Linda Worley

Using relationship styles based on attachment theory to improve understanding of specialty choice in medicine

BackgroundPatient-provider relationships in primary care are characterized by greater continuity and depth than in non-primary care specialties. We hypothesized that relationship styles of medical students based on attachment theory are associated with specialty choice factors and that such factors will mediate the association between relationship style and ultimately matching in a primary care specialty.MethodsWe determined the relationship styles, demographic characteristics and resident specialty match of 106 fourth-year medical students. We assessed the associations between 1) relationship style and specialty choice factors; 2) specialty choice factors and specialty match, and 3) relationship style and specialty match. We also conducted mediation analyses to determine if factors examined in a specialty choice questionnaire mediate the association between relationship style and ultimately matching in a primary care specialty.ResultsPrevalence of attachment styles was similar to that found in the general population and other medical school settings with 59% of students rating themselves as having a secure relationship style. Patient centeredness was directly associated, and career rewards inversely associated with matching in a primary care specialty. Students with a self-reliant relationship style were significantly more likely to match in a non-primary care specialty as compared to students with secure relationship style (OR = 5.3, 95% CI 1.8, 15.6). There was full mediation of the association between relationship style and specialty match by the specialty choice factor characterized by patient centeredness.ConclusionAssessing relationship styles based on attachment theory may be a potentially useful way to improve understanding and counsel medical students about specialty choice.

Our fallen peers: a mandate for change.

ObjectiveThe author identifies and seeks to remove barriers contributing to physician/medical students’ decisions NOT to seek mental health care.MethodsFollowing a cluster of medical student and physician suicides in one medical community, medical trainees anonymously shared their views regarding seeking mental health treatment in light of the current disclosure requirements for medical licensure. In an effort to identify medical licensure questions that more accurately assess for potential impairment—replacing the stigmatizing global inquiry about past mental health treatment—47 states’ medical licensure questions available on the web were examined. Representatives from the state’s psychiatric and medical societies joined efforts to formally request the State Medical Board to revise the licensure questions.ResultsThe State Medical Board unanimously approved the recommended changes.ConclusionOvercoming stigma within the medical profession regarding seeking psychiatric care is a difficult process requiring ongoing education of our colleagues. Physicians must have the opportunity to seek confidential mental health treatment at their earliest signs of distress in order to maximize their optimal functioning in an effort to prevent impairment.

Follow-up consultation billing and documentation.

Frequently, bills are not submitted for follow-up visits for patients who have been evaluated psychiatrically on medical-surgical services. There often is confusion regarding which procedure codes are most appropriate to use in billing. To help the consultant understand the documentation requirements for various procedure codes, information from several sources was synthesized and distilled. This paper should help minimize documentation errors and maximize reimbursement for clinical services. The authors have reviewed available billing choices, and clarified the documentation requirements for different procedure codes according to Medicare regulations.