BACKGROUND Although differences between Internal Medicine (IM) and Family Practice (FP) physicians have been examined in terms of care outcomes and cost, there have been few studies of specialty differences in physician-patient communication. METHODS In 1995, 277 clinical encounters with 29 full-time, community-based FP physicians and 287 clinical encounters with 30 full-time, community based...

BACKGROUND Incorporating evidence based medicine (EBM) into clinical practice requires clinicians to learn to efficiently gain access to clinical evidence and effectively appraise its validity. Even using current electronic systems, selecting literature-based data to solve a single patient-related problem can require more time than practicing physicians or residents can spare. Clinical libraria...

This report addresses the difficult situation in which a patient or surrogate decision maker wishes cardiopulmonary resuscitation to be attempted even though the physician believes that resuscitation efforts would be futile. It also reviews current controversies surrounding the subject of do-not-resuscitate (DNR) orders and medical futility, discusses the complex medical, legal, and ethical con...

Requests by patients or their families for treatment which the patient's physician considers to be "inappropriate" are becoming more frequent than refusals of treatment which the physician considers appropriate. Such requests are often based on the patient's religious beliefs about the attributes of God (sovereignty, omnipotence), the attributes of persons (sanctity of life), or the individual'...

PURPOSE To investigate the effects of a fully functional electronic patient record (EPR) system on clinicians' work during team conferences, ward rounds, and nursing handovers. METHOD In collaboration with clinicians an EPR system was configured for a stroke unit and in trial use for 5 days, 24h a day. During the trial period the EPR system was used by all clinicians at the stroke unit and it...

BACKGROUND The InBox messaging system is an internal, electronic program used at Mayo Clinic, Rochester, MN, to facilitate the sending, receiving, and answering of patient-specific messages and alerts. A standardized InBox was implemented in the Division of General Internal Medicine to decrease the time physicians, physician assistants, and nurse practitioners (clinicians) spend on administrati...

The importance of a person's spirit and eternal destiny are eclipsed in American medi- cine. The most alarming effect of this eclipse is that the prevalence of burnout among physicians is high (about 46 percent) and growing.' It is alarming because trends that deplete the physician's spirit tragically impair the physician's capacity as a healer and as one who renews the spirit.

Several studies stressed that the introduction of CPOE applications deteriorates the doctor-nurse communication. But there are many factors that might influence communication behaviors, as for example the way these communications are organized. The present study aims at showing that the impact of a CPOE system on the cooperative activities can be controlled given that a good understanding of th...

OBJECTIVE To present preliminary evidence for the reliability and validity of the Four Habits Coding Scheme (4HCS), an instrument based on a teaching model used widely throughout Kaiser Permanente to improve clinicians' communication skills. METHODS One hundred videotaped primary care visits were coded using the 4HCS, and the data were assessed against a previously available data set for thes...

CONTEXT The adoption of pay-for-performance mechanisms for quality improvement is growing rapidly. Although there is intense interest in and optimism about pay-for-performance programs, there is little published research on pay-for-performance in health care. OBJECTIVE To evaluate the impact of a prototypical physician pay-for-performance program on quality of care. DESIGN, SETTING, AND PAR...