The counseling practices of internists

Article Abstract:

The main causes of death in the US are the result of personal behaviors (smoking, failure to use seat belts, alcohol consumption, sexual habits) that can be controlled. Internists (physicians who practice internal medicine) are ideally situated to counsel patients regarding health risks. To determine whether they do, in fact, promote such efforts among patients, a mail survey was conducted of a selected sample of 1,349 internists who were members of the American College of Physicians (ACP). Questions concerned the ''aggressiveness'' of counseling patients about personal habits, and ''indications'', the extent to which all patients, or only those deemed at risk, were counseled. The personal habits of interest were smoking, drinking, exercise, and seat belt use. Physicians' personal health habits were also explored. Results showed that physicians who practiced general internal medicine were more likely than specialists to counsel patients at least once, and to be more aggressive when they did so. Sixty-five percent of the respondents who counseled spent more than three minutes talking about smoking, and more than half talked for more than three minutes about drinking. However, when aggressiveness and indications were evaluated together, much smaller proportions of practitioners could be said to thoroughly counsel their patients. Less than four percent of the respondents were current smokers; 37 percent drank alcohol either daily (11 percent) or several times a week. Most used seat belts, and fewer than 20 percent said they were not very active. Evaluation of these physicians' perceived effectiveness in changing their patients' behaviors showed that higher perceived effectiveness was associated with longer amounts of time devoted to counseling. In general, the personal health habits of the physician were correlated with the physician's tendencies to counsel patients for the same behaviors. Internists do not appear to counsel patients as often and as intensely as they should. This issue should be addressed in medical schools and by other training programs. Other findings concerning health promotion by internists appear in a companion article in the January 1, 1990 issue of the Annals of Internal Medicine. (Consumer Summary produced by Reliance Medical Information, Inc.)

Services, Smokers, Patients

---

Internists' practices in health promotion and disease prevention: a survey

Article Abstract:

Internists (physicians who practice internal medicine) are ideally situated to advise patients with respect to disease prevention, but whether they do, in fact, promote such efforts among patients has not been systematically studied. To this end, a mail survey was conducted of a selected sample of 2,610 internist members of the American College of Physicians (ACP) to elicit information concerning respondents' preventive practices. Seventy-five percent of eligible physicians participated. Questions concerned background information for participating physicians (personal health behaviors, type of medical practice, immunizations); record keeping; and patient-directed practices such as immunization, advice regarding screening tests, and counseling regarding smoking, exercise, seat belt use, and alcohol consumption. The findings concerning counseling behaviors are presented in a companion article in the January 1, 1990 issue of the Annals of Internal Medicine. Results showed that, in general, these physicians did not conform well to expert guidelines regarding disease prevention. For instance, although vaccination against pneumococcus and influenza should be offered to the same patients, patients were given influenza vaccine far more often than pneumococcal vaccine. Personal attitudes and practices appeared to be more influential in physicians' use of preventive approaches, exemplified in the greater tendency of female physicians to recommend screening for cervical or breast cancer, but not for other disorders. Half the respondents did not themselves have personal physicians, and more than half had not undergone a physical examination in the previous three years. Nor were their own vaccination schedules up-to-date. Younger physicians, those practicing general internal medicine, those practicing in groups, and female physicians, were more likely to adhere to health promotion guidelines. Overall, internists do not make appropriate use of expert recommendations concerning disease prevention. Since many major medical problems are now known to be preventable, correction of these failings would undoubtedly result in improved patient health. (Consumer Summary produced by Reliance Medical Information, Inc.)

Preventive medicine, Medicine, Preventive

---

How satisfying is the practice of internal medicine? A national survey

Article Abstract:

In response to many signs that physicians who practice internal medicine (internists) are dissatisfied with their careers, the American College of Physicians carried out a questionnaire survey of 1,290 of its members in 1989. Questions concerned the extent to which respondents experienced satisfaction or distress; the most satisfying and dissatisfying aspects of practicing internal medicine; differences among subgroups of internists who might feel more dissatisfaction; whether internists would advise medical students to follow in their footsteps on the career path; concerns over patients' lack of access to medical care; and the proportion of internists who believe that major changes are needed in the health care system. Results showed that 69 percent of the participants were satisfied with their practices, although only 39 percent said they would ''do it all over again.'' Seventeen and 23 percent, respectively, they were strongly or mildly discouraging of students' desires to enter the specialty. Most internists were satisfied with the basic aspects of medical practice, although satisfaction declined with age. Half of those who were generalists, and two thirds of those who had specialized, were satisfied with their incomes. Most lamented the loss of time for nonmedical activities, and this trend was stronger among older physicians. Almost one third of those surveyed had many patients who were unable to pay physicians' bills; 61 percent had some patients. In such cases, 55 percent of these doctors said they saw the patients free of charge, and 59 percent bill at a reduced rate. Forty-three percent, however, said they refer some to public clinics or hospitals. Only two percent felt the health care system works well, while 30 percent believed it needs major change. The institution of health insurance to allow care for all people was the change considered most important. The study's limitations are discussed. The results suggest that a restructuring of the US health care system is desirable. Physicians need to consider what they will give up, and what they expect to gain in return. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physicians, Medical professions, Employment, Job satisfaction

Similar abstracts:

• Abstracts: Tons of work go into CDC's ounces of prevention. CDC expands dental disease prevention role. Focus on adolescent health enrolls school helpers
• Abstracts: Continued comments on changes in the education of residents in surgery. The future of general surgery training
• Abstracts: Energy content of stools in normal healthy controls and patients with cystic fibrosis. Excessive faecal losses of vitamin A (retinol) in cystic fibrosis
• Abstracts: Evaluating periodontal status of US employed adults. Variations in the prevalence and extent of periodontitis
• Abstracts: The use and applications of single-photon emission computerised tomography in dementia. Cranial computerised tomography in dementia of the Alzheimer type

This website is not affiliated with document authors or copyright owners. This page is provided for informational purposes only. Unintentional errors are possible.