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"Family physicians"
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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
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
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
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
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
The agenda-setting process for urban family physician program within Iran’s health insurance
Background and objective
Since 2005, health policymakers in Iran have focused on the rural family physician plan to minimize unnecessary specialist referrals and enhance both efficiency and equitable access to services. In September 2021, the urban family physician plan was launched, engaging various organizations, including insurance companies. A trustee was appointed to manage the implementation of the Iranian health insurance program. This study examines how Iran Health Insurance prioritized the urban family physician program on its agenda by applying Kingdon’s agenda-setting model.
Materials and methods
This descriptive qualitative study gathered data through semi-structured interviews with 13 stakeholders in Iran’s urban family physician program, including planners, policymakers, and implementers. Purposive sampling, followed by snowball sampling, was used until data saturation was reached. Directed content analysis was applied, guided by Kingdon’s multiple streams framework.
Results
Three themes emerged: problem, policy, and political streams. The problem stream for Iran’s family physician plan included structural challenges (such as incomplete implementation, physician shortages, fragmented health data systems, poor stakeholder coordination), social-cultural barriers (including low public awareness, resistance to change), and economic issues (such as high treatment costs, inadequate insurance coverage). The policy stream proposed solutions such as electronic systems, standardized protocols, new technologies, expanded education, and improved physician working conditions. Strong government and parliamentary backing were identified as critical to addressing these challenges, emphasizing the need for sustained commitment and holistic strategies.
Discussion and conclusion
The WHO, Iranian Parliament, Ministry of Health, and health insurers can serve as policy entrepreneurs to advance the family physician program within Iran’s health insurance system. The WHO can leverage global health data to emphasize Iran’s healthcare challenges, while the Ministry of Health and insurers can pinpoint issues via national research. The Parliament can facilitate public voices to gather input from citizens and experts.
Journal Article
Demand and level of service inflation in Floating Catchment Area (FCA) methods
Floating Catchment Area (FCA) methods are a popular tool to investigate accessibility to public facilities, in particular health care services. FCA approaches are attractive because, unlike other accessibility measures, they take into account the potential for congestion of facilities. This is done by 1) considering the population within the catchment area of a facility to calculate a variable that measures level of service, and then 2) aggregating the level of service by population centers subject to catchment area constraints. In this paper we discuss an effect of FCA approaches, an artifact that we term demand and level of service inflation. These artifacts are present in previous implementations of FCA methods. We argue that inflation makes interpretation of estimates of accessibility difficult, which has possible deleterious consequences for decision making. Next, we propose a simple and intuitive approach to proportionally allocate demandand and level of service in FCA calculations. The approach is based on a standardization of the impedance matrix, similar to approaches popular in the spatial statistics and econometrics literature. The result is a more intiuitive measure of accessibility that 1) provides a local version of the provider-to-population ratio; and 2) preserves the level of demand and the level of supply in a system. We illustrate the relevant issues with some examples, and then empirically by means of a case study of accessibility to family physicians in the Hamilton Census Metropolitan Area (CMA), in Ontario, Canada. Results indicate that demand and supply inflation/deflation affect the interpretation of accessibility analysis using existing FCA methods, and that the proposed adjustment can lead to more intuitive results.
Journal Article