This article identifies the role played by a series of medical scandals in the UK, occurring from the mid-1990s onwards, in ending a collegial model of self-regulation of the medical profession that ...had endured for 150 years. The state’s original motive in endorsing professional self-regulation was to resolve the principal–agent problem inherent in the doctor–patient relationship. The profession, in return for its self-regulating privileges, undertook to act as a reliable guarantor for the competence and conduct of each of its members. Though sufficient to ensure that most doctors were “good”, the collegial model adopted by the profession left it fatally vulnerable to the problem of “bad apples”: those unwilling, incapable or indifferent to delivering on their professional commitments and who betrayed the trust of both patients and peers. Weak administrative systems in the NHS failed to compensate for the defects of the collegium in controlling these individuals. The scandals both provoked and legitimised erosion of the profession’s self-regulatory power. Though its vulnerability to bad apples had been present since the founding of the 19th century profession, it was the convergence of social and political conditions at a particular historical moment that transformed the scandals into an unstoppable imperative for reform. Huge public anger, the voice permitted to a coalition of critics, shifts in social attitudes, the opportunity presented for imposing standards for accountability, and the increasing ascendancy of pro-interventionist managerialist and political agendas from the early 1990s onwards were all implicated in the response made to scandals and the shape the reforms took. Scandals need to be understood not as simple determinants of change, but as one performative element in a constellation of socially contingent forces and contexts. The new rebalancing of the “countervailing powers” has dislodged the profession as the senior partner in the regulation of doctors, but may introduce new risks.
► The era of collegial self-regulation for the UK medical profession has ended after 150 years. ► The role of scandal in provoking and legitimising reform is important but under-examined. ► We show that the profession harboured a structural susceptibility to transgression by individuals since its foundation. ► A contingent set of social and political forces and contexts both created the opportunity for reform and shaped the outcomes of reform.
Improving the training of physicians about communication skills and patient health literacy (HL) is a major priority that remains an open question. We aimed to examine the effectiveness of ...communication skills training for physicians on the hypertension outcomes and the health literacy skills, self-efficacy and medication adherence in patients with uncontrolled blood pressure (BP).
A randomized, controlled trial method was conducted on 240 hypertensive patients and 35 physicians presenting to healthcare clinics in the Mashhad, Iran, from 2013 to 2014. Using stratified blocking with block sizes of 4 and 6, eligible patients with uncontrolled blood pressure were randomly allocated to the intervention and control groups. Physicians in the intervention group received educational training over 3 sessions of Focus -Group Discussion and 2 workshops. The control group received the routine care. The primary outcome was a reduction in systolic and diastolic BP from baseline to 6 months. The secondary outcome was promoting HL skills in hypertensive patients. Data were analyzed using the regression model and bivariate tests.
After the physician communication training, there was a significant improvement in physicians-patient communication skills, hypertension outcomes, medication adherence, and self-efficacy among the patients being managed by the physicians receiving training, compared to the control group.
The educational intervention leads to better BP control; it may have been sufficient training of physicians change to impact counseling, HL and self-efficacy and adherence. The quality of physician-patient communication is an important modifiable element of medical communication that may influences health outcomes in hypertensive Iranian patients.
Iranian Registry of Clinical Trials (IRCT), IRCT20160710028863N24. Registered April 4, 2018 retrospectively registered.
100 YEARS AGO/50 YEARS AGO
American journal of public health (1971),
04/2016, Letnik:
106, Številka:
4
Journal Article
Recenzirano
From AJPH, April 1916 50YEARS AGO Recent Federal Legislation: Its Meaning for Public Health One does not hear that old myth so much anymore, about the good medical care in this country being ...available to the very rich and the very poor.
Within the medical community there is persistent debate as to whether the information available through social media is trustworthy and valid, and whether physicians are ready to adopt these ...technologies and ultimately embrace them as a format for professional development and lifelong learning.
To identify how physicians are using social media to share and exchange medical information with other physicians, and to identify the factors that influence physicians' use of social media as a component of their lifelong learning and continuing professional development.
We developed a survey instrument based on the Technology Acceptance Model, hypothesizing that technology usage is best predicted by a physician's attitudes toward the technology, perceptions about the technology's usefulness and ease of use, and individual factors such as personal innovativeness. The survey was distributed via email to a random sample of 1695 practicing oncologists and primary care physicians in the United States in March 2011. Responses from 485 physicians were analyzed (response rate 28.61%).
Overall, 117 of 485 (24.1%) of respondents used social media daily or many times daily to scan or explore medical information, whereas 69 of 485 (14.2%) contributed new information via social media on a daily basis. On a weekly basis or more, 296 of 485 (61.0%) scanned and 223 of 485 (46.0%) contributed. In terms of attitudes toward the use of social media, 279 of 485 respondents (57.5%) perceived social media to be beneficial, engaging, and a good way to get current, high-quality information. In terms of usefulness, 281 of 485 (57.9%) of respondents stated that social media enabled them to care for patients more effectively, and 291 of 485 (60.0%) stated it improved the quality of patient care they delivered. The main factors influencing a physician's usage of social media to share medical knowledge with other physicians were perceived ease of use and usefulness. Respondents who had positive attitudes toward the use of social media were more likely to use social media and to share medical information with other physicians through social media. Neither age nor gender had a significant impact on adoption or usage of social media.
Based on the results of this study, the use of social media applications may be seen as an efficient and effective method for physicians to keep up-to-date and to share newly acquired medical knowledge with other physicians within the medical community and to improve the quality of patient care. Future studies are needed to examine the impact of the meaningful use of social media on physicians' knowledge, attitudes, skills, and behaviors in practice.
8 Questions with Dr. Moshfeghi Schwartz, Stephen G; Moshfeghi, Darius M
Ophthalmic surgery, lasers & imaging,
10/2016, Letnik:
47, Številka:
10
Journal Article
Recenzirano
Physician Stephen G. Schwartz is interviewed. He discusses, among other things, the greatest influence on his career.
During World War II, Mom Chung's wastheplace to be in San Francisco. Soldiers, movie stars, and politicians gathered at her home to socialize, to show their dedication to the Allied cause, and to ...express their affection for Dr. Margaret Chung (1889-1959). The first known American-born Chinese female physician, Chung established one of the first Western medical clinics in San Francisco's Chinatown in the 1920s. She also became a prominent celebrity and behind-the-scenes political broker during World War II. Chung gained national fame when she began "adopting" thousands of soldiers, sailors, and flyboys, including Ronald Reagan, Admiral Chester W. Nimitz, and Admiral William F. Halsey, Jr. A pioneer in both professional and political realms, Chung experimented in her personal life as well. She adopted masculine dress and had romantic relationships with other women, such as writer Elsa Gidlow and entertainer Sophie Tucker. This is the first biography to explore Margaret Chung's remarkable and complex life. It brings alive the bohemian and queer social milieus of Hollywood and San Francisco as well as the wartime celebrity community Chung cultivated. Her life affords a rare glimpse into the possibilities of traversing racial, gender, and sexual boundaries of American society from the late Victorian era through the early Cold War period.
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