Hava Tabenkin

Gender differences in time spent during direct observation of doctor-patient encounters.

BACKGROUND Despite increasing recognition of womens health needs, little is known about how primary care physicians spend time with women. Therefore, we examined differences in time use and preventive service delivery during outpatient visits by male and female patients. METHODS As part of a multimethod study of 138 family physicians, 3384 outpatient visits by adults were directly observed, medical records were reviewed, and patient surveys were performed. Time use was assessed by the Davis Observation Code, which classifies every 15 seconds into 20 behavioral categories. Receipt of health habit counseling recommended by the U.S. Preventive Services Task Force was assessed by direct observation, and eligibility was determined by chart review. Logistic regression and multivariate analysis of variance (ANOVA) were used to compare time use and preventive service delivery in visits by women vs. men. RESULTS Sixty-four percent of adult visits were from women. Women reported poorer physical health, had higher rates of anxiety (12.5% vs. 7.4% in men), and depression (21.9% vs. 8.4% in men), a higher percent of visits for well care (10.2% vs. 8.8% in men), and more drugs prescribed (64.8% vs. 61% in men) and raised more emotional issues than men (14.7% vs. 7.5%). After controlling for visit and patients characteristics, visits by women had a higher percent of time spent on physical examination, structuring the intervention, patient questions, screening, and emotional counseling. Visits by men involved a higher percent of time spent on procedures and health behavior counseling. More eligible men than women received exercise, diet, and substance abuse counseling. Patients of female physicians exhibited gender differences in only one category of how time was spent (substance abuse), whereas among patients of male physicians, gender differences were noted in 10 of the 20 categories. CONCLUSIONS Outpatient visits by women differ from those of men in ways that reflect womens unique healthcare needs but also raise concern about unequal delivery of health habit counseling for diet and exercise.

Differences in cardiovascular disease risk factor management in primary care by sex of physician and patient

PURPOSE The purpose of this study was to evaluate differences in the management of cardiovascular disease (CVD) risk factors based upon the sex of the patient and physician and their interaction in primary care practice. METHODS We evaluated CVD risk factor management in 4,195 patients cared for by 39 male and 16 female primary care physicians in 30 practices in southeastern New England. RESULTS Many of the sex-based differences in CVD risk factor management on crude analysis are lost once adjusted for confounding factors found at the level of the patient, physician, and practice. In multilevel adjusted analyses, styles of CVD risk factor management differed by the sex of the physician, with more female physicians documenting diet and weight loss counseling for hypertension (odds ratio [OR] = 2.22; 95% confidence interval [CI], 1.12–4.40) and obesity (OR = 2.14; 95% CI, 1.30–3.51) and more physical activity counseling for obesity (OR = 2.03; 95% CI, 1.30–3.18) and diabetes (OR = 6.55; 95% CI, 2.01–21.33). Diabetes management differed by the sex of the patient, with fewer women receiving glucose-lowering medications (OR = 0.49; 95% CI, 0.25–0.94), angiotensin-converting enzyme inhibitor therapy (OR = 0.39; 95% CI, 0.22–0.72), and aspirin prophylaxis (OR = 0.30; 95% CI, 0.15–0.58). CONCLUSION Quality of care as measured by patients meeting CVD risk factors treatment goals was similar regardless of the sex of the patient or physician. Selected differences were found in the style of CVD risk factor management by sex of physician and patient.

Physician managers: Personal characteristics versus institutional demands

This article presents results of a survey of 169 physician managers and addresses what influences their task performance—organizational demands or personal characteristics?

Rehabilitation of elderly patients in the community following surgery for hip fracture – utilization of personal and health care services

Purpose: To assess the change in utilization of personal and health care services following surgery for hip fracture in elderly patients rehabilitated in the community. Methods: A descriptive study of patients hospitalized in the orthopedic surgery ward for traumatic hip fracture. The first interview took place after surgery and included functional and medical data, and details on utilization of personal and health care services in the month prior to surgery. The second interview took place at home three months after discharge from the hospital and documented corresponding data for the last month. Results: The study included 91 elderly patients. The mean number of contacts with health care providers increased from 4.6/month before HF to 6.4/month during rehabilitation; in particular an increase in home visits by primary care nurses and physicians from 0.4 to 1.0 visit/month (p < 0.001). Personal care showed a greater increase from 32.5 to 95.0 weekly hours (p < 0.001). Multivariate analyses showed that the increase in primary care visits was associated with chronic co-morbidity and being single, while the increase in personal care was associated with medium dependence level and an ambulatory rehabilitation setting. Conclusions: During the rehabilitation period in the community there was an increase in non-rehabilitative services-medical and personal. Morbidity and functional data could predict the increase in use at time of discharge from hospital. Implications for Rehabilitation Fracture of hip is a common event in the elderly that necessitates surgical repair. Rehabilitation treatment after surgery for hip fracture aimed to return the patients to pre-event functional status and prevent the further development of disability. Rehabilitation treatment can be provided either in the hospital or in the community. During rehabilitation period there is an increase in use of primary care and personal services. Part of the increase can be predicted at time of hospitalization.

Variations in referrals to consultants: a study of general practitioners' characteristics in southern Israel.

The rate at which primary physicians refer patients to consultants varies considerably, not only within different regions, but also among practices within defined areas. Differences also have been identified between doctors within the same practice. This variation in referral rates is a source of concern because of the costs generated and implications for quality and quantity of care. Many studies that tried to identify the sources for this variation explained only part of it; however, these studies were based on small numbers.

Medical Ethics: Training Residents in Family Medicine

Ethical dilemmas are an inevitable part of the physician’s professional life and experience in dealing with them is acquired over time. The experience that is acquired depends, largely, on the spectrum of medical situations that the physician encounters and the degree to which he or she is involved in them. A descriptive study was conducted among junior residents in family medicine in Israel. The study instrument was a questionnaire that assessed the experience and exposure the residents have to ethical issues in their family medicine residency programme. Residents were exposed to a broad spectrum of problems and involved in varying degrees in their solution. This provided a good opportunity for training in medical ethics, an approach which we believe should be an integral part of the residency programme. Research of this nature can provide information to guide curriculum development aimed at integrating theoretical teaching with experiential training while also monitoring residents’ achievements. Education for Primary Care (2008) 19: 303–12 # 2008 Radcliffe Publishing Limited