[Social change in the physician's role and medical practice caused by managed care in Switzerland]. / Sozialer Wandel der Arztrolle und der Arzteschaft durch Managed Care in der Schweiz.

Switzerland is the first European country where health maintenance organizations (HMOs) characterised by capitation (per capita lumpsum) and gatekeeping were implemented according to the HMO staff model known in the USA. The development of managed health care in Switzerland relies on the belief that adequate economic incentives and competition result in cost reduction and high quality health care. Whether this is true or not--in any case the deregulation of legally accepted forms of health insurance and managed care result in profound changes in the Swiss health care system. Observations are made by using expert interviews and analysis of documents. The implementation of managed care induces socio-cultural changes of the medical profession which are as profound as the induced economic changes. We discuss conflicts of interests among physicians using four main dimensions of conflict: (1) control, (2) monopolization, (3) valuation, and (4) specialization. In the HMOs we observe pronounced conflicts of the physicians' role. The changes of the physicians' role in HMOs is on the one hand the result of new duties. On the other hand it expresses strategies of coping with the role conflict between the main clinical duties and the new obligation to control cost and to monitor treatment via gatekeeping. In HMOs the teamwork of doctors and the quality control of care promotes the satisfaction of physicians with their work, however, it can also have dysfunctional effects.

[Psychosocial aspects of malignant melanoma]. / Psychosoziale Aspekte der Melanomerkrankung.

Psychosocial aspects play a role in every stage of malignant melanoma: they are significant in terms of sun exposure habits (primary prevention) and have an important influence on the time lapse between the onset of malignant melanoma and its diagnosis (secondary prevention). Knowledge about psychosocial aspects is also necessary during the course of illness following primary treatment as during this phase patients make critical efforts in understanding and adapting to their illness. These efforts in turn interact with treatment measures and the course of the illness (tertiary prevention). Effective psychosocial interventions are available that can have an important impact on patients' quality of life. Stage-appropriate disease management requires knowledge of relevant psychosocial aspects during the course of cancer and has practical consequences not only for future prevention measures, but also for individual patients, physician-patient relationship and interdisciplinary patient care.

[The Patient Satisfaction Questionnaire: a suitable tool for quality control in the physician-patient relationship?]. / Patientenzufriedenheits-Fragebogen (PZF): Ein taugliches Mittel zur Qualitätskontrolle der Arzt-Patient-Beziehung?

The relationship between doctor and patient receives increasing interest in the public press and in scientific discussions. An increasing number of intervention studies aiming at an enhancement of doctor-patient communication is currently in action. This paper examines the potential of a patient satisfaction questionnaire (PSQ) to assess the need for such an intervention study or to identify those residents who would profit most from an intervention. We investigated a sequential sample of 257 outpatients at the Outpatient Clinic of a Medical University Clinic (137 men, 120 women, mean age 42 +/- 17 years) who were seen by eleven residents for the first time. We used the german translation of an american 14-item questionnaire. Typical psychosocial characteristics of the sample were also assessed. 73.2 percent of the patients are "satisfied" or "very satisfied" with various physician activities during the examination, the mean sum score of the PSQ is 60.1 +/- 7.1 points (range: 39-70 points; maximum score: 70 points). Residents reach a mean total score between 58 and 63 points. Neither in single items nor in the sum score was there any significant difference between residents. We found no differences in PSQ values attributable to sociodemographic variables. The results show that the PSQ is not able to identify those residents to whom intervention studies should be offered in order to enhance psychosocial skills. Its use as an evaluation tool seems also limited because patient satisfaction is very high already prior to an intervention.