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Professionalism and professional ethics in medicine

The JAMA Network Journals

The March 28 issue of Archives of Internal Medicine contains several articles relevant to the topic of professionalism in medicine and/or professional ethics. The Archives of Internal Medicine is one of the JAMA/Archives journals.

"Several years ago, a study conducted by a group at Vanderbilt University demonstrated that unsolicited complaints about physicians correlated with physicians who...were rude to patients and families, and who did not show respect to the patient and family," writes Philip Greenland, M.D., editor of Archives of Internal Medicine, in an accompanying editorial. "The same study also suggested that practice volume, translating into less time available for each patient, was associated with a higher volume of complaints and higher malpractice risk....We must remember that we accepted the duty of caring for patients when we entered medicine, and we must continue to practice with professional attitudes and behaviors no matter what the pressures we face. ... I believe strongly that we can address our share of the crisis in health care today by returning and holding fast to these long-held values."

(Arch Intern Med. 2005; 165: 607 - 608. Available post-embargo at

Related Articles:
Negative Physician Attitudes Toward HIV-Infected Injection Drug Users
To contact corresponding author, Paul D. Cleary, Ph.D., call John Lacey at 617-432-0442.

Lin Ding, Ph.D., of Harvard Medical School, Boston, and colleagues surveyed a representative sample of 2,864 HIV-infected patients and their physicians to determine if negative attitudes toward HIV-infected injection drug users affected the patient's exposure to highly active antiretroviral therapy, reported problems, satisfaction with care, unmet needs, or perceived access to care.

The researchers found that 23.2 percent of HIV-infected patients had physicians with negative attitudes toward injection drug users. Injection drug users who were cared for by physicians with negative attitudes had a significantly lower rate of exposure to highly active antiretroviral therapy (HAART) than either patients treated by physicians with more positive attitudes or patients who were not injection drug users. Physician attitudes were not associated with any other problems with care.

(Arch Intern Med. 2005; 165: 618 - 623. Available post-embargo at

The Effect of Physician Financial Disclosure on Patient Trust
To contact Wendy Levinson, M.D., call Janet Wong at 416-978-5949.

Wendy Levinson, M.D., of the University of Toronto, and colleagues analyzed interviews with 2,765 individuals to determine how specific communication styles impact patient response to information about physician financial incentives to limit ordering of expensive tests and procedures. Nearly half of the respondents had heard of this type of financial incentive and nearly all, 94.8 percent, felt they should be informed about incentives. Most (80.5 percent) felt they should be told at the time of enrollment either by their health plan representative (44.8 percent), their physician (17.1 percent) or both (38.1 percent).

The researchers compared six different communication styles to determine how physicians might best communicate financial disclosure information increasing trust and supporting the physician-patient relationship. "Of the six different disclosure strategies, 'addressing emotions' and 'negotiation' were associated with the best outcomes, while 'common enemy' and 'denying influences' were most negatively perceived. Black and Hispanic respondents were less likely to express satisfaction or trust and more likely to disenroll or seek a second opinion," the authors found.

(Arch Intern Med. 2005; 165: 625 - 630. Available post-embargo at

How Physicians Try to Reduce Patients' Prescription Costs
To contact G. Caleb Alexander, M.D., M.S., call Catherine Gianaro at 773-702-6241.

G. Caleb Alexander, M.D., of the University of Chicago, and colleagues analyzed 519 responses to a national random sample mail survey of cardiologists and general internists to determine why physicians often do not communicate with patients about out-of-pocket prescription costs, even though previous research indicates that out-of pocket costs may lead to cost-related failure to use prescribed medication and threaten quality of care and that physicians and patients value such discussions.

The researchers found that the most common barriers to physician-patient communication about out-of-pocket costs were lack of habit, insufficient time and concern over patient discomfort. "Despite barriers, physicians use multiple strategies that may vary in efficacy to assist patients burdened by these costs," the authors write. The most common strategies were switching to a generic drug, using office samples and discontinuing nonessential medicines. "Further work is needed to evaluate the safety and effectiveness of these strategies," the authors conclude.

(Arch Intern Med. 2005; 165: 633 - 636. Available post-embargo at

Physicians' Response to Scarcity
To contact Samia A. Hurst, M.D., e-mail

Samia A. Hurst, M.D., of the National Institutes of Health, Bethesda, Md., and colleagues surveyed U.S. internists, oncologists and intensive care physicians about recent ethical dilemmas encountered in practice. Difficulties regarding resource allocations (reported by 18 percent of the 344 respondents) were analyzed to determine the strategies used to resolve them and the physician's rationales. "The situations described were often handled by negotiating a solution, rather than primarily withholding an intervention," the authors found. "Although our respondents reported being pitted between conflicting obligations, most of them found overt ways of negotiating solutions without resorting to covert rule breaking."

"Physicians' experiences in situations of resource constraints appear to be more complex than the normative literature on health care rationing assumes," the authors conclude. "In addition, reasoning about justice in health care seems to play only a small part in clinical decision making. Bridging this gap could be an important step in fostering fair allocation of resources in difficult cases."

(Arch Intern Med. 2005; 165: 639 - 644. Available post-embargo at

Advertising in Academic Medical Centers
To contact Robin J. Larson, M.D., M.P.H., call Anselm Beach at 802-295-9363, ext. 5424.

Robin J. Larson, M.D., M.P.H., of the Department of Veteran Affairs Medical Center, White River Junction, Vt., and colleagues, systematically analyzed all 2002 non-research print ads for the 17 medical centers named to the U.S. News & World Report 2002 honor roll of "America's Best Hospitals." Of the 127 unique non-research-related print ads identified by the study, three promoted community events, two announced genuine public services and 122 were aimed at attracting patients. Of those 122, 36 ads (29.5 percent) promoted the medical center as a whole, while 65 (53.3 percent) promoted specific clinical departments and 21 (17.2 percent) promoted single therapeutic interventions or diagnostic tests, the researchers found.

"The most commonly used marketing strategies included appealing to emotions (61.5 percent), highlighting institution prestige (60.7 percent), mentioning a symptom or disease (53.3 percent), and promoting introductory lectures or special offers likely to lead to further business (47.5 percent)," the authors state. "Of the 21 ads for single intervention, most were for unproved (38.1 percent) or cosmetic (28.6 percent) procedures. While more than half of these ads presented benefits, none quantified their positive claims and just one mentioned potential harms...Advertising to attract patients is common among top academic medical centers but is not subjected to the oversight standard for clinical research," the authors conclude.

(Arch Intern Med. 2005; 165: 645 - 651. Available post-embargo at


Editor's Note: Complete information on funding for these articles is available in each article.

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