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The importance of ensuring the well-being of physicians is determined by the serious changes in medical organizations that transform the traditional “doctor - patient” relationship and set different indicators of the medical care quality (Melnyk et al., 2020; Sandy et al., 2019; Tawfik et al., 2019).
The main objective was to study the characteristics of the well-being of physicians working in public and commercial medical institutions. The difference in these “environments” is the degree of independence and responsibility in the course of diagnosis and treatment.
The study involved 102 people: 66 of them are employees at public hospitals, 36 –at commercial medical centers. The respondents were offered a methodic package aimed to diagnose: career orientations; the degree of satisfaction with various work aspects; severity of burnout symptoms; subjective assessment of their work.
The estimating factor analysis identified 3 factors (73% of the total variance of the data) –such as emotional acceptance of one’s work, stress and tension, intellectual workload. The indicator of emotional exhaustion among physicians of commercial centers is significantly higher than that of doctors of public hospitals, which indicates a greater emotional involvement in the situation of providing paid services (p≤0.007).
The main direction of psychological work with physicians of commercial institutions is teaching them to regulating the emotional state and to master communicative techniques. An important part of psychological support of physicians in public hospitals is to provide a favorable psychological climate that ensures the professional growth and adherence to humane principles of working with patients.
In this chapter I introduce the thesis that Aristotle’s biology was considerably influenced by medical tradition as represented by the so-called Hippocratic writings. I start with a brief discussion of the history of the debate and the state of investigation and introduce the main advocates as well as opponents of the thesis. I then focus on Aristotle’s remarks on distinguished physicians and the relationship between medicine and natural philosophy in Parva Naturalia. With the help of selected passages from the Hippocratic On Regimen, On Flesh and On Ancient Medicine I make the case that Aristotle reflects upon a specific medical debate on the first principles of human (and animal) physiology and clarifies his own position in it, namely that he takes sides with those physicians who practice their discipline “in a more philosophical manner” and who employ heat, cold, and other such qualities as the starting points of their physiological explanations.
This chapter documents and identifies the presence of several kinds of European medical practitioners in West-Central Africa. It shows that African healers were not the only ones whose practice could come under the scrutiny of ecclesiastical or secular authorities. The legitimacy of white healers was similarly discussed from time to time. In Luanda, ailing patients could theoretically go to a number of Portuguese practitioners, but in reality the number of physicians and surgeons was limited and concentrated on treating the colonial elites and soldiers serving in the military. A fair number of Africans were trained as and served as barbers in Angola and Kongo, pointing to the transfer of European medical technology to Africans. Medical pluralism reflected mostly local African practices and values, but global influences were also present in the form of the charitable brotherhoods, which ran hospitals in Luanda, Benguela and Massangano. It is also evident in the arrival of quina bark from Brazil as early as the 1720s.
King Asa in 2 Chr 16 suffers from a foot ailment, which is framed by the specific trait of self-reliance and his disrespect for prophets and the people. The Chronicler uses the king’s foot disease to underscore Asa’s character flaw of self-reliance. Even when his illness is severe, Asa does not turn to Yahweh, but relies on the physicians (2 Chr 16:12b). This interpretation of Asa’s illness is not only integrated into the overall trajectory of Asa’s reign as envisioned by the Chronicler, but also introduces a hitherto unmentioned group of health care professional, namely the physicians (רופאים). This chapter will first give an overview of Asa’s reign both in Kings and Chronicles. Then, I will analyze the role of the physicians. It is shown that Asa’s mistake, according to the Chronicler, consists of turning to physicians alone when he should also have consulted with priests and prophets.
To explore if there is an interaction effect between gender (men and women) and profession (nurses and physicians) in posttraumatic growth (PTG).
PTG is defined as a positive psychological change experienced as a result of struggling with highly challenging life circumstances. It may take the form of improved self-image, a deeper understanding of self, increased spirituality, and/or enhanced interpersonal relationships. Gender and profession were found separately to be associated with PTG, but to date were not examined under interaction effect.
We employed a cross-sectional study conducted in the tertiary medical center in Israel using a convenience sample. One hundred and twenty-eight nurses and seventy-eight physicians gave their consent and agreed to fill out self-report questionnaires regarding personal and professional data and PTG Inventory.
The correlation matrix revealed that being a woman was associated with higher PTG total scale (r = 0.242; P ≤ 0.001) and its subscales except for spiritual change that showed no evidence of statistical effect. Similar pattern was found for being a nurse with PTG total scale (r = 0.223; P ≤0.001) and its subscales except for relating to others that showed no evidence of statistical effect. However, the interaction effect revealed that among men, there was no difference in the level of PTG and its subscales based on profession (Physicians men = 62.54 (20.82) versus Nurses men = 60.26 (22.39); F = 9.618; P = 0.002). Among women, nurses had a significantly higher scores in PTG (Physicians women = 61.81 (18.51) versus Nurses women = 73.87 (12.36); F = 9.618; P = 0.002) and its subscales in comparison to physicians except for subscale relating to other.
Our findings suggest implications for research and practice namely exploring PTG among nurses and physicians would benefit from applying interaction effect of gender and profession. For practice, advocating PTG within the health care organization is needed to be tailored with gender and professional sensitivity.
An examination of invasive procedure cancellations found that the lack of pre-procedural oral screening was a preventable cause, for children with congenital heart disease. The purpose of this study was to implement an oral screening tool within the paediatric cardiology clinic, with referral to paediatric dental providers for positive screens. The target population were children aged ≥6 months to <18 years old, being referred for cardiac procedures.
The quality implementation framework method was used for this study design. The multi-modal intervention included education, audit and feedback, screening guidelines, environmental support, and interdisciplinary collaboration. Baseline rates for oral screenings were determined by retrospective chart audit from January 2018 to January 2019 (n = 211). Provider adherence to the oral screening tool was the outcome measure. Positive oral screens, resulting in referral to the paediatric dental clinic, were measured as a secondary outcome. Provider adherence rates were used as a process measure.
Data collected over 14 weeks showed a 29% increase in documentation of oral screenings prior to referral, as compared to the retrospective chart audit. During the study period, 13% of completed screenings were positive (n = 5). Provider compliance for the period was averaged at 70% adherence.
A substantial increase in pre-procedural oral screenings by paediatric cardiologists was achieved using the quality implementation framework and targeted interventions.
Substance use disorders affect physicians at a prevalence like the general population, yet they are difficult to detect and are inextricably linked to job dissatisfaction and burnout. Often physicians develop complex denial strategies and rationalizations, and shame and stigma prevent them from seeking help. However, when engaged in treatment and monitored through state-level Physicians Health Programs (PHPs), including long term monitoring and systems of accountability, approximately 80 percent will stay sober for and return to work in five years. This continuing care model with long-term monitoring and follow up, if adopted for the general population, may provide a paradigm shifting approach for the treatment of substance addictions, and might be extended to behavioral addictions.
Protecting patients with disabilities against discrimination in the provision of healthcare, especially violations of their civil or human rights, requires an understanding of the common biases that undermine equal treatment in clinical, diagnostic, and therapeutic contexts. Nevertheless, this topic is rarely acknowledged in legal or social scientific studies of bias in healthcare decision-making. Consequently, prejudices against persons with disabilities – “ableism” – in these settings remain prevalent and unaddressed.
Physicians have a higher suicide rate than the general population or other academics. Little is known about the reasons for this. Analysing risk factors may be a valuable way of identifying reasons for the high suicide rate among physicians, thereby leading to preventive efforts. The present study is one of the first papers on suicidal thoughts and attempts among physicians. A questionnaire about suicidal thoughts (developed by E.S. Paykel) was completed by 1,063 of 1,476 active Norwegian physicians (72%). Lifetime prevalence ranged from 51.1% for feelings that life was not worth living to 1.6% for a suicide attempt. Risk factors were being female, living alone, and depression. Suicidal thoughts, however, were hardly attributed to working conditions. A high rate of suicide and a low rate of suicidal attempts support the hypothesis that physicians do not ‘cry for help,' but are inclined to act out their suicidal impulses.
Chapter 6 uses public writings by physicians and business records, especially from the Pullman Corporation, to show how physicians employed by large companies became the front line in employer efforts to control compensation costs by discriminating against disabled people. The chapter shows how the medical subfield of industrial medicine was always rooted in perspectives and practices that treated working-class people as economic objects. At the same time, early on specialists in the field emphasized that industrial medicine could be a source of mutual benefit for both employers and employees. The field matured and became more independent at the height of the aftermath of the creation of compensation laws, with industrial physicians forming their professional association in the mid-1910s. The leading lights of the field quickly came to emphasize benefits to employers over and against employees, above all medicalized employment discrimination in the form of physical examinations of applicants and employees. Those examinations in turn rapidly lost most medical value for the people examined, focused as they were on employer-side cost control.
During the final years of Ottoman rule and the three decades of British rule, Palestine witnessed the emergence of a community of professionally trained Palestinian Arab doctors. This study traces the evolution of the medical profession in Palestine against the background of the shifting cultural and symbolic capital of an expanding urban middle class and the educational possibilities that enabled this development. Palestinian Arab doctors are examined through a number of interconnected prisms: their activity in social, political, and professional regional networks, their modus operandi under British colonial rule, their response to Zionism and its accompanying influx of immigrant Jewish doctors, and their ability to mobilize collectively under a shared national vision.
Chapter 1 explores the gradual introduction of family planning to Cuban women, highlighting the Revolution’s centralization of state authority as well as its rejection of medical plurality. The chapter argues that medical leadership implemented policies that ultimately increased state control over women’s labor and reproductive decisions. Early public health models failed to include access to abortion and helped fuel rumors that the government had criminalized the procedures. But revolutionary leadership never responded to these popular rumors and instead emphasized the benefits of hospital births and the ideological dangers of birth control; evidence suggests that poor Afro-Cuban women and rural women were specific targets of this effort to regulate reproduction. By 1965, following an unexpected baby boom, the Ministry of Public Health began to provide women with some contraceptive options. But reproductive autonomy was not the goal of these reforms, and Cuban women’s persistent reliance on unauthorized abortions to regulate reproduction reveals that state health programs were not meeting the needs of all its citizens. The chapter shows that it was only after 1971 that both contraceptives and abortions became more available to Cuban women, reflecting a shift to bring the ideology more in line with that advanced by the Soviets.
The “Defense of Medicine” prefaces the Codex Bambergensis Medicinalis 1, a Carolingian collection of medical texts. Some scholars have dismissed the Defense as an incoherent patchwork of quotations. Yet, missing from the literature is an adequate assessment of the Defense's arguments. This present study includes the first English translation accompanied by a complete source commentary, a prerequisite for valid content analysis. When read systematically and with attention to the author's use of sources, the Defense is limpid and cogent. Its first purpose is to defend the compatibility of Christian faith and secular medicine. Key propositions include the following: God made nature good, so the natural sciences are reconcilable with divine learning; scripture respects medicine; God expects the sick to avail of physicians and deserves honor for healings done through physicians. Counter-arguments used by the Defense's opponents, who rejected medicine on principle, can also be reconstructed from the text. Two further purposes of the Defense have hitherto been explored insufficiently. After justifying medicine, the Defense addresses sick patients. It encourages them that illness can be spiritually healthful, an instrument for curing their souls. The Defense then addresses caregivers. It tells them why they should succor the sick, even the poor: not for gain or fame, but in imitation of Christ and as if treating Christ himself, whose image the sick bear. The Defense thus contributes to the history of ideas on medicine, health, sickness, and the ethics of altruistic care.
Chapter 5 traces the evidence for the practice of astrometeorology by scholars and professionals in the service of the European elite. This phenomenon faced criticism from those who feared the rise of judicial astrology and the associated threat of demonic intervention. The chapter analyses the level of meteorological knowledge displayed by scholars such as William of Conches, adviser to Geoffrey of Anjou. William knew works attributed to Masha’allah as well as Seneca, and deployed the new, scientific terminology that spread in the twelfth century. A key point is that works like William’s depict secular rulers as keenly interested in understanding and predicting the weather. From this the chapter moves on to the more advanced astrometeorological teachings of Abraham Ibn Ezra, a Jewish scholar from al Andalus who travelled across Italy and Spain. One of his innovations was to provide tables of mathematical values to be applied to astrometeorological configurations, making forecasting much simpler. This was to be followed by others in the thirteenth century. The chapter ends with comment on the scarcity of surviving twelfth-century copies of these works.
Consensus guidelines recommend that children consume reduced-fat (0·1–2 %) cow’s milk at age 2 years to reduce the risk of obesity. Behaviours and perspectives of parents and physicians about cow’s milk fat for children are unknown. Objectives were to: (i) understand what cow’s milk fat recommendations physicians provide to 2-year-old children; (ii) assess the acceptability of reduced-fat v. whole cow’s milk in children’s diets by parents and physicians; and (iii) explore attitudes and perceptions about cow’s milk fat for children.
Online questionnaires and individual interviews were conducted. Questionnaire data were analysed using descriptive statistics. Interview transcripts were analysed using a general inductive approach and thematic analysis.
The TARGet Kids! practice-based research network in Toronto, Canada.
Questionnaire respondents included fifty parents and fifteen physicians; individual interviews were conducted with with fourteen parents and twelve physicians.
Physicians provided various milk fat recommendations for 2-year-old children. Parents also provided different cow’s milks: eighteen (36 %) provided whole milk and twenty-nine (58 %) provided reduced-fat milk. Analysis of qualitative interviews revealed three themes: (i) healthy eating behaviours, (ii) trustworthy nutrition information and (iii) importance of dietary fat for children.
Parents provide, and physicians recommend, a variety of cow’s milks for children and hold mixed interpretations of the role of cow’s milk fat in children’s diets. Clarity about its effect on child adiposity is needed to help make informed decisions about cow’s milk fat for children.
Chaucer lived in a society that was aware of childhood and adolescence as distinctive stages of human life and which inherited practices whereby young people were brought up and trained for adulthood. Informally, at home, children were introduced to social norms, religion and work. Those from wealthier families underwent more formal education, mastering literacy at home, in schools or in great households, where they learnt reading, rules of courtesy, French and, in the case of some boys, Latin. Chaucer’s works refer in passing to most of these processes, with particular attention to adolescents, including university scholars. During the fifteenth century his works in general came to be seen as having educational value. The Astrolabe, first written for his son Lewis, seems to have been used for teaching reading to other young children while his major writings were recommended as suitable literature for older ones.
This chapter addresses the tension between care for the body and care for the Christian soul within medieval medicine. In particular, it argues that medieval patients often devalued the skill and knowledge of physicians, since physicians were perceived to be overly concerned with the study of medicine rather than its praxis. Moreover, the relative inability of the medieval medical practitioner to combat death effectively (despite charging large fees for his service) led to the development of literary motifs mocking the incompetence of physicians. This chapter argues that Chaucer shared many medieval English prejudices against physicians as a social class, as well as the perception that human beings had only limited recourse against the dictates of mortality. It also provides a survey of many of Chaucer’s invocations of medical theory, and contextualises Chaucer’s attitudes to medicine and medical practice within a larger literary and historical context.
The tension between theoretical and practical knowledge was particularly problematic for trainee physicians. Unlike civic apprenticeships in surgery and pharmacy, in early modern England there was no standard procedure for obtaining education in the practical aspects of the physician’s role, a very uncertain process of certification, and little regulation to ensure a suitable reward for their educational investment. For all the emphasis on academic learning and international travel, the majority of provincial physicians returned to practice in their home area, because establishing a practice owed more to networks of kinship, patronage and credit than to formal qualifications. Only when (and where) practitioners had to rely solely on their professional qualification to establish their status as young practitioners that the community could trust would proposals to reform medical education, such as those put forward to address a crisis of medicine in Restoration London, which are examined here, be converted into national regulation of medical education in the early nineteenth century, although these proposals prefigured many informal developments in medical training in the eighteenth century.
Restoration London saw a wave of publications by physicians advocating that the ‘compleat physician’ should be one who experimented and produced his own medicines. Only thus, they argued, could the medical hierarchy be restored and medical authority re-established on a defensible basis. This article seeks to explain the context for this unusual approach, and why it failed to attract mainstream physicians by the end of the century, by considering the sixty-year career of one of its leading advocates, Everard Maynwaring (c.1629–1713), a prolific medical author, and what his own failure to enter the medical establishment may show about the problems inherent in this model for the physician. A university-trained gentleman physician who converted to chymical medicine c.1660, Maynwaring published learned and relatively unpolemical texts to persuade both medical and lay audiences of the superiority of experimental medicine as a mode of learned practice, yet could not easily reconcile this with the advocacy and sale of his own chymical medicines (especially as he focused increasingly on a small group of ‘universal medicines’) without being branded an ‘empirick’. Fragmentary evidence regarding his career suggests he became increasingly marginalised, and as an old man was reduced to advertising his cures like the ‘empiricks’ from whom he had sought to distance both himself and physicians in general.
International research has generated strong evidence that healthcare providers (HCPs) play a key role in the return to work (RTW) process. However, pressure on consultation time, administrative challenges and limited knowledge about a patient's workplace can thwart meaningful engagement. Aim: Our study sought to understand how HCPs interact with workers compensation boards (WCBs), manage the treatment of workers compensation patients and navigate the RTW process. Method: The study involved in-depth interviews with 97 HCPs in British Columbia, Manitoba, Ontario and Newfoundland and Labrador and interviews with 34 case managers (CMs). An inductive, constant comparative analysis was employed to develop key themes. Findings: Most HCPs did not encounter significant problems with the workers compensation system or the RTW process when they treated patients who had visible, acute, physical injuries, but faced challenges when they encountered patients with multiple injuries, gradual-onset or complex illnesses, chronic pain and mental health conditions. In these circumstances, many experienced the workers compensation system as opaque and confusing. A number of systemic, process and administrative hurdles, disagreements about medical decisions and lack of role clarity impeded the meaningful engagement of HCPs in RTW. In turn, this has resulted in challenges for injured workers (IWs), as well as inefficiencies in the workers compensation system. Conclusion: This study raises questions about the appropriate role of HCPs in the RTW process. We offer suggestions about practices and policies that can clarify the role of HCPs and make workers compensation systems easier to navigate for all stakeholders.