Which primary care resident is more likely to initiate the discussion of designating a healthcare proxy?

Abstract

Despite widespread support for the concept of advance care planning, few Americans have a healthcare proxy. It is not known if certain physician characteristics make it less likely that the discussion of a healthcare proxy will be initiated, particularly in the case of physicians in training. The objective of this descriptive, cross-sectional study was to determine if resident characteristics (specialty, race, age, gender, and religion) affect his or her decision to initiate discussions with patients regarding designation of a healthcare proxy. Participants consisted of primary care residents employed at The Brooklyn Hospital Center, Brooklyn, New York, from the departments of Internal Medicine, Pediatrics, Obstetrics and Gynecology, and Family Practice. An anonymous 14-item questionnaire was distributed to all primary care residents (N = 151) at the hospital during their respective conferences and grand rounds. Seventy-eight residents returned the instrument for analysis. When compared to other primary care specialties (n = 40), internal medicine residents (n = 38) were more likely to initiate healthcare proxy discussions with patients (p < 0.05). Residents who were younger than 35 were more inclined to encourage decision-making by surrogates (p < 0.05). Of the total number of residents, 92 percent correctly defined a healthcare proxy, and 66 percent thought a physician should initiate patient selection of a healthcare proxy, yet only 55 percent of physicians did so. Our results indicated that a little over half of the physicians surveyed initiated discussion for a surrogate decision-maker, even though most thought it was their duty. Younger internal medicine residents are more likely to ask patients about healthcare proxies. Some residents were unable to correctly identify the definition of a healthcare proxy, and this lack of knowledge is likely to result in poor advance care planning.

The effects of recreational drug use on the genitourinary tract

“…For example, with regular use, amphetamines increase libido in 23% of men but produce impotence in 35%, while long-term use of cannabis promotes recreational use of sildenafil, inhibits orgasm and causes dyspareunia. 1,2 Furthermore, most drugs also disinhibit sexuality leading to unsafe practice, random coupling, dependence on sildenafil or similar drugs and increased incidence of sexually transmitted diseases (STDs). At least 10% of users associate sex Recreational use of drugs may be viewed by those who indulge as a relatively victimless pursuit.…”

“…Dyspareunia is also reported. 2 Now that medicinal cannabis use has been legalised and controlled in some areas, more accurate research should be possible. There are some interesting data emerging on the effect of maternal cannabis use on their children.…”