Computerized physician order entry (CPOE) is touted as a major improvement in patient safety, primarily as a result of the Institute of Medicine's 1999 report on medical errors and the subsequent formation of the "Leapfrog Group" of companies to preferentially direct their employees' health care to those institutions that install such systems (as part of directives that "Leapfrog" feels will im...

BACKGROUND Diabetes is widespread among Mexican-Americans, and erectile dysfunction is a well-recognized complication for which effective treatments are available. Men who desire treatment, however, might not volunteer erectile complaints to their physician, especially across cultural lines. METHODS We surveyed diabetic Mexican-American men cared for in two community health centers to estimat...

Diagnostic failure can be due to a variety of psychological errors on the part of the diagnostician. An erroneous diagnosis rendered by previous clinicians can lead a diagnostician to the wrong diagnosis. This report is the case of a patient who misdiagnosed herself and then led an emergency room physician and subsequent treating physicians to the wrong diagnosis. This mechanism of diagnostic e...

Some clinicians still believe that qualitative research is a “soft” science and of lesser value to clinical decision making, but this position is no longer tenable.2-4 A quick search using the key word qualitative on the Canadian Family Physician website generated more than 100 qualitative research articles published in the past 3 years alone. This paper provides an overview of the history of s...

The benefits of computerized physician order entry have been widely recognized, although few institutions have successfully installed these systems. Obstacles to successful implementation are organizational as well as technical. In the spring of 2000, following a 4-year period of planning and customization, a 9-month pilot project, and a 14-month hiatus for year 2000, the Ohio State University ...

OBJECTIVE To study physician-smoker interactions around the receipt of smoking cessation medication prescriptions to better understand the low rates of reported assistance and follow-up. METHODS A stratified random sample of smokers recently filling prescriptions for cessation medications was identified for a phone interview about the quitting experience. The transcriptions of those portions ...

Formal methods for the development of clinical practice guidelines have emerged to address societal needs to decrease physician practice variation, slow the rise of health-care costs, monitor inappropriate care, assist clinicians to stay abreast of new clinical information, set research priorities, and promote better health-care outcomes. Evidence-based methods ensure that guidelines provide va...

First-line chemotherapy for metastatic breast cancer has been the focus of ongoing controversy, a condition that partially reflects the imperfections of available therapy. It also partially reflects not only the imperfections in our ability to monitor response, but also the disagreements among clinicians over the goals of therapy. Each physician maintains a hierarchy of goals for the treatment ...

Objective To update the "Endocrine Treatment of Transsexual Persons: An Endocrine Society Clinical Practice Guideline," published by the Endocrine Society in 2009. Participants The participants include an Endocrine Society-appointed task force of nine experts, a methodologist, and a medical writer. Evidence This evidence-based guideline was developed using the Grading of Recommendations, As...

Adult primary care in the United States faces a dilemma. Many patients report poor access to their primary care clinician. Yet the growing demand for primary care leads to high levels of clinician burnout. A commonly voiced solution is to increase the numbers of adult primary care clinicians—physicians, nurse practitioners, and physician assistants. However, most workforce projections find that...