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Get caught up on the latest articles on professionalism in this week’s Recommended Reading:
- The author of a new JAMA Internal Medicine commentary discusses how physician specialty societies are dealing with costs. He notes that addressing cost is part of the Physician Charter, which calls on physicians to “be committed to working with other physicians, hospitals, and payers to develop guidelines for cost-effective care.”
- In Supporting students in self-regulation: Use of formative feedback and portfolios in a problem-based learning setting, researchers reported that first-year medical students incorporated formative feedback from peers and students to address areas of improvement in their professionalism behaviors.
- A recent survey of third-year medical students at Imperial Medical College in London examined students’ perceptions of professionalism. The authors found that the “most commonly cited aspects of professionalism by students in this study were confidentiality, good medical knowledge and practical skill. Students also cited promptness, hygiene and appearance as being important, although these factors are rarely cited in the literature.” In addition to their formal coursework on professionalism, students cited their observations of physicians, interactions with patients, the media, and their parents as important influences on their perceptions of professionalism.
After speaking at an academic medical center and physician-run health plan about Choosing Wisely, a physician told me that he had concluded that the complexity of implementing the Choosing Wisely recommendations was like solving a Rubik’s Cube. I took that to mean there were multiple changes that all had to align before the recommendations could be implemented. His comment made me think of all the interlocking pieces that would need to be put into place before better care—in the form of better quality, safety and appropriate care—occurred.
- Researchers interviewed medical students to assess the impact of Clinical Reflection Training (CRT) on how students handled professional dilemmas. Students reported that CRT reduced their stress, improved patient care and was a useful part of professional development.
- On The Health Care Blog, a primary care physician discusses the importance of “Testing Wisely” and shares his rules of preventing unnecessary tests and procedures.
- The American Academy of Family Physicians, the American Congress of Obstetricians and Gynecologists, and other professional groups issued a letter to hospitals providing maternity care urging them to eliminate non-medically indicated deliveries before 39 weeks’ gestation as part of the HHS Strong Start Initiative. According to AAFP Executive Vice-President Douglas Henley, “Strong Start allows the AAFP to spread the message from the Choosing Wisely campaign to another important target audience.”
As our nation continues to grapple with financial and ethical challenges facing its health care system, and provisions of the Affordable Care Act begin to take effect, the third annual ABIM Foundation Professionalism Article Prize serves as a call to physicians and all health care providers to fulfill the principles and commitments of the Physician Charter. This year’s winning articles highlight challenges—and opportunities—in the areas of negativity, burnout and overuse, which relate back to multiple aspects of the Charter.
- The authors of “Five Years’ Time and The Next Five Things for the List of Choosing Wisely” reflect on the evolution of hospice and palliative medicine and discuss research needed to develop another five items for physicians and patients to question.
- A new article in the Journal of the American College of Radiology suggests ways to modify the curriculum and assessment tools for radiology residents to place a greater emphasis on professionalism.
- The authors of a literature review on professionalism in surgical education provide recommendations for developing an effective surgical professionalism curriculum.
In my previous post, Incurable and Irreversible, I addressed the ambiguous language of my mother-in-law’s advanced directive at the time of her initial stroke. This post addresses the events surrounding my mother-in-law’s final days.
During her stay in the hospital after her stroke, we were confronted by the decision whether or not my mother-in-law should have her pacemaker changed. It was up for replacement and her cardiologist felt it would be convenient to have it done while she was in the hospital, and thought she would suffer from heart arrhythmia if she didn’t have it replaced. They did the procedure and afterwards she had considerable post-surgical pain and discomfort. Given her fragile state, it now seems like an unnecessary procedure but at that moment, to the family who was only concerned about her comfort level and restoring her back to health, it seemed like the logical decision to go through with it.
This Recommended Reading installment features new articles on conflicts of interest, transitions of care and patient autonomy:
- The American Medical Student Association has released its 2013 PharmFree Scorecard, which issues letter grades to medical schools based on their conflict of interest policies. A Community Catalyst blog post provides highlights from this year’s PharmFree Scorecard and reactions from several medical school leaders.
- Researchers developed a Handoff Clinical Evaluation Exercise (CEX) to assess the quality of handoffs of patient care from one physician to another, which included an assessment of the transferring physician’s professionalism. They found that the tool performed similarly in two institutions, although peer evaluators consistently gave one another higher marks than external evaluators.
- The authors of a new JAMA commentary argue that physicians can use “evidence-based persuasion” with patients while still respecting patient autonomy and provide advice on how physicians can balance persuasion and patient autonomy.
The day we launched the Choosing Wisely campaign, one year ago, we never envisioned that it would attract the attention of so many physicians across the county. Choosing Wisely has become a catalyst for conversations between patients and physicians. It has provided tools to support both patients and physicians in the pursuit of appropriate health care and evidence-based medicine. This blog has addressed the reasons for its initial resonance: its focus on waste and potential harm, and its messengers, the specialty societies—now 42 strong—Consumer Reports , and 14 consumer and employer groups.
This week’s Recommended Reading features articles on stewardship of resources and online professionalism:
- Johns Hopkins researchers conducted a randomized-controlled trial to determine whether presenting cost data to providers when they ordered a test affected test ordering. They found that presenting this data to providers resulted in a modest decrease in test ordering.
- In a recent Teaching and Learning in Medicine article (pdf), the authors presented internal medicine residents with vignettes illustrating common stewardship challenges, such as patient requests for brand-name medications or deciding whether to repeat an imaging test conducted at another facility. They found that the residents had inconsistent responses to the vignettes.
- The American College of Physicians and the Federation of State Medical Boards issued a policy statement on online professionalism and physician-patient relationships. Among their recommendations, they advise that physicians behave professionally in both personal and professional social media communication, and “should not ‘friend’ or contact patients through personal social media.”
Dr. Blair Erb of Bozeman Deaconess Health Group, located in Bozeman, MT, is a Trustee of the American College of Cardiology and sits on the Clinical Quality Committee steering committee. He is board certified in Internal Medicine and in Cardiovascular Disease. His special interests include echocardiography, valvular heart disease and risk factor modification.
Dr. Erb recently shared his thoughts on the Choosing Wisely® campaign: