The quality of physician-patient communication is a critical factor in treatment outcomes and patient satisfaction with care. To date, few studies have specifically conducted an in-depth evaluation of the effect of telemedicine (TM) on physician-patient communication in a medical setting. Our objective was to determine whether physical separation and technology used during TM have a negative effect on physician-patient communication. In this noninferiority randomized clinical trial, patients were randomized to receive a single consultation with one of 9 physicians, either in person (IP) or via TM. Patients (n = 221) were recruited from pulmonary, endocrine, and rheumatology clinics at a Midwestern Veterans Administration hospital. Physician-patient communication was measured using a validated self-report questionnaire consisting of 33 items measuring satisfaction with visit convenience and physician's patient-centered communication, clinical competence, and interpersonal skills. Satisfaction for physician's patient-centered communication was similar for both consultation types (TM = 3.76 versus IP = 3.61), and noninferiority of TM was confirmed (noninferiority t-test p = 0.002). Patient satisfaction with physician's clinical competence (TM = 4.63 versus IP = 4.52) and physician's interpersonal skills (TM = 4.79 versus IP = 4.74) were similar, and noninferiority of TM was confirmed (noninferiority t-test p = 0.006 and p = 0.04, respectively). Patients reported greater satisfaction with convenience for TM as compared to IP consultations (TM = 4.41 versus IP = 2.37, noninferiority t-test p < 0.001). Patients were equally satisfied with physician's ability to develop rapport, use shared decision making, and promote patient-centered communication during TM and IP consultations. Our data suggest that, despite physical separation, physician-patient communication during TM is not inferior to communication during IP consultations.

Among internists providing primary care at 4 VA medical centers, there were no significant differences between those with time-limited ABIM certification and those with time-unlimited ABIM certification on 10 primary care performance measures. Additional research to examine the difference in patient outcomes among holders of time-limited and time-unlimited certificates in non-VA and nonacademic settings and the association with other ABIM goals may help clarify the potential benefit of Maintenance of Certification participation.

The prevalence of exercise-induced asthma (ElA) was determined in a population of 12- and 13-year-old schoolchildren whose parents returned a questionnaire regarding a previous diagnosis of asthma, recent asthmatic symptoms and symptoms of allergic rhinitis. El A was defined as a >15% fall in peak expiratory flow rate (PEFR) following 6 min of free running in a gymnasium. Among the 201 children studied, 18 (8.9%) demonstrated El A. Of 21 children with symptomatic asthma in the 6 months prior to study, 9 (43%) developed El A compared to none of 6 children with asymptomatic asthma (p <0.0001). Among 48 children with a history of allergic rhinitis alone, 7 (14.6%) demonstrated El A. The mean postexercise changes in PEFR were 14.9% for 16 children with both asthma and allergic rhinitis, 6.4% among 48 children with allergic rhinitis only, and 1.8% among 125 normal children. Recent symptoms of asthma and a history of allergic rhinitis appeared to be risk factors for EIA. EIA was readily demonstrated in a gym class setting; the use of such screening may facilitate its diagnosis and treatment.

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