions. When analyzing the question: "What grade would you give to the doctor's general communication?" a significantly higher value (p=0.007) was given to the Medical Clinic (average 4.46±0.76) when compared to the Surgical Clinic (average 4±1.19). Conclusion: The doctor-patient communication showed significant deficits. Therefore, it is necessary for medical schools to offer students the development of this competence. Additionally, for an adequate generalization of the obtained results, new studies need to be carried out at different levels of medical care.

Resumo: Introdução: A maneira de transmitir informações é essencial na relação médico-paciente, pois a boa comunicação reduz queixas por práticas inadequadas e preocupações dos pacientes, e melhora a adesão aos tratamentos e a recuperação da saúde. Porém, não são raras as insatisfações dos pacientes sobre esse assunto. Objetivo: O objetivo deste trabalho foi avaliar a percepção dos pacientes internados em um complexo hospitalar sobre a comunicação de médicos clínicos e cirurgiões durante o período de internação. Método: Trata-se de estudo transversal, descritivo e analítico, do tipo inquérito, com aplicação de um questionário com perguntas sobre a comunicação geral do médico. O instrumento foi construído pelos pesquisadores e respondido por 120 pacientes adultos. A amostra foi definida por conveniência, estratificada por clínica médica e cirúrgica. Realizaram-se análises de frequência e estatística dos resultados encontrados. Resultados: Dos 120 pacientes, 53,33% (n = 64) foram internados na clínica cirúrgica e 46,67% (n = 56) na clínica médica. Desse total, 57,5% (n = 69) tinham escolaridade que variava de ensino médio a superior. Os pacientes relataram respostas mais negativas do que positivas em questões referentes a: informações sobre os efeitos colaterais dos medicamentos (66%), orientações de procedimentos pós-cirúrgicos (68,75%) e informações sobre promoção e prevenção da saúde no ambiente hospitalar (63,33%). A clínica cirúrgica teve proporções de respostas positivas significativamente menores para: "O médico disse o nome dele" (p < 0,01; OR bruta 0,33; IC95% 0,15-0,76); "O paciente foi informado sobre como será seu tratamento" (p = 0,02; OR bruta 0,38; IC95% 0,17-0,87); e "O paciente foi informado sobre a necessidade de realizar exames" (p = 0,02; OR bruta 0,40; IC95% 0,18-0,90), que se mantiveram significativas após o ajuste por determinados fatores intervenientes. Não se observaram diferenças significativas para as demais questões. Na análise da questão "Que nota você daria para a comunicação geral do médico? ", verificou-se valor significativamente maior (p = 0,007) para a clínica médica (média 4,46 ± 0,76) quando comparada à clínica cirúrgica (média 4 ± 1,19). Conclusão: A comunicação médico-paciente apresentou déficits significativos. Por isso, é necessário que as escolas médicas ofereçam para os discentes o desenvolvimento dessa competência. Além disso, para uma generalização adequada dos resultados encontrados, novos estudos precisam ser realizados em níveis diferentes do cuidado médico.

Physicians' Earnings Do Not Affect Their Online Ratings.

Objective: Physician-rating websites have exploded in popularity in recent years. Consequently, these sites have garnered attention from researchers interested in factors influencing patient satisfaction. A doctor's earnings might reflect practice patterns that could influence their patients' perceptions. We sought to explore any association between physicians' earnings and their online ratings. Methods: The names and billings of 500 physicians from British Columbia, Canada were randomly extracted from the 2016-17 BC Blue Book and matched to their profiles on RateMDs.com. Physicians' earnings were compared to their global ratings and to their Staff, Punctuality, Helpfulness, and Knowledge scores. Earnings and ratings were also compared between men and women, as well as between family medicine, surgical, and internal medicine and subspecialties cohorts. Results: We found no significant correlation between physicians' earnings and their global online ratings (p = 0.304). Weak negative correlations existed between earnings and Staff and Helpfulness ratings (Spearman's rho = -0.055, p < 0.001; rho = -0.033, p < 0.028). Online ratings were largely favorable (mean MD rating of 3.85/5. Male physicians earned significantly more than their female colleagues ($371,734.85 and $261,590.82, respectively; p < 0.001), but no significant difference existed between men and women with regards to online ratings (mean 3.87 and 3.81, respectively, p = 0.191). Surgical and Family Medicine specialties showed a negative correlation between income and ratings; no relationship was seen in the internal medicine and subspecialties cohort. Conclusions: No meaningful association was found between physicians' earnings and their online ratings, although there is an impact of specialty grouping. Patients tend to review doctors favorably online; these data add to the discussion of whether male and female doctors are differentially rated. Trends toward increased transparency in health care systems may help to elucidate how doctors' earnings influence patients' perception of and satisfaction with the care they receive.

Patients' Experience and Assessment on the Transition from Paper to Electronic Medical Records.

By the implementation of the EMR in the Primary Care Centers of the City of Buenos Aires, it has been claimed that there is a need to obtain systematic and accurate information about the assessment that patients have about such incorporation. A qualitative research has been carried out in order to answer this query.

Walk with a Doc-a Call to Action for Physician-Led Walking Programs.

PURPOSE OF REVIEW: An abundance of data supports the health benefits of physical activity, social connectedness, and spending time outdoors. Yet, a majority of Americans are living lives that are sedentary, lonely, and not connected with nature. We have three primary goals in writing this paper. First, we will review the well-documented health challenges arising from a sedentary, isolated lifestyle. Second, we will discuss the benefits of walking as a primary means of increasing physical activity. Finally, we will shine a light on the exponential success of Walk with a Doc, a national non-profit organization. Walk with a Doc focuses on bringing physician-led enthusiasm into our communities by organizing regular doctor-led walks in the outdoors; as well as Walk with a Future Doc, which encourages medical students to start their own Walk with a Doc programs. RECENT FINDINGS: The Physical Activity Guidelines for Americans share that physical activity is an important action that people of all ages can take to improve their health. These guidelines recommend that adults partake in at least 150 min of moderate aerobic physical activity. Currently, only 23% of Americans are achieving this amount of aerobic activity. In addition, recent data suggest that 3 in 4 people are lonely, a significant social determinant of health. Finally, over half of all Americans spend fewer than 5 h outside each week. Walk with a Doc and Walk with a Future Doc are having an enormous impact on combating the negative effects of these health challenges. An evaluability assessment was completed in 2018 showing Walk with a Doc attendees felt the program increased their physical activity and their social connections, with a majority of Walk with a Doc gatherings occurring in nature. Physicians and other Walk with a Doc program leaders also reported high levels of satisfaction with their participation in Walk with a Doc. As teammates in this healthcare fight, we are all painfully aware of the crisis on our hands. Of our patients, 70% are overweight or obese, nearly 80% of us are not getting enough physical activity, with all of this leading to billions of dollars in healthcare costs. Adding fuel to the fire, our doctors are burning out because of it. Today, we want to share what we have learned to be an extremely viable solution. The solution has the capacity to save 5 million lives and $68 billion dollars per year. Additionally, it is bolstering the job satisfaction and happiness of our providers. Personally, it turned my life around in 2005, and since then, it is now greater than 560 communities around the USA (and 34 other countries). We call it, simply, Walk with a Doc.

The Impact of Physician Social Media Behavior on Patient Trust.

Introduction: Institutions have developed professionalism policies to help guide physician social media behavior in light of professionalism lapses that have resulted in serious consequences. Prior research has gathered perspectives on online professionalism; however, the public's views remain poorly understood. Importantly, the impact of physician social media behavior on patient trust is unknown. Methods: To determine whether patients' trust might change based on their physicians' social media behavior, we conducted a cross-sectional survey across three U.S. cities (n = 491). The survey assessed patient trust using hypothetical scenarios. Results: Most respondents reported they would have less trust if their physician posted racist comments online, wrote a disrespectful patient narrative, appeared intoxicated in a photograph, or wrote profanity. Respondent age and education impacted change in trust. Conclusions: We conclude that physicians' social media behavior may affect patient trust. Better understanding of how physicians' online presence impacts their relationships with patients can help guide policy and inform educational efforts.

Compassion in the Clinical Context: Constrained, Distributed, and Adaptive.

BACKGROUND: Compassion is intrinsically situated within particular contexts and how these contexts can shape compassion has not been well-described. OBJECTIVE: The purpose of the study was to describe how individual and contextual challenges can impact compassion within critical care and palliative care settings. DESIGN: This qualitative study adopted phenomenology and autoethnography to inform data collection, and principles of activity theory and realist inquiry for data interpretation. PARTICIPANTS: Five clinicians who work in critical care (n = 3) and palliative care (n = 3) participated in the study. APPROACH: Qualitative data were obtained from ethnographic observations, interviews, and focus groups. Participants observed and recorded field notes (n = 53) on instances of suffering and compassion in their workplace settings. At the end of the study period, they participated in a focus group or individual interview to reflect on their experiences. Data was analyzed using constructivist grounded theory techniques and iteratively synthesized through group discussion and model building. KEY RESULTS: The findings reflected four phenomena associated with compassion in context: individual gaps and lapses in compassion, relational challenges, contextual constraints on compassion, and distributed compassion. Individual gaps and lapses in compassion involved inattention, intention vs. perception, personal capacity, and personal toll. Relational challenges included receptivity, fragmentation, and lack of shared understanding. Contextual constraints consisted of situational pressures, the clinical environment, gaps in education, and organizational culture. The distribution of compassion within teams and how teams adapt their behaviors in response to perceived needs for greater compassion modulated these challenges. CONCLUSIONS: The study illustrates the many ways in which compassion can be shaped by context and highlights the role of teamwork in identifying gaps and lapses in compassion and responding in a way that supports patients, families, and colleagues.

Professional-Patient Boundaries: a National Survey of Primary Care Physicians' Attitudes and Practices.

BACKGROUND: The essence of humanism in medicine and health care is relationships-caring relationships between clinicians and patients. While raising concerns regarding professional-patient boundaries has positively contributed to our understanding and prevention of potentially harmful boundary violations, there is controversy about which types of relationships, caring acts, and practices are acceptable versus cross boundary lines. OBJECTIVE: To examine primary care physicians' practices and attitudes regarding acts that have been questioned as potentially "inappropriate" or "unethical" crossing of professional-patient boundaries. DESIGN: Surveys conducted via in-person polling or electronic and mailed paper submissions from April 2016 to July 2017. We calculated descriptive statistics and examined associations with practices and attitudes using logistic regression. PARTICIPANTS: Random sample of all US primary care physicians who treat adult patients; convenience sample of attendees at medicine grand rounds presentations. MAIN MEASURES: Outcomes were self-reported practices and attitudes related to giving patients rides home, paying for patients' medication, helping patients find jobs, employing patients, going to dinner with patients, and providing care to personal friends. KEY RESULTS: Among 1563 total respondents, 34% had given a ride home, 34% had paid for medications, 15% helped patients find a job, 7% had employed a patient, 10% had dinner with patients, and 59% provided care to personal friends. A majority disapproved of dinner with a patient (75%) but approved of or were neutral on all other scenarios (61-90%). CONCLUSIONS: The medical profession is quite divided on questions related to drawing lines about appropriate boundaries. Contrary to official and widespread proscriptions against such practices (with exception of dinner dates), many have actually engaged in such practices and the majority found them acceptable.

Rural health services' relationships with patients: An enabler and a barrier to advance care planning.

OBJECTIVE: The barriers and enablers to the uptake of advance care plans has been well documented but more so in metropolitan health services. Rural and regional areas have their own challenges of higher rates of chronic illness and an aging population when considering end of life care. This study aimed to explore the creation of advance care plans in a regional location that has service links to smaller health services. DESIGN: A qualitative study involving thematic analysis of interview data. SETTING: A regional local government area in Victoria, Australia. PARTICIPANTS: Twelve representatives from rural and regional health services, including hospital, private practice and community organisation staff. MAIN OUTCOME MEASURES: Barriers and enablers to the creation of advance care planning documents. RESULTS: The data analysis yielded two main identified themes around Plan creation and communication of patient wishes: system and societal challenges to the creation and communication in advance care planning; and rural communities' expectation of the health service-patient relationship and advance care planning. CONCLUSION: Although barriers to advance care planning are well known, rural and regional practitioners need to be aware of the effect long-term continuity of care from health practitioners and connections with health services has on advance care plan creation, and whether the paucity of written Plans effects end-of-life care. A potential solution was seen in the pending linkages to the national electronic patient record.

La Comunicación en la Relación Médico-Paciente-Familiaen Cuidados Paliativos / Communication in the Doctor-Patient-Family Relationshipin PalliativeCare

Propósito de la revisión: el objetivo de la revisión es delinear el rol dela Comunicación en la relación Médico-Paciente-Familia.Buscamos reportes endonde se incluyeala familia en la relación de cuidadores de pacientes enfocados en el área oncológica de cuidados paliativos. Recientes hallazgos:La verdad es uno de los agentes terapéuticos más potentes disponibles.El objetivo de la comunicación es: Disminuir la incertidumbre, por dolorosa que sea la información solicitada.La informacióny entrevista al paciente oncológico debe ser preparada con anterioridad tomando en cuenta un Formato el más usado es el protocolo "COMFORT"por sus siglas en inglés. Extracto: Dentro de cualquier ámbito de trabajo que concierne a los profesionales de la salud, pero muy especialmente en el de los Cuidados Paliativos, la comunicación se constituye como uno de los elementos terapéuticos fundamentales en la intervención médica y psicológica. La manera de transmitir malas noticias y el manejo del impacto emocional que esto puede ocasionar, el acompañamiento profesional necesario en las distintas fases de la enfermedad, o la fundamental coordinación y manejo de situaciones difíciles por parte de los profesionales sanitarios son sólo algunos de los aspectos importantes en la calidad, eficacia y eficiencia del abordajeintegral en Cuidados Paliativos Esta revisión tiene por objetivo estudiar la bibliografía existente y hacer un análisis en relación con la comunicación con la familia y con el paciente en cuidados paliativos

Purpose of the review: the objective of thisreview is to delineate the role of Communication in the Doctor-Patient-Family relationship. We seek reports where the family is included in the relationship of caregivers of patients focused on the oncology area of palliative care. Recent Findings: The Truth is one of the most powerful therapeutic agents available. The goal of communication is: Reduce uncertainty, no matter how painful the information requested. The information and interview to the oncology patient must be prepared in advance, taking into account the most used format is the "COMFORT" protocol for its acronym in English. Extract: Within any field of work that concerns health professionals, but especially in that of Palliative Care, communication is constituted as one of the fundamental therapeutic elements in medical and psychological intervention. The way of transmitting bad news and the management of the emotional impact that this can cause, the necessary professional support in the different phases of the disease, orthe fundamental coordination and management of difficult situations by health professionals are just some of the aspects important in the quality, efficacy and efficiency of the comprehensive approach in Palliative Care This review aims to study the existing bibliography and make an analysis in relation to communication with the family and with the patient in palliative care