BACKGROUND This study was undertaken to determine when patients feel that physician inquiry about spirituality or religious beliefs is appropriate, reasons why they want their physicians to know about their spiritual beliefs, and what they want physicians to do with this information. METHODSTrained research assistants administered a questionnaire to a convenience sample of consenting patients and accompanying adults in the waiting rooms of 4 family practice residency training sites and 1 private group practice in northeastern Ohio. Demographic information, the SF-12 Health Survey, and participant ratings of appropriate situations, reasons, and expectations for physician discussions of spirituality or religious beliefs were obtained. RESULTSOf 1,413 adults who were asked to respond, 921 completed questionnaires, and 492 refused (response rate = 65%). Eighty-three percent of respondents wanted physicians to ask about spiritual beliefs in at least some circumstances. The most acceptable scenarios for spiritual discussion were lifethreatening illnesses (77%), serious medical conditions (74%) and loss of loved ones (70%). Among those who wanted to discuss spirituality, the most important reason for discussion was desire for physician-patient understanding (87%). Patients believed that information concerning their spiritual beliefs would affect physicians' ability to encourage realistic hope (67%), give medical advice (66%), and change medical treatment (62%).CONCLUSIONS This study helps clarify the nature of patient preferences for spiritual discussion with physicians. INTRODUCTIONS piritual inquiry in health care is controversial. Patient spirituality and religiosity have been shown to be correlated with reduced morbidity and mortality, better physical and mental health, healthier lifestyles, fewer required health services, improved coping skills, enhanced well-being, reduced stress, and illness prevention. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] Many of these studies have been criticized, yet most physicians believe spirituality has a positive effect on physical and mental well-being of patients. [16][17][18][19][20] Patients desire spiritual discussions with physicians, and believe spiritual health is as important as physical health, but they report spiritual discussions rarely take place. 1,12,21 Outpatient studies have found 13% to 73% of patients want physicians to have knowledge of their spiritual or religious beliefs. [22][23][24][25] Problematic physician issues include departing from established areas of expertise to promote nonmedical agendas, lack of spirituality training, ethics of physicians acting as pastoral counselors, the possibility of doing harm, time constraints, invasion of privacy, and diffi culty determining which patients want to talk. 9,16,18,19,26,27 To help physicians develop a holistic, patient-centered assessment of spiritual and religious beliefs, this study investigated (1) acceptance of spiritual discussion in a wide range of clinical scenarios, (2) Item content ...
Compared with direct observation of outpatient visits, the NAMCS physician report method is more accurate for procedures and examinations than for health behavior counseling. Underreporting of behavioral counseling and overreporting of visit duration should lead to caution in interpreting findings based on these variables.
PURPOSE Comprehensive medical care requires direct physician-patient contact, other offi ce-based medical activities, and medical care outside of the offi ce. This study was a systematic investigation of family physician offi ce-based activities outside of the examination room. METHODSIn the summer of 2000, 6 medical students directly observed and recorded the offi ce-based activities of 27 northeastern Ohio community-based family physicians during 1 practice day. A checklist was used to record physician activity every 20 seconds outside of the examination room. Observation excluded medical care provided at other sites. Physicians were also asked to estimate how they spent their time on average and on the observed day. RESULTSThe average offi ce day was 8 hours 8 minutes. On average, 20.1 patients were seen and physicians spent 17.5 minutes per patient in direct contact time. Offi ce-based time outside of the examination room averaged 3 hours 8 minutes or 39% of the offi ce practice day; 61% of that time was spent in activities related to medical care. Charting (32.9 minutes per day) and dictating (23.4 minutes per day) were the most common medical activities. Physicians overestimated the time they spent in direct patient care and medical activities. None of the participating practices had electronic medical records.CONCLUSIONS If offi ce-based, medically related activities were averaged over the number of patients seen in the offi ce that day, the average offi ce visit time per patient would increase by 7 minutes (40%). Care delivery extends beyond direct patient contact. Models of health care delivery need to recognize this component of care.
The results support the Agency for Health Care Research and Quality's call for medical system improvements at the point of care. Additionally, it may be necessary to teach residents better information-management skills in addition to EBM skills.
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