Familiarity breeds discontent: senior hospital doctors' attitudes towards complementary/alternative medicine.

UNLABELLED: Studies have shown that many general medical practitioners refer their patients to complementary/alternative medicine (CAM) practitioners and believe in the therapeutic benefit of these modalities. However, there is less information concerning the beliefs and practices of senior hospital doctors. OBJECTIVES: In view of the increasing institutionalization of CAM and moves to incorporate CAM into secondary and tertiary healthcare settings, the objective of this study is to understand the attitudes and practices of senior hospital doctors, a sector whose members are often responsible for formulating and implementing institutional policy. DESIGN AND SETTING: A questionnaire was administered to 294 directors of hospital departments and their deputies on their attitudes and practices concerning CAM. Response rate was 70%. Almost all general hospitals in Israel participated in the study. RESULTS: The findings show, in general, that while senior hospital physicians in Israel hold positive attitudes towards CAM, they are not well disposed towards co-operation with CAM practitioners. Incorporating a CAM clinic into the hospital site does not seem to enhance clinical co-operation between conventional physicians and CAM practitioners. In hospitals that had functioning CAM clinics, doctors were consistently and significantly more opposed to co-operation with CAM than in hospitals without CAM clinics.

Use of humour in primary care: different perceptions among patients and physicians.

PURPOSE: (1) To explore the frequency with which humorous behaviour and statements occur in family medicine practice in Israel, and (2) to quantitatively assess the correlation between the subjective perceptions of humour in medical encounters between patients and physicians. METHOD: In a cross sectional study, two populations (doctors and patients) were surveyed with paired structured questionnaires completed immediately after primary care practice visits. Two hundred and fifty consecutive encounters from 15 practices were sampled. The physician questionnaire was self administered, and patient questionnaire was administered by a trained research assistant. RESULTS: A mean of 16.7 questionnaires was completed per physician (range 6-20). The physicians reported having used some humour in only 95 encounters (38%), whereas almost 60% of patients agreed with the statement, "The doctor used some humour during the visit". At the same time, for specific encounters, the agreement between patients' perception and physicians' perceptions on the use of humour, although not completely by chance (p = 0.04), is low (kappa = 0.115). Patient characteristics (age, education, gender, family status, mother tongue, self perceived heath status, stress, mood, and expectations) were not related to the degree of agreement between the patients' and physicians' perceptions. CONCLUSION: Humour was used in a large proportion of encounters, independently of patient characteristics. Patients seem to be more sensitised to humour than physicians, probably because of their high stress level during medical encounters. Cultural differences may also play a part. Physicians should be made aware of this magnifying effect, and the issue should be discussed in medical schools.

The family physician, the patient and the hospital.

BACKGROUND: Family physicians coordinate the care of their patients and follow them in a longitudinal manner. Do they have a role to play when their patients are hospitalized? Does the system of care expect them to play a role, and how does it support or integrate it? OBJECTIVES: To discuss the various models of relations between hospital and primary care physicians in the world as compared to those in Israel. METHOD: Short cases are reported describing the author's personal experiences and difficulties encountered in a family practice. DISCUSSION: Identifying and defining problems encountered, as well as their origin and development within the history and evolution of the system of delivery of care in Israel, will lead to some suggestions for a possible solution. Maturation of the system, especially education of the junior staff within the hospital system, is still needed to facilitate the hospital-physician relationship. CONCLUSION: More active participation of the family physician offers added value to patients' management during their hospital stay and is welcomed by them. The full implementation of a system promoting continuity of care requires further attempts at developing suitable models of cooperation between hospital and family physicians.

Choosing primary care? Influences of medical school curricula on career pathways.

In countries in which a primary care-oriented system has developed, general practitioners, family physicians, and other primary care doctors are the keystone of an approach that aims to achieve high quality and satisfaction with relatively low costs. Despite this new trend, medical schools still produce excessive numbers of sub-specialists rather than primary care physicians. Among multiple reasons influencing a career choice either towards or away from primary care (institutional, legislative, and market pressures), the present article discusses ways in which medical school curricula may affect students in their perceptions of the role of primary care physicians. Since students are greatly influenced by the cultures of the institutions in which they train, the negative attitude of a university towards family medicine may negatively affect the number of students going into this specialty. Examples from Israeli faculties are presented.