¿Cuáles son los conflictos éticos más frecuentes para los internistas españoles? / Which are the most prevalent ethical conflicts for Spanish internists?

Antecedentes y objetivo Los clínicos se enfrentan en su práctica diaria a multitud de conflictos éticos. No hay estudios sobre los tipos de conflictos éticos que se encuentran con más frecuencia y que preocupan más a los clínicos en España. El objetivo de este estudio es describir los conflictos éticos más frecuentes con los que se encuentran los internistas españoles, así como la importancia que los profesionales atribuyen a cada conflicto. Materiales y métodos Estudio observacional transversal a través de una encuesta voluntaria y anónima, dirigida a médicos internistas españoles y distribuida a través de una plataforma ad hoc de la Sociedad Española de Medicina Interna. Resultados Los problemas éticos más frecuentes y relevantes para los internistas españoles son los relacionados con: el final de la vida (decisiones de limitación del esfuerzo terapéutico, uso de tratamientos paliativos, instauración de órdenes de no reanimación cardiopulmonar); los conflictos que se producen en el seno de la relación clínica, bien con familiares o con pacientes, y la toma de decisiones con pacientes incompetentes. Estos resultados son similares a los de otras series anglosajonas y europeas. Los problemas éticos dificultan más la actividad asistencial a los clínicos que perciben con más frecuencia dichos problemas (50,3%) que los que no los perciben (16%). Conclusiones Los conflictos éticos más frecuentes y relevantes entre los internistas españoles son los relacionados con el manejo del final de la vida, seguidos de los derivados de la relación clínica y el manejo de pacientes incompetentes. Es prioritario diseñar programas de formación que permitan abordar y reconocer mejor dichos problemas (AU)

Background and objective Clinicians face a multitude of ethical conflicts in their daily practice. There have been no studies on the types of ethical conflicts encountered most frequently and that are of most concern to clinicians in Spain. The aim of this study is to report the most common ethical conflicts faced by Spanish internists, as well as the importance that the practitioners attribute to each conflict. Materials and Methods Our observational cross-sectional study employed a voluntary and anonymous survey aimed at Spanish medical internists and distributed through an ad hoc platform of the Spanish Society of Internal Medicine. Results The most common and relevant ethical issues for Spanish internists are related to patients’ end of life (decisions limiting therapeutic effort, use of palliative treatments, the establishment of do-not-resuscitate orders), the conflicts arising within the doctor-patient/family relationship, and making decisions with noncompetent patients. These results are similar to those of other English and European series. The ethical problems further complicate the healthcare activity of clinicians who more often notice these problems (50.3%) than those who do not notice them (16%). Conclusions The most common and relevant ethical conflicts among Spanish internists are related to managing patients’ end of life, followed by those related to the doctor-patient relationship and the management of noncompetent patients. It is essential that training programs be designed to better address and recognise these problems (AU)

Los médicos y la industria farmacéutica: impacto sobre actitudes y hábitos de prescripción / Physicians and the pharmaceutical industry: impact on prescription attitudes and habits

Resumen Introducción: La relación médico-industria farmacéutica (IF) se ha identificado como un problema ético por favorecer conflictos de interés derivados de los beneficios que reciben los médicos y que pueden afectar su juicio clínico. Objetivo: Identificar la frecuencia de participación de médicos en actividades financiadas por la IF, las actitudes de estos profesionales hacia los representantes de la IF, su conducta prescriptiva y la asociación de sus características y del trabajo con la participación en actividades financiadas por la IF. Método: Encuesta transversal a médicos internistas y cardiólogos. El cuestionario incluyó características de los médicos y centro de trabajo, participación en actividades financiadas por la IF, actitudes hacia los representantes y conducta de prescripción. Resultados: Se analizaron 455 cuestionarios, 78.5 % de los encuestados tuvo conocimiento de la relación médico-IF, la mayoría respondió reunirse con representantes de la IF, 30 % indicó haber recibido subsidios financieros y 10 % consideró que los obsequios afectan su prescripción. Tener conocimiento previo de la relación médico-IF se asoció con menor participación en actividades educativas financiadas por por la IF. Conclusión: Las prácticas y preferencias hacia la IF muestran la necesidad de diseñar estrategias para evitar la prescripción inapropiada.

Abstract Introduction: The physician-pharmaceutical industry relationship has been identified as an ethical problem, due to conflicts of interest motivated by the benefits that doctors receive and that can affect their clinical judgment. Objective: To identify the frequency of physicians participation in activities financed by the pharmaceutical industry (PI), their attitudes towards PI representatives (PIRs), their prescriptive behavior and the association between their characteristics and their workplace with their participation in activities financed by the PI. Method: Cross-sectional survey to internists and cardiologists. The questionnaire included characteristics of the doctors and their workplace, participation in activities financed by the PI, attitudes towards PIRs, and prescription behavior. Results: 455 questionnaires were analyzed; 78.5 % of surveyed subjects were aware of the physician-PI relationship, the majority acknowledged meeting with PIRs, 30 % indicated having received financial subsidies and 10 % considered that gifts affect their prescription. Having prior knowledge of the physician-PI relationship was associated with less participation in PI-financed educational activities. Conclusion: Practices and preferences towards the PI show the need to design strategies to avoid inappropriate prescription.

Toward Historical Accountability and Remembrance: The German Society for Internal Medicine and Its Legacies From the Nazi Past.

After decades of silence, the German Society for Internal Medicine (DGIM) has made considerable efforts to come to terms with its role and actions during the Nazi era (1933 to 1945). This is particularly important because, with more than 27 000 members, the DGIM is the largest medical society in present-day Germany. Since 1882, the society's annual congress in Wiesbaden has provided a forum and focus for the key medical topics of the day. Based on ongoing historical research, this article is organized in 2 parts. The first describes how the DGIM willingly adapted to the ideology and politics of the Nazi regime, showing no solidarity with its persecuted Jewish members. To illustrate their fates, the cases of Leopold Lichtwitz, who was forced to resign as elected chairman in 1933, and committee member Julius Bauer are investigated. Both men emigrated to the United States. Light is also shed on the decisions of those who led the society during the Nazi era and on the involvement of high-ranking members in medical crimes. The second part of the article analyzes developments in the postwar period and considers why it took so long to hold up a mirror to the past. Although critical voices could be heard from both outside and within the society, they remained isolated and without consequence. Only the past 2 decades have brought about both general and specific developments toward historical accountability and an active culture of remembrance. With a declaration first published in 2015, a new website bringing history and memory together, and a strong commitment to the norms and values of liberal democracy, the DGIM has found its way to a clear position-and has lessons to teach.

Physicians and the pharmaceutical industry: impact on prescription attitudes and habits.

INTRODUCTION: The physician-pharmaceutical industry relationship has been identified as an ethical problem, due to conflicts of interest motivated by the benefits that doctors receive and that can affect their clinical judgment. OBJECTIVE: To identify the frequency of physicians participation in activities financed by the pharmaceutical industry (PI), their attitudes towards PI representatives (PIRs), their prescriptive behavior and the association between their characteristics and their workplace with their participation in activities financed by the PI. METHOD: Cross-sectional survey to internists and cardiologists. The questionnaire included characteristics of the doctors and their workplace, participation in activities financed by the PI, attitudes towards PIRs, and prescription behavior. RESULTS: 455 questionnaires were analyzed; 78.5 % of surveyed subjects were aware of the physician-PI relationship, the majority acknowledged meeting with PIRs, 30 % indicated having received financial subsidies and 10 % considered that gifts affect their prescription. Having prior knowledge of the physician-PI relationship was associated with less participation in PI-financed educational activities. CONCLUSION: Practices and preferences towards the PI show the need to design strategies to avoid inappropriate prescription. INTRODUCCIÓN: La relación médico-industria farmacéutica (IF) se ha identificado como un problema ético por favorecer conflictos de interés derivados de los beneficios que reciben los médicos y que pueden afectar su juicio clínico. OBJETIVO: Identificar la frecuencia de participación de médicos en actividades financiadas por la IF, las actitudes de estos profesionales hacia los representantes de la IF, su conducta prescriptiva y la asociación de sus características y del trabajo con la participación en actividades financiadas por la IF. MÉTODO: Encuesta transversal a médicos internistas y cardiólogos. El cuestionario incluyó características de los médicos y centro de trabajo, participación en actividades financiadas por la IF, actitudes hacia los representantes y conducta de prescripción. RESULTADOS: Se analizaron 455 cuestionarios, 78.5 % de los encuestados tuvo conocimiento de la relación médico-IF, la mayoría respondió reunirse con representantes de la IF, 30 % indicó haber recibido subsidios financieros y 10 % consideró que los obsequios afectan su prescripción. Tener conocimiento previo de la relación médico-IF se asoció con menor participación en actividades educativas financiadas por por la IF. CONCLUSIÓN: Las prácticas y preferencias hacia la IF muestran la necesidad de diseñar estrategias para evitar la prescripción inapropiada.

Do poor patients suffer from inaccurate diagnoses more than well-to-do patients? A randomized control trial.

BACKGROUND: Poor patients have greater morbidity and die up to 10 years earlier than patients who have higher socio-economic status. These findings are often attributed to differences in life-style between groups. The present study aimed at investigating the extent to which physicians contribute to the effect by providing relative poorer care, resulting in relative neglect in terms of time spent with a poor patient and more inaccurate diagnoses. METHODS: A randomised experiment with 45 internal medicine residents. Doctors diagnosed 12 written clinical vignettes that were exactly the same except for the description of the patients' socio-economic status. Each participant diagnosed four of the vignettes in a poor-patient version, four in a rich-patient version, and four in a version that did not contain socio-economic markers, in a balanced within-subjects incomplete block design. Main measurements were: diagnostic accuracy scores and time spent on diagnosis. RESULTS: Mean diagnostic accuracy scores (range 0-1) did not significantly differ among the conditions of the experiment (for poor patients: 0.48; for rich patients: 0.52; for patients without socio-economic markers: 0.54; p > 0.05). While confronted with patients not presenting with socio-economic background information, the participants spent significantly less time-to-diagnosis ((for poor patients: 168 s; for rich patients: 176 s; for patients without socio-economic markers: 151 s; p < 0.01), however due to the fact that the former vignettes were shorter. CONCLUSION: There is no reason to believe that physicians are prejudiced against poor patients and therefore treat them differently from rich patients or patients without discernible socio-economic background.

El internista como consultor de ética clínica: un antídoto contra "la barbarie delespecialismo" en la práctica hospitalaria / The internist as clinical ethics consultant: An antidote to "the barbarism of specialization" in hospital practice

El desarrollo de la ética clínica hospitalaria en España depende casi exclusivamente de los comités de ética asistencial. Estos han sido criticados por su falta de cercanía a la cabecera del paciente en los conflictos éticos cotidianos y por su escasa operatividad práctica, que se refleja en el escaso número de consultas que reciben. En el presente trabajo reflexionamos sobre la necesidad de modificar el modelo actual de atención en ética clínica para reactivarlo y llamar la atención sobre el papel primordial del internista como motor de dicho cambio. Para ello proponemos un modelo en que los comités de ética asistencial incorporen consultores de ética, mejor posicionados para la discusión de casos a la cabecera del enfermo. Seguidamente analizamos las características que dichos consultores deberían poseer

The development of hospital clinical ethics in Spain depends almost exclusively on the healthcare ethics committees, which have been criticized for a lack of proximity to the patient's bedside in day-to-day ethical conflicts and for their scarce practical operation, reflected in the low number of consultations they receive. In this study, we reflect on the need to change the current healthcare model in clinical ethics so as to reactivate it and call attention to the essential role of internists as the engine for this change. To this end, we propose a model in which the healthcare ethics committees incorporate ethics consultants, who are better positioned to discuss cases at the patient's bedside. We then analyse the characteristics that these consultants should have

What do Japanese residents learn from treating dying patients? The implications for training in end-of-life care.

BACKGROUND: How medical residents' experiences with care for dying patients affect their emotional well-being, their learning outcomes, and the formation of their professional identities is not fully understood. We examine residents' emotional states and learning occurring during the provision of care to dying patients and specifically discuss the impact of providing end-of-life (EOL) care on professional identity formation. METHODS: Semi-structured interviews were conducted with 13 residents who had graduated in the last 3 to 5 years. Thematic theoretical analysis was applied, and key themes were developed based on Kolb's experiential learning cycle. RESULTS: Eight key themes emerged from the analysis. The residents experienced dilemmas in confronting the reality of medical uncertainty as well as a disruption of emotional state and self-efficacy. Although the residents felt a sense of helplessness and guilt, they were able to reflect on strategies for handling medical care that focused on patients and that required a truly sincere attitude. They also contemplated the importance of palliative care and communication with patients, patients' family members and medical staff. Building on these experiences, the residents rebuilt a sense of awareness that allowed them to directly engage with the type of medical care that they are likely to be called upon to perform in the future as the population continues to age. CONCLUSIONS: This study revealed Japanese residents' perceptions, emotions and learning processes in caring for dying patients by applying Kolb's experiential learning theory. The findings of this study may illuminate valuable pieces of knowledge for future education in EOL care.

Impact of a Video-Based Interactive Workshop on Unprofessional Behaviors Among Internal Medicine Residents.

BACKGROUND: Unprofessional behaviors undermine the hospital learning environment and the quality of patient care. OBJECTIVE: To assess the impact of an interactive workshop on the perceptions of and self-reported participation in unprofessional behaviors. METHODS: We conducted a pre-post survey study at 3 internal medicine residency programs. For the workshop we identified unprofessional behaviors related to on-call etiquette: "blocking" an admission, disparaging a colleague, and misrepresenting a test as urgent. Formal debriefing tools were utilized to guide the discussion. We fielded an internally developed 20-item survey on perception and participation in unprofessional behaviors prior to the workshop. An online "booster" quiz was delivered at 4 months postworkshop, and the 20-item survey was repeated at 9 months postworkshop. Results were compared to a previously published control from the same institutions, which showed that perceptions of unprofessional behavior did not change and participation in the behaviors worsened over the internship. RESULTS: Of 237 eligible residents, 181 (76%) completed both pre- and postsurvey. Residents perceived blocking an admission and the misrepresentation of a test as urgent to be more unprofessional at a 9-month follow-up (2.0 versus 1.74 and 2.63 versus 2.28, respectively; P < .05), with no change in perception for disparaging a colleague. Participation in unprofessional behaviors did not decrease after the workshop, with the exception of misrepresenting a test as urgent (61% versus 50%, P = .019). CONCLUSIONS: The results of this multi-site study indicate that an interactive workshop can change perception and may lower participation in some unprofessional behaviors.

Reflections on Cultural Preferences and Internal Medicine: The Case of Jehovah's Witnesses and the Changing Thresholds for Blood Transfusions.

Jehovah's witnesses oppose receiving blood transfusions based on religious grounds. This refusal raises complex medical, legal and ethical issues for the treating medical staff. In the past physicians attempted to force patients and children to accept transfusions when deemed medically necessary through the use of court orders. However, in recent years the threshold for blood transfusion has been gradually raised by medical experts as expressed in consensus guidelines, which means that Jehovah's witnesses' aversion to transfusion would have been partially justified medically. This article will further discuss these current trends.

Retractions in general and internal medicine in a high-profile scientific indexing database.

CONTEXT AND OBJECTIVE: Increased frequency of retractions has recently been observed, and retractions are important events that deserve scientific investigation. This study aimed to characterize cases of retraction within general and internal medicine in a high-profile database, with interest in the country of origin of the article and the impact factor (IF) of the journal in which the retraction was made. DESIGN AND SETTING: This study consisted of reviewing retraction notes in the Thomson-Reuters Web of Knowledge (WoK) indexing database, within general and internal medicine. METHODS: The retractions were classified as plagiarism/duplication, error, fraud and authorship problems and then aggregated into two categories: "plagiarism/duplication" and "others." The countries of origin of the articles were dichotomized according to the median of the indicator "citations per paper" (CPP), and the IF was dichotomized according to its median within general and internal medicine, also obtained from the WoK database. These variables were analyzed using contingency tables according to CPP (high versus low), IF (high versus low) and period (1992-2002 versus 2003-2014). The relative risk (RR) and 95% confidence interval (CI) were estimated for plagiarism/duplication. RESULTS: A total of 86 retraction notes were identified, and retraction reasons were found for 80 of them. The probability that plagiarism/duplication was the reason for retraction was more than three times higher for the low CPP group (RR: 3.4; 95% CI: [1.9-6.2]), and similar results were seen for the IF analysis. CONCLUSION: The study identified greater incidence of plagiarism/duplication among retractions from countries with lower scientific impact.

A comparison of medical litigation filed against obstetrics and gynecology, internal medicine, and surgery departments.

BACKGROUND: The aim of this study was to review the typical factors related to physician's liability in obstetrics and gynecology departments, as compared to those in internal medicine and surgery, regarding a breach of the duty to explain. METHODS: This study involved analyzing 366 medical litigation case reports from 1990 through 2008 where the duty to explain was disputed. We examined relationships between patients, physicians, variables related to physician's explanations, and physician's breach of the duty to explain by comparing mean values and percentages in obstetrics and gynecology, internal medicine, and surgical departments with the t-test and χ(2) test. RESULTS: When we compared the reasons for decisions in cases where the patient won, we found that the percentage of cases in which the patient's claim was recognized was the highest for both physician negligence, including errors of judgment and procedural mistakes, and breach of the duty to explain, in obstetrics and gynecology departments; breach of the duty to explain alone in internal medicine departments; and mistakes in medical procedures alone in surgical departments (p = 0.008). When comparing patients, the rate of death was significantly higher than that of other outcomes in precedents where a breach of the duty to explain was acknowledged (p = 0.046). The proportion of cases involving obstetrics and gynecology departments, in which care was claimed to be substandard at the time of treatment, and that were not argued as breach of a duty to explain, was significantly higher than those of other evaluated departments (p <0.001). However, internal medicine and surgical departments were very similar in this context. In obstetrics and gynecology departments, the proportion of cases in which it had been conceded that the duty to explain had been breached when seeking patient approval (or not) was significantly higher than in other departments (p = 0.002). CONCLUSION: It is important for physicians working in obstetrics and gynecology departments to carefully explain the risk of death associated with any planned procedure, and to obtain genuinely informed patient consent.

Detección de eventos adversos en pacientes adultos hospitalizados mediante el método Global Trigger Tool / Detection of adverse events in hospitalized adult patients by using the Global Trigger Tool method

Objetivos. Identificar y caracterizar los eventos adversos (EA) en el servicio de Medicina Interna de un hospital comarcal mediante el uso de la herramienta Global Trigger Tool (GTT) ampliada, analizando su validez diagnóstica. Material y métodos. Estudio observacional, analítico, descriptivo y retrospectivo de altas de pacientes en 2013 en un servicio de Medicina Interna para la detección de EA mediante la identificación de triggers (evento relacionado frecuentemente con EA). Los triggers y los EA se localizaron mediante la revisión sistemática de la documentación clínica. Una vez detectado el EA, se procedió a su caracterización. Resultados. Se detectaron 149 EA en 291 altas durante el año 2013, de los cuales el 75,3% fueron puestos en evidencia directamente por la herramienta, mientras que el resto no tuvieron asociado un trigger. El porcentaje de altas que presentó al menos un EA fue del 35,4%. El EA más frecuentemente hallado fue la úlcera por presión (12%), seguido de delirium, estreñimiento, infección respiratoria nosocomial y alteración del nivel de conciencia por fármacos. El 47,6% de los EA estuvieron relacionados con el uso de fármacos. Se consideraron evitables el 32,2% de EA. La herramienta demostró tener una sensibilidad del 91,3% (IC 95%: 88,9-93,2) y una especificidad del 32,5% (IC 95%: 29,9-35,1). Presentaron un valor predictivo positivo del 42,5% (IC 95%: 40,1-45,1) y un valor predictivo negativo del 87,1% (IC 95%: 83,8-89,9). Conclusiones. La herramienta empleada en este trabajo es válida, útil y reproducible para la detección de EA. Asimismo, sirve para determinar tasas de daño y observar su evolución en el tiempo. En este estudio se ha hallado una frecuencia elevada tanto de EA como de eventos evitables (AU)

Objectives. To identify and characterize adverse events (AE) in an Internal Medicine Department of a district hospital using an extension of the Global Trigger Tool (GTT), analyzing the diagnostic validity of the tool. Methods. An observational, analytical, descriptive and retrospective study was conducted on 2013 clinical charts from an Internal Medicine Department in order to detect EA through the identification of ‘triggers’ (an event often related to an AE). The ‘triggers’ and AE were located by systematic review of clinical documentation. The AE were characterized after they were identified. Results. A total of149 AE were detected in 291 clinical charts during 2013, of which 75.3% were detected directly by the tool, while the rest were not associated with a trigger. The percentage of charts that had at least one AE was 35.4%. The most frequent AE found was pressure ulcer (12%), followed by delirium, constipation, nosocomial respiratory infection and altered level of consciousness by drugs. Almost half (47.6%) of the AE were related to drug use, and 32.2% of all AE were considered preventable. The tool demonstrated a sensitivity of 91.3% (95% CI: 88.9-93.2) and a specificity of 32.5% (95% CI: 29.9-35.1). It had a positive predictive value of 42.5% (95% CI: 40.1-45.1) and a negative predictive value of 87.1% (95% CI: 83.8-89.9). Conclusions. The tool used in this study is valid, useful and reproducible for the detection of AE. It also serves to determine rates of injury and to observe their progression over time. A high frequency of both AE and preventable events were observed in this study (AU)

Informe de los Editores, 2014 / Report of the Editors, 2014

Los editores de Revista Clínica Española(Rev Clin Esp) informan de su actuación editorial durante los últimos 12 meses: a) Objetivos y logros en 2014; b) Actividad editorial, 2014 y c) Factor impacto 2013. Durante el año 2014 se han alcanzado los 5 objetivos trazados. Hemos publicado los 9 números programados en el año con un 103% de artículos publicados sobre los previstos en las secciones fijas habituales. Destacamos la publicación de 29 editoriales, de los cuales 21 están firmados por autores extranjeros de gran prestigio. Entre el 1 de enero y el 30 de septiembre de 2014 hemos recibido 421 manuscritos (46,8 manuscritos/mes), cifra algo inferior a la del año 2013 (50,9 manuscritos/mes). De 404 manuscritos con proceso editorial concluido hemos aceptado un 32,3% (originales, 22,4%). Hemos cursado 315 solicitudes de revisión a 240 revisores, y hemos recibido el 53,3% de las revisiones solicitadas en menos de 2 semanas (10,4 días). El tiempo medio para adoptar una decisión editorial definitiva para todos los manuscritos («aceptado» o «rechazado») ha sido de 18,3 días (más de la mitad que en 2009). Para los «originales» esta cifra ha descendido desde 56,6 días en 2009 a 26,6 días en 2014. Desde la recepción de un manuscrito hasta su publicación on-line el tiempo medio ha sido de 103 días en 2014. En el año 2014, los grupos de trabajo de la Fundación Española de Medicina Interna (FEMI) han publicado 11 manuscritos. En julio de 2014 conocimos que el Journal Citation Reports había otorgado a Rev Clin Esp un Factor Impacto de 1.314 (año 2013). Este Factor Impacto sin autocita es de 0,705 (en el año 2009, el Factor Impacto global fue de 0,584). Con el adiós al comité editorial de Rev Clin Esp damos la bienvenida al nuevo equipo editorial y damos las gracias sinceras a la sucesivas Juntas Directivas de la SEMI, a los compañeros, personal de la revista, revisores, lectores y autores, que desde el año 2009 han confiado en nuestra gestión editorial (AU)

The editors of Revista Clínica Española(Rev Clin Esp) inform on their editorial activity during the last 12 months: (a) Objectives and attainments in 2014, (b) Editorial activity, 2014, and (c) 2013 impact factor. In 2014 we achieved the 5 planned objectives. We have published the 9 programmed issues and 103% of the planned papers according to the usual fixed sections. We emphasize the publication of 29 editorials, 21 of which are signed by prestigious foreign authors. From the first January to the 30th September 2014 we received 421 manuscripts (46.8 manuscripts per month), a slight lower figure to that obtained in 2013 (50.9 manuscripts per month). The acceptance rate of the 404 manuscripts whose editorial process has been concluded was 32.3% (originals, 22.4%). We asked for 315 revisions to 240 reviewers and we received 53.3% revisions in less than two weeks (10.4 days). The mean time to adopt an editorial decision for all manuscripts («accepted»/«rejected») has been 18,3 (less than half than in 2009). For «originals» this figure has dropped from 56,6 days in 2009 to 26.6 days in 2014. The mean time elapsed from manuscript reception to its on-line publication was 103 days. In 2014 the collaboration with the working groups from the Internal Medicine Spanish Foundation (FEMI) has reported 11 published manuscripts. In July 2014 we were informed that the Journal Citation Reports gave Rev Clin Esp an Impact Factor of 1,314 (year 2013). This Impact Factor without self-citations would have been 0.705 (in 2009 the global impact factor was 0,584). With the Editorial Committee farewell we welcome the new editorial team and we sincerely thank the SEMI Steering Committee, our colleagues, journal officers, reviewers, readers and authors that since 2009 have trusted on our editorial work (AU)

Cheaters never prosper... if only that were true / Los tramposos nunca prosperan... si eso fuera cierto

No disponible

Physicians caring for physicians: the perspective of the primary care physician.

OBJECTIVES: How physicians provide longitudinal primary care to physician-patients (ie, physicians as patients) has not been well studied. The potential challenges of providing care to physician-patients include maintaining professional boundaries and adhering to practice guidelines. The objective was to explore the differences in identifying how physicians perceive caring for physicians-patients in the longitudinal setting versus caring for other patients in the general population. METHODS: The study consisted of focus groups, followed by quantitative survey. Participants were primary care physicians (internal medicine and family medicine) at an academic multispecialty group practice. Thematic analysis of focus groups informed the development of the survey. RESULTS: In focus groups, participants identified several benefits, challenges, and differences in caring for physician-patients versus the general population. When these findings were explored further by quantitative survey, participants noted differences in care regarding chart documentation protocols, communication of results, and accommodation of schedules. They agreed that there were benefits to providing care to physician-patients, such as believing their work was valued and discussing complex issues with greater ease. There also were challenges, including anxiety or self-doubt. Participants also agreed on the following strategies when caring for this population: make recommendations based on evidence-based medicine, follow routine assessment and examination protocols, follow routine scheduling and communication protocols, recommend the same follow-up visit schedule, and define boundaries of the relationship. CONCLUSIONS: Physicians perceive caring for physician-patients as different and rewarding, although some find that it provokes anxiety. Many are willing to make concessions regarding scheduling and testing. With increasing experience, the anxiety decreased as did the need to follow protocols and maintain boundaries. Further investigation is needed to determine the impact of physician experience and training on the quality of care for physician-patients.