Physician Perspectives on Long-Term Relationships and Friendships with Patients: A National Assessment

Objectives: Shifts in the healthcare environment have introduced challenges to the long-term continuity of the doctor–patient relationship. This study examines whether certain demographic or religious characteristics of physicians are associated with maintaining long-term relationships (LTRs) and/or friendships with their patients and describes physicians’ opinions regarding the influence of such patient relationships on health...

Still Invisible After All These Years

I still wonder what happened to him after he left the hospital against medical advice (AMA). About a week before, David had been admitted for a severe leg infection to the general medicine ward where I served as his attending physician. His hospitalization had an inauspicious beginning; he seemed very anxious from the moment he arrived on the...

Commentary on “Still Invisible After All These Years”

In this issue of the Southern Medical Journal, Dr Manian contemplates how best to provide high-quality care, despite unusual patient behaviors, attitudes, or other problems.1...

Assisted Death and the Public Good

The movement toward physician-assisted suicide, also called assisted death (AD), is built upon a fundamental moral premise: each of us should have control over our lives and deaths. Moreover, the relief of suffering, a core premise of traditional medical ethics, is integral to the care of dying people. Physician assistance in facilitating death is therefore appropriate and justified. We disagree. Although autonomy is a fundamental principle...

Resident Workshop Standardizes Patient Handoff and Improves Quality, Confidence, and Knowledge

Objectives: Residency programs are required to instruct residents in handoff; however, a handoff curriculum endorsed by the Accreditation Council for Graduate Medical Education does not exist. Although curricula are available, we preferred to use a curriculum that could be taught quickly, was easy to implement, and used a mnemonic that resembled current practices at our institution. We designed and implemented a novel handoff educational...

Commentary on “Assisted Death and the Public Good”

The debate over whether physician-assisted suicide is ethically justifiable often focuses on the conflict between the principles of beneficence and autonomy. It is invigorating that Dugdale and Callahan remind us of an alternative, often neglected perspective by invoking the concept of the public good.1 The authors present a communitarian approach to the problem of assisted suicide, and this seems appropriate to describe a phenomenon that...

Commentary on “Discussing Advance Care Planning and Directives in the General Population”

In this issue of the Southern Medical Journal, de Caprariis and colleagues make three recommendations in regard to the approach that healthcare professionals should use to promote the utilization of advance care planning (ACP) and advance directives (ADs).1. These recommendations address the ethical complexities raised when broaching the idea of planning for death with terminally ill patients and with prospective completers of ACP, especially...

Discussing Advance Care Planning and Directives in the General Population

The concept of end-of-life planning, along with medical and legal issues, has been discussed and has evolved over several years. The 1990 Patient Self-Determination Act and individual states’ Department of Health Advance Directive forms helped overcome past problems. Patients with terminal and chronic illness are now able to have their wishes recognized for their future care. Any healthy individual’s decision during an advance care planning...

Bedside Rounds Valued But Not Preferred: Perceptions of Internal Medicine Residents and Attending Physicians in a Diverse Academic Training Program

Objectives: Bedside rounds/rounding (BDR) is an important tool for patient-centered care and trainee education. This study aimed at understanding the attitudes toward BDR among residents and attending physicians. Methods: A survey was conducted using the Qualtrics survey tool. Responses were measured using a five-point Likert scale. Results: The survey was sent to 301 attending physicians and 195 residents. Attending physicians conducted...

The Premedical Curriculum: We Can Do Better for Future Physicians

I n the long journey toward becoming a doctor in the United States, the first day of medical school often is considered the starting point. The fact is that medical education begins long before that epochal event. Indeed, the first dedicated steps take place in college, with enrollment and successful completion of the premedical curriculum, a battery of courses that includes three semesters each of biology, physics, general chemistry, and...

Effects of a 12-Month Educational Intervention on Clinicians’ Attitudes/Practices Regarding the Screening Spiritual History

Objectives: Patients’ spiritual values, beliefs, and preferences are identified in outpatient medical settings by the taking of a screening spiritual history (SSH). We report the impact of an educational/training program on the attitudes/practices of physicians (MDs) and midlevel practitioners (MLPs). Methods: A convenience sample of 1082 MDs or MLPs in outpatient practices was approached to participate in a 12-month educational/ training...

Commentary on “Effects of a 12-Month Educational Intervention on Clinicians’ Attitudes/Practices Regarding the Screening Spiritual History”

The interventional study by Koenig and colleagues charts the change in physician habits and perceived importance of taking a screening spiritual history (SSH) for patients.1 Two important findings bear further attention. First, physicians who “always/often” took an SSH increased from 17% to 35%, and, second, exposure to SSH training during medical school proved a positive predictor for taking an SSH as a part of one’s...

Initial Experience of a Primary Urgent Care Clinic Curriculum and Subspecialty Lectureship Series Implementation in a Los Angeles County Hospital

Objectives: Urgent care clinics are extremely busy in the University of California-Los Angeles (UCLA) County hospital system. We determined that residents and medical students in the internal medicine residency program who are rotating through these clinics did not receive enough teaching during their rotation. We decided to create and implement an urgent care curriculum and lectures to help achieve structure for the rotation. The goal of this...

Development of a Flipped Medical School Dermatology Module

Objectives: The flipped classroom module incorporates independent study in advance of in-class instructional sessions. It is unproven whether this methodology is effective within a medical school second-year organ system module. We report the development, implementation, and effectiveness of the flipped classroom methodology in a second-year medical student dermatology module at the University of Miami Leonard M. Miller School of...

Nurturing Competence and Compassion in Future Physicians

The stories at the low-income clinic that day were even more gut-wrenching, the usual shocking pathology was perhaps more obscure. Yet, the premedical school student who was translating for the non–Spanish-speaking clinicians seemed unmoved and disinterested. Although he did his job efficiently, he had no questions for the attending physician. Late in the session, the student complained about the overuse of resources after an ambulance arrived...

Family Medicine–Specific Practice-Based Research Network Productivity and Clinical and Translational Sciences Award Program Affiliation

Objective: Practice-based research networks (PBRNs) are groups of practices that work together to conduct research. Little is known about the degree to which PBRNs may be achieving success. This is the first general survey of family medicine–based PBRN directors in the United States and Canada to examine research productivity outcomes of PBRNs and explore the association between Clinical and Translational Science Awards (CTSA) program...

Commentary on “Nurturing Competence and Compassion in Future Physicians”

The article by Sherling and Hennekens in this issue of the Southern Medical Journal powerfully emphasizes the importance of assessing noncognitive factors in the selection for medicine.1 No question – patients demand and deserve compassionate humane care. My experience suggests that medical school personnel involved in selection (faculty, staff, alumni, students, community members, and others) all want decision making to be careful, fair,...

Navigating Clinical Ethics: Using Real Case Constellations to Guide Learners and Teachers in Medicine

Case-based learning is a staple of clinical ethics education in medicine. The sources for medical educators generally are lengthy case books or single, often rare, case analyses in the literature. Busy clinicians may not have the time or inclination to sift through case books to find suitable teaching material, and the latter present unusual cases that many physicians may never encounter in their own practice. Relatively few articles present...

On “Does Timing of Internal Medicine Residency Interview Affect Likelihood of Matching?”

To the Editor: Heidemann and colleagues analyzed the timing of internal medicine interviews and concluded that the interview date had no major influence on matching at their program.1 We believe that a more circumspect interpretation of the results is...

Effects of Starting a Gastroenterology Fellowship Training Program on Quality Measures of Colonoscopy

Objectives: Adenoma detection rate (ADR) is the most established indicator of the quality of screening colonoscopy. The effect of gastroenterology (GI) fellows on the quality of screening colonoscopies has been evaluated previously; however, the effect of starting a new GI fellowship program on the quality of screening colonoscopies has not been studied. The aim of our study was to assess the effects of starting a GI fellowship program and the...