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The forgotten room
\"When the critically wounded Captain Cooper Ravenal is brought to a private hospital on Manhattan's Upper East Side, young Dr. Kate Schuyler is drawn into a complex mystery that connects three generations of women in her family to a single extraordinary room in a Gilded Age mansion\"-- Provided by publisher.
Book
Training family physicians in shared decision-making to reduce the overuse of antibiotics in acute respiratory infections: a cluster randomized trial
Few interventions have proven effective in reducing the overuse of antibiotics for acute respiratory infections. We evaluated the effect of DECISION+2, a shared decision-making training program, on the percentage of patients who decided to take antibiotics after consultation with a physician or resident.
We performed a randomized trial, clustered at the level of family practice teaching unit, with 2 study arms: DECISION+2 and control. The DECISION+2 training program included a 2-hour online tutorial followed by a 2-hour interactive seminar about shared decision-making. The primary outcome was the proportion of patients who decided to use antibiotics immediately after consultation. We also recorded patients' perception that shared decision-making had occurred. Two weeks after the initial consultation, we assessed patients' adherence to the decision, repeat consultation, decisional regret and quality of life.
We compared outcomes among 181 patients who consulted 77 physicians in 5 family practice teaching units in the DECISION+2 group, and 178 patients who consulted 72 physicians in 4 family practice teaching units in the control group. The percentage of patients who decided to use antibiotics after consultation was 52.2% in the control group and 27.2% in the DECISION+2 group (absolute difference 25.0%, adjusted relative risk 0.48, 95% confidence interval 0.34–0.68). DECISION+2 was associated with patients taking a more active role in decision-making (Z = 3.9, p < 0.001). Patient outcomes 2 weeks after consultation were similar in both groups.
The shared decision-making program DECISION+2 enhanced patient participation in decision-making and led to fewer patients deciding to use antibiotics for acute respiratory infections. This reduction did not have a negative effect on patient outcomes 2 weeks after consultation.
Journal Article
The tiger's wife : a novel
Remembering childhood stories her grandfather once told her, young physician Natalia becomes convinced that he spent his last days searching for \"the deathless man,\" a vagabond who claimed to be immortal. As Natalia struggles to understand why her grandfather, a deeply rational man would go on such a farfetched journey, she stumbles across a clue that leads her to the extraordinary story of the tiger's wife.
Book
Acceptance, knowledge, and attitude of family physicians towards obesity as a chronic disease: a multinational cross-sectional study
Obesity was previously perceived to be a lifestyle issue; however, it was declared a chronic disease by the American Medical Association (AMA) in 2013. However, family physician's views and actions toward managing obesity remain ambiguous and occasionally conflicting.
This cross-sectional study explores the acceptance and knowledge of 171 family medicine physicians regarding obesity as a chronic disease. Family physicians were recruited through different channels, including members of professional scientific societies of family medicine that belong to the World Organization of Family Doctors (WONCA) Eastern Mediterranean Regional Office EMRO, a publicly available list of United States (US) family physicians, and authors' personal Facebook and LinkedIn connections. Data was collected across various countries through an anonymous online survey.
While most participants acknowledged obesity as a chronic condition with multifactorial origins, there was a notable discrepancy in treatment practices compared to other chronic diseases. A dual perspective emerged, as family physicians often emphasized self-responsibility and behavioral change over medical interventions, potentially hindering effective management. Lower initiation rates for obesity management was exhibited compared to other chronic diseases.
There is a gap between recognition and effective management of obesity as a chronic disease within family practice. The findings underscore the need for comprehensive obesity education in medical training to bridge knowledge gaps and reduce weight stigma, enabling physicians to provide optimal care for patients with obesity.
Journal Article
The bookshop at water's end
\"Bonny Blankenship's most treasured memories are of idyllic summers spent in Watersend, South Carolina, with her best friend Lainey McKay. Amid the sand dunes and oak trees draped with Spanish moss, they swam and wished for happy-ever-afters, then escaped to the local bookshop to read and whisper in the glorious cool silence. Until the night that changed everything, the night that Lainey's mother disappeared. Now, in her early fifties, Bonny is desperate to clear her head after a tragic mistake threatens her career as an emergency room doctor, and her marriage crumbles around her\"-- Provided by publisher.
Book
Insufficient evidence on the effectiveness of family physician program in Iran: a systematic review of existing literature
Background
The Family Physician Program (FPP), initiated by the Iranian Ministry of Health in 2005 for rural areas and expanded to select urban regions in 2011, aimed to enhance community access to healthcare services. This systematic review aimed to examine empirical research evaluating the impact of the FPP on health indicators in both rural and urban settings in Iran.
Methods
Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a comprehensive search across four international databases (ISI/Web of Science, PubMed, Embase, and Scopus) and three Iranian databases (Magiran, Irandoc, and Scientific Information Database). We identified peer-reviewed studies that investigated the effects of FPP on various health indicators. The risk of bias was assessed using a nine-item quality assessment tool developed by Hawker. Data were synthesized narratively through content analysis.
Results
Our search yielded 963 titles, of which 28 studies met the inclusion criteria for full-text review. The findings from these studies were contradictory regarding the FPP’s impact on access to and utilisation of healthcare services, the prevention and control of non-communicable diseases, maternal and child mortality rates, financial protection, and the satisfaction of healthcare recipients and providers.
Conclusion
While most existing studies have concentrated on access to healthcare services, the available evidence regarding the effectiveness of the FPP in Iran remains inconclusive. As a result, firm conclusions about the overall impact of the FPP cannot yet be established. Generating more robust evidence would contribute to more informed decision-making on the continuation and possible refinement of the program. Therefore, further national-level studies are recommended to provide clearer insights into the outcomes and broader implications of the FPP in Iran.
Journal Article
The book of summer
\"Physician Bess Codman has returned to her family's Nantucket compound, Cliff House, for the first time in four years. Her great-grandparents built Cliff House almost a century before, but due to erosion, the once-grand home will soon fall into the sea. Though she's purposefully avoided the island, Bess must now pack up the house and deal with her mother, a notorious town rabble-rouser, who refuses to leave\"-- Provided by publisher.
Book
Family physician pay inequality: a qualitative study exploring how physician responses to perceived patient expectations may explain gender, race, and immigration status pay differences
Pay inequality related to social identity has been observed among physicians, even after accounting for hours worked and specialty. Physician identity factors, such as gender and race, may contribute to practice behaviours in ways that affect income. In this study, we sought to explore how Ontario family physicians understand the relation between their identities and practice patterns and to form a theory of how identities may influence practice decisions in ways that result in income disparities.
We conducted a constructivist grounded theory study to understand how social identities affect income discrepancies among physicians. We conducted interviews with family physicians practising in Ontario. Physicians were purposively and then theoretically sampled for variation on several identity factors. We staged the analysis using constant comparative techniques.
Fifty-five family physicians participated. The analysis identified physician perception of patient expectations as a key factor influencing income. Based on the interviews, we developed a 4-stage theory to explain this mechanism: physician understanding of patient expectations, the nature of the expectations, physician responses to those expectations, and financial implications of those responses. We illustrate this theory with data from 2 frequently occurring examples: how physician gender influences income via patient expectations, and how physician culture, language, and immigrant or nonimmigrant status influence income via patient expectations.
Patient-centred care requires individualized approaches, yet common physician remuneration models fail to account for the time needed to provide these meaningful interactions. This dynamic may create structural disincentives for physicians who provide relational, emotionally intensive, or culturally tailored care, potentially reinforcing income disparities related to social identities.
Journal Article
Family physician preferences and knowledge gaps regarding the care of adolescent and young adult survivors of childhood cancer
Purpose
Childhood cancer survivors are at risk for long-term morbidity and early mortality. Since most adult and some adolescent survivors of childhood cancer will receive their long-term care from a primary care physician, we sought to determine family physicians’ comfort with caring for this population.
Methods
A survey was mailed to 2,520 United States (US) and Canadian family physicians to assess their attitudes and knowledge regarding the care of adolescent and young adult survivors of childhood cancer.
Results
One thousand one hundred twenty-four family physicians responded (704 US, 420 Canadian). Median age was 53 years; 63 % were men; 81 % had cared for ≤2 childhood cancer survivors in the past 5 years. Of those who had cared for a survivor, 48 % had never or almost never received a treatment summary from the referring cancer center; 85 % preferred to care for survivors in consultation with a cancer center-based physician or long-term follow-up program. Only 33, 27, and 23 % of respondents were very comfortable caring for survivors of childhood Hodgkin lymphoma, acute lymphoblastic leukemia or osteosarcoma, respectively. Only 16, 10, and 74 % of respondents correctly identified the guideline recommended surveillance for secondary breast cancer, cardiac dysfunction and hypothyroidism in response to a vignette describing a Hodgkin lymphoma survivor. Respondents rated access to clinical care guidelines and receipt of a patient-specific letter from specialists with surveillance recommendations as the modalities most likely to assist them in caring for survivors.
Conclusions
Most family physicians are willing to care for childhood cancer survivors in consultation with a cancer center, and with specific tools to facilitate this care.
Implications for Cancer Survivors
Adult and adolescent survivors of childhood cancer who receive their follow-up care from a family physician must be empowered to choose a physician who is comfortable with caring for survivors. Further, the survivor must ensure that their physician has access to a treatment summary as well as to patient-specific recommendations for surveillance for late effects of cancer therapy.
Journal Article