Journal of general internal medicine
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Editorial Comment
Evaluation of humanistic qualities and communication skills.
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The past decade has seen declining interest in primary care medicine and a dramatic increase in the cost of a medical degree. Seventy-nine percent of housestaff in an internal medicine residency program responded to a survey to determine whether medical school loan burden was related to career choice in a primary care field or specialty area. ⋯ Fourteen percent of those with debts < 40,000 and 59% with debts > $40,000 stated that financial conditions had a moderate to marked impact on their career decision making. Excessive loan burden has a significant influence on residents' career decision making and a negative influence on choosing careers in primary care internal medicine.
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Comparative Study
A questionnaire for patients' evaluations of their physicians' humanistic behaviors.
To determine what behaviors patients perceive as reflecting a physician's humanistic qualities, to develop an instrument for patients to use to assess the humanistic behaviors of their own physicians, and to compare patient assessment of residents' humanistic behaviors with patient satisfaction and the assessment of attending physicians. ⋯ Patients can evaluate the humanistic behaviors of their physicians using the PHBQ. There is good correlation between the PHBQ and patient satisfaction, which supports the validity of the PHBQ. The relative lack of agreement between patients and attending physicians suggests different observations, criteria, or standards. The higher ratings from patients in the clinic compared with those from patients in the hospital suggest that residents' behaviors are different or that patients have different observations, criteria, or standards in the two settings. Therefore, a complete assessment of residents' humanistic behaviors may require sampling in both settings.
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To determine: 1) whether a simple clinical prediction rule could identify emergency department patients with ureteral calculi; 2) whether the kidney, ureter, and bladder (KUB) radiograph provides diagnostic information beyond that obtained from the history and physical examination; and 3) whether ureteral calculi can be diagnosed accurately in the emergency department without emergency excretory urography, commonly known as intravenous pyelography (IVP). ⋯ These findings, which should be confirmed in another emergency department, suggest that subsets of patients with suspected ureteral calculi may be managed without emergency IVP; this approach thereby reduces the time a patient spends in the emergency department, radiation exposure, expense, and morbidity.