How Can We Create Osler’s “Great Physician”? Fundamentals for Physicians’ Competency in the Twenty-first Century

Ronen, Gabriel M.; Camargo, Olaf Kraus de; Rosenbaum, Peter

doi:10.1007/s40670-020-01003-1

Cited by 11 publications

(8 citation statements)

References 19 publications

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“…22 There is a rich literature and increasing emphasis in medical training on how to convey serious news. 8,[23][24][25][26][27] This study identifies additional factors that may influence the diagnostic experience of receiving a life-altering genetic diagnosis like CDD.…”

Section: Discussionmentioning

confidence: 99%

The Lived Experience of Parents’ Receiving the Diagnosis of CDKL5 Deficiency Disorder for Their Child

et al. 2022

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CDKL5 deficiency disorder (CDD), a severe developmental and epileptic encephalopathy, is being diagnosed earlier with improved access to genetic testing, but this may also have unanticipated impacts on parents’ experience receiving the diagnosis. This study explores the lived experience of parents receiving a diagnosis of CDD for their child using mixed methods. Thirty-seven semistructured interviews were conducted with parents of children with a diagnosis of CDD, which were coded and analyzed to identify themes. Grief was a nearly universal theme expressed among participants. Parents of younger children discussed grief in the context of receiving the diagnosis, whereas parents of older children indicated they were at different stages along the grieving journey when they received the diagnosis. Parents with less understanding of their child's prognosis (poorer prognostic awareness) connected their grief to receiving the diagnosis as this brought a clear understanding of the prognosis. Several themes suggested what providers did well to improve the diagnostic experience for parents, much of which aligns with existing literature around how to provide serious news. Additionally, parents identified long-term benefits of having a diagnosis for their child's medical problems. Although interview data were concordant with a survey of parents’ diagnostic experience from a large international cohort, most participants in this study were relatively affluent, white mothers and further research is needed to better understand if other groups of parents have a different diagnostic experience. This study gives context of parental experience that providers should be aware of when conveying new genetic diagnoses to families.

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Section: Discussionmentioning

confidence: 99%

The Lived Experience of Parents’ Receiving the Diagnosis of CDKL5 Deficiency Disorder for Their Child

et al. 2022

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“…William Osler, regarded as the father of integrated scientific and personalized medicine, placed the study of blood central to teaching, research, and clinical practice. 13,14 He was a foremost proponent of treating the patient who has the disease.…”

Section: Table 1 Definition and Components Of Shared Decision-makingmentioning

confidence: 99%

Patients’ Choice, Consent, and Ethics in Patient Blood Management

Pearse

Delaforce

Farmer

2022

Anesthesia &Amp; Analgesia

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The goal of patient blood management (PBM) is to optimize clinical outcomes for individual patients by managing their blood as a precious and unique resource to be safeguarded and managed judiciously. A corollary to successful PBM is the minimization or avoidance of blood transfusion and stewardship of donated blood. The first is achieved by a multidisciplinary approach with personalized management plans shared and decided on with the patient or their substitute. It follows that the physician-patient relationship is an integral component of medical practice and the fundamental link between patient and doctor based on trust and honest communication. Central to PBM is accurate and timely diagnosis based on sound physiology and pathophysiology as the bedrock on which scientifically based medicine is founded. PBM in all disease contexts starts with the questions, "What is the status of the patient's blood?" "If there are specific abnormalities in the blood, how should they be managed?" and "If allogeneic blood transfusion is considered, is there no reasonable alternative therapy?" There are compelling scientific reasons to implement a nontransfusion default position when there is clinical uncertainty and questionable evidence of clinical efficacy for allogeneic blood transfusion due to known potential hazards. Patients must be informed of their diagnosis, the nature, severity and prognosis of the disease, and treatment options along with risks and benefits. They should be involved in decision-making regarding their management. However, as part of this process, there are multifaceted medical, legal, ethical, and economic issues, encompassing shared decisionmaking, patient choice, and informed consent. Furthermore, variability in patient circumstances and preferences, the complexity of medical science, and the workings of health care systems in which consent takes place can be bewildering, not only for the patient but also for clinicians obtaining consent.

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“…Patients' (women included) trust in the healthcare system is regarded as a binding mechanism of interactions, based on a 'decision to trust' and as a resource of social capital (Straten et al, 2002). A patients' voice is an integral part of the contemporary framework for reaching a model of Osler's "Great Physician", comprising of physicians' knowledge and ethics, science, and patient's voice (Ronen et al, 2020), or for developing interventions to even further improve trust in physicians (Rolfe et al, 2014). Today, when the paternalistic model is officially abandoned, the documents of WHO and many national medical associations state "Doctor-patient relations must be based on mutual trust and responsibility, so that the patient actively participates in her treatment", to increase involvement in her/his treatment, which is one of the pillars of quality and, more importantly, safe health care (Article 51 of Ethical Codex of Medical Chamber of Serbia).…”

Section: Women's' Trust Within the Paternalistic Modelmentioning

confidence: 99%

Women’s Trust in the Healthcare System in Serbia: Validation of the Women’s Trust and Confidence in Healthcare System (Witch) Scale

Ninković¹,

Damnjanović²,

Ilić³

2022

Preprint

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Trust in the healthcare system is one of the prerequisites for positive treatment outcomes. Studies continuously show positive association of trust and patients’ desirable health behaviours, such as sticking to the recommended therapy. Being a quintessential social role, the role of women as patients is associated with other relations of power embedded in society, and studies have repeatedly shown the influence of gender on healthcare-seeking behaviour. Gender stereotypes reduce women's agency in health behaviour and women are more likely to be distrusted by physicians. Furthermore, most of the current psychological measures of trust in the healthcare system have been constructed and validated in Western, educated, industrialised, rich, and democratic (WEIRD) countries, and hence have a limited application in the other social contexts, such as South-eastern Europe. In this study, we constructed a Women’s Trust and Confidence in Healthcare System (WITCH) scale and validated its structure in Serbia. Exploratory factor analysis in Sample 1 (N=329) indicated four-factor structure of trust in the healthcare system, with two dimensions that capture trust (particularised trust, generalised mistrust), the third being confidence, and the fourth that relates to behavioural outcomes of trust. In sample 2 (N=333), we validated the 3+1 factor structure using Confirmatory factor analysis. We observed that interpersonal trust predicted women’s desirable health behaviours in a positive direction, while generalised trust in the system had a negative impact. This pattern of the results indicates the complex interplay between trust in the healthcare system and health-related behaviours.

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How Can We Create Osler’s “Great Physician”? Fundamentals for Physicians’ Competency in the Twenty-first Century

Cited by 11 publications

References 19 publications

The Lived Experience of Parents’ Receiving the Diagnosis of CDKL5 Deficiency Disorder for Their Child

The Lived Experience of Parents’ Receiving the Diagnosis of CDKL5 Deficiency Disorder for Their Child

Patients’ Choice, Consent, and Ethics in Patient Blood Management

Women’s Trust in the Healthcare System in Serbia: Validation of the Women’s Trust and Confidence in Healthcare System (Witch) Scale

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