Primary Care Physicians’ Decisions About Discharging Patients from Their Practices

Farber, Neil J.; Jordan, Michelle E.; Silverstein, Julie; Collier, Virginia U.; Weiner, Joan; Boyer, E. Gil

doi:10.1007/s11606-007-0495-7

Cited by 12 publications

(31 citation statements)

References 14 publications

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“…The discharge rates were higher among senior clinicians than juniors . In a U.K. study the discharge rate of consultant dermatologists was 48%, clinical assistants 29% and senior house officers 0% .…”

Section: Resultsmentioning

confidence: 95%

“…Similarly, in a U.K. study, 64% of GPs reported that they would remove patients from their list if they were violent or abusive . In a U.S.A. study using hypothetical scenarios, 40% of primary care physicians and general internists stated they would discharge patients if they were verbally abusive or violent . Clinicians would discharge patients if they were nonadherent to medication and appointments .…”

Section: Resultsmentioning

confidence: 98%

“…Some clinicians also struggle with guilt in discharging patients who have been on long‐term follow up . Others, however, may feel no qualms on discharging such patients . Physicians develop the art of negotiating with patients, while maintaining professionalism as well as exercising ethical awareness upon discharging patients.…”

Section: Resultsmentioning

confidence: 99%

“…Seventeen 3-8,16-26 outpatient discharge articles were identified of which seven concerned dermatology. [5][6][7]19,[24][25][26] Fourteen described prospective studies, [3][4][5][6][7][8][17][18][19][20][21][22]25,26 two described retrospective studies 16,24 and one described general views 23 of the clinicians (Table 2). Major clinical influences included diagnosis and disease severity.…”

Section: Resultsmentioning

confidence: 99%

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The dermatology outpatient discharge decision: understanding a critical but neglected process

et al. 2014

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Discharge from dermatology outpatients is a critical endpoint of patient care. Despite this, there has been very little research concerning the discharge process and factors influencing the discharge decision. To identify the factors influencing discharge decisions, articles from 1970 to April 2013 were searched in MEDLINE via Ovid, CINAHL, PROQUEST and Google Scholar using the keywords 'patient discharge', 'discharge decision', 'factors influencing discharge', 'clinical decision making', 'discharge decision making', 'process of discharge decision', 'outpatient', 'follow up', 'skin disease' and 'dermatology'. Only articles describing outpatient discharge decisions were included. Seventeen outpatient discharge articles were identified, 12 from the U.K. (seven dermatology) and five from the U.S.A., Canada, Australia and Taiwan (all nondermatology). The main influences on outpatient discharge identified were diagnosis and disease severity, clinician's level of experience and perception, patient's preferences, patient's behaviour and quality of life. These influences affected the clinician's judgement on discharge decisions both in appropriate and in inappropriate ways. Little is known concerning discharge decision making in dermatology. Given the central importance of such decisions in the appropriate care of patients and the efficient running of any dermatology service, greater understanding of the influences on discharge decision making is needed. It is therefore critical for dermatologists to be aware of these influences and to ensure that decisions are taken only in the best interests of patients. Further research is required to inform the training of dermatologists on how to take the most appropriate discharge decisions.

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Section: Resultsmentioning

confidence: 95%

Section: Resultsmentioning

confidence: 98%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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The dermatology outpatient discharge decision: understanding a critical but neglected process

et al. 2014

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“…Terminating the relationship is sometimes very tempting. US psychiatric guidelines regard termination when violence is threatened as appropriate44 and these are the grounds that primarily influence most physicians' decisions 45…”

Section: Abandonmentmentioning

confidence: 99%

Bioethics in a clinic for women with psychosis

Seeman¹,

Seeman

2011

J Med Ethics

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Clinical ethics takes on a special cast in a rehabilitation clinic for psychosis where many patients come from severely disadvantaged backgrounds and many suffer from fluctuating decisional capacity. This paper illustrates several ethical issues-truth telling and partiality, prescribing concealed medication, questionable billing practices, industry collaboration, limits of confidentiality, grounds for abandonment and the primacy of autonomy-in the hope that discussing such matters will lead to a clearer framework for work with this population.

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