Physician burnout, as a prolonged response to chronic emotional and interpersonal stressors on the job, has been associated with suboptimal patient care and deterioration in the patient-provider relationship. Although prior studies have identified a range of factors associated with decreased patient satisfaction, most have been conducted in tertiary care settings, with staff burnout examined at the hospital unit-level. To examine the impact of physician burnout on patient satisfaction from consultation in the primary care setting, a cross-sectional survey was conducted in Western Greece. Using a one-with-many design, 30 physicians and 300 of their patients, randomly selected, responded to the survey. Results showed that patient satisfaction correlated significantly with physician emotional exhaustion (r = -.636, p < .01) and physician depersonalization (r = -.541, p < .01). Mixed-effects multilevel models indicated that 34.4% of total variation in patients' satisfaction occurred at the physician level, after adjustment for patients' characteristics. Moreover, physician emotional exhaustion and depersonalization remained significant factors associated with patient satisfaction with consultation, after controlling for patient and physician characteristics. Patients of physicians with high-exhaustion and high-depersonalization had significantly lower satisfaction scores, compared with patients of physicians with low-exhaustion and low-depersonalization, respectively. Future studies need to explore the mechanisms by which physician burnout affects patient satisfaction.
Tourette syndrome (TS) is a neurodevelopmental disorder characterized by early onset motor and vocal tics. Tics are brief, stereotypical, repetitive and non-rhythmic movements or phonations that typically follow a waxing and waning pattern of severity, intensity and frequency; they can be distinguished from other hyperkinetic movement disorders on the basis of their temporary voluntary suppression. TS should be differentiated from various movement disorders. We report a case of a young man who presented with torticollis, which was eventually attributed to TS.Case reportA 21-year-old man was admitted to our clinic due to treatment resistant cervical dystonia attributed to neuroleptics. During the last five years he had been treated for depressed mood, somatic delusions and aggressive behaviour. He had been given SSRIs and atypical antipsychotics at low doses; six months prior to his admission he had been switched to risperidone.Present clinical examination revealed torticollis, motor stereotypies, vocal tics (sniffing, repetition of words), mental koprolalia and obsessive-compulsive symptoms. He complained of repetitive intrusive thoughts of harming his sister and thoughts of a ‘delusional’ nature regarding somatic complaints were also present. The patient was diagnosed as TS and was successfully treated accordingly.TS can mimic many hyperkinetic states. Whether patients with TS are at higher risk of developing dystonia, or tics and dystonia share a common pathophysiological mechanism (dopamine-inhibiting processes are probably involved in both conditions) is still debatable.
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