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Background: Systematic reviews have found that doctors can have a substantial effect on patients' physical health, beyond what can be explained by known factors. In a previous qualitative study, 13 medical doctors were interviewed on their experiences of exceptionally good doctors, and all had met at least one such doctor. Objective: To determine how common it is for exceptionally good doctors to be encountered by patients and what are the characteristics of exceptionally good doctors. Design: Mixed methods cross-sectional survey of 580 Amazon Mechanical Turk participants. Questions included doctor and participant demographics, and 34 Likert questions on characteristics of exceptionally good and average doctors. Free-text questions allowed participants to describe exceptional doctors, record their experience, and provide survey feedback. Stratified sampling ensured gender parity and 33% of participants aged ≥55 years. Analysis included descriptive statistics, statistical modelling of associations between Likert scale scores and patient demographics, and factor analysis. Results: Of 580 responses, 505 (86%) were included in the analysis. Factor analysis confirmed internal validity. Most respondents (86%) had met at least two exceptionally good doctors, of whom 55% were specialists. 58% of respondents regarded doctors as exceptional based on an overall impression with multiple reasons. Doctors were most commonly considered exceptional based on one or more of their personality, diagnostic, or intervention ability. Respondents who reported the doctors "willingly listened to them to the end" scored their doctors higher on 33 of 34 Likert questions, except for popularity. They also rated average doctors lower throughout. Conclusions: Exceptionally good doctors appear to be commonly encountered by the adult public. Listening to patients willingly to the end is a highly rated and influential characteristic, suggesting that listening could be targeted for quality improvement.
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Background: Doctors constitute a significant proportion of a very large number of medical interactions. They are known to vary in the quality of their work, with some having an exceptionally beneficial effect on patients' physical health. In a qualitative study, we interviewed medical doctors on their opinions and experiences of exceptionally good doctors. Their responses and the results from previous research are used as a basis for this proposed cross-sectional survey directed to members of the public on their encounters with exceptionally good doctors. The primary aim of this cross-sectional study is to describe the characteristics of exceptional doctors as reported by a large representative sample of adult patients. Methods and Analysis: A mixed qualitative and quantitative anonymous cross-sectional survey of 500 Amazon Mechanical Turk (MTurk) respondents, who have met one or more exceptionally good doctors in their life, will be conducted. Information requested will include reasons for nominating a particular doctor; experience of how that doctor differs from other and average doctors; and 34 5-point Likert scale questions on the characteristics of that doctor and the same Likert questions for the average doctor. An opportunity to report their experience in free-text form will be provided. Sample size will be sufficient to obtain a margin of error of 4%. The authors will provide descriptive statistics, including graphs of the Likert scale question responses; conduct factor analysis for internal validity; investigate satisficing and logical inconsistencies; and explore whether there are multiple types of exceptionally good doctors. Discussion: Previous surveys of patients' perceptions of doctors exist though none have focused on exceptionally good doctors. The expected results will include a list of characteristics that are important to patients in determining exceptionally good doctors.
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Background: It is generally accepted that there is a therapist effect in psychotherapy, with master therapists being studied using qualitative methods. There are surgeons with exceptionally positive patients' physical health outcomes, and qualitative research on what makes good doctors. However, characteristics of exceptionally good doctors are less studied and understood. Objective: To qualitatively study the opinions of physicians on exceptionally good doctors. Methods: Thirteen semi-structured interviews of English-speaking medical doctors of any specialty were conducted. Recruitment was achieved through the authors' network; contacting authors of relevant research papers; and Bond University's General Practitioner recruitment program. Their opinion was sought on what makes an exceptionally good doctor, whether they have met such a person, what was their experience of that person, and whether they consider themselves as exceptionally good doctors. Analysis: A six-phase thematic analysis in an experiential framework, as per Braun and Clarke, was implemented to identify themes and their details in an inductive approach with a realist epistemological position, ie, assuming truthful knowledge on what makes exceptionally good doctors can be obtained. Results: Each interviewee had met and been inspired by exceptionally good doctors. Descriptions covered six themes: character traits; other characteristics; patient relationships; peer and health care system relations; education; and treatment examples. Exceptionally good doctors were found to have up-to-date extensive medical knowledge and skills, relate well with patients, and have excellent diagnostic abilities. They tend to be humble, approachable, inspiring, and are long-remembered role models. However, they may not always be appreciated by their peers and their health care system because of their exceptional abilities. Discussion and Conclusion: Exceptional doctors are beneficial for their peers, their patients, and their health care system. Identifying, acknowledging, and making such doctors more accessible to medical students and junior doctors could have a positive impact on medical practice.
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Background: Previous research suggests that when a treatment is delivered, patients' outcomes may vary systematically by medical practitioner. Objective: To conduct a methodological review of studies reporting on the effect of doctors on patients' physical health outcomes and to provide recommendations on how this effect could be measured and reported in a consistent and appropriate way. Methods: The data source was 79 included studies and randomized controlled trials from a systematic review of doctors' effects on patients' physical health. We qualitatively assessed the studies and summarized how the doctors' effect was measured and reported. Results: The doctors' effects on patients' physical health outcomes were reported as fixed effects, identifying high and low outliers, or random effects, which estimate the variation in patient health outcomes due to the doctor after accounting for all available variables via the intra-class correlation coefficient. Multivariable multilevel regression is commonly used to adjust for patient risk, doctor experience and other demographics, and also to account for the clustering effect of hospitals in estimating both fixed and random effects. Conclusion: This methodological review identified inconsistencies in how the doctor's effect on patients' physical health outcomes is measured and reported. For grading doctors from worst to best performances and estimating random effects, specific recommendations are given along with the specific data points to report.
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Purpose: Despite billions of doctor visits worldwide each year, little is known on whether doctors themselves affect patients' physical health after accounting for intervention and confounders such as patients' and doctors' data, hospital effects, nor how strong that doctors' effect is. Knowledge of surgeons' and psychotherapists' effects exists, but not for 102 other medical specialties notwithstanding the importance of such knowledge. Methods: Eligibility Criteria: Randomized controlled trials (RCTs), case-control, and cohort studies including medical doctors except surgeons for any intervention, reporting the proportion of variance in patients' outcomes owing to the doctors (random effects), or the fixed effects of grading doctors by outcomes, after multivariate adjustment. Exclusions: studies of <15 doctors or solely reporting doctors' effects for known variables. Sources: Medline, Embase, PsycINFO, inception to June 2020. Manual search for papers referring/referred to by resulting studies. Risk of Bias: Using Newcastle-Ottawa scale. Results: Despite all medical interventions bar surgery being eligible, only thirty cohort papers were found, covering 36,239 doctors, with 10 specialties, 21 interventions, 60 outcomes (17 unique). Studies reported doctors' effects by grading doctors from best to worst, or by diversely calculating the doctor-attributed percentage of patients' outcome variation, ie the intra-class correlation coefficient (ICC). Sixteen studies presented fixed effects, 18 random effects, and 3 another approach. No RCTs found. Thirteen studies reported exceptionally good and/or poor performers with confidence intervals wholly outside the average performance. ICC range 0 to 33%, mean 3.9%. Highly diverse reporting, meta-analysis therefore not applicable. Conclusion: Doctors, on their own, can affect patients' physical health for many interventions and outcomes. Effects range from negligible to substantial, even after accounting for all known variables. Many published cohorts may reveal valuable information by reanalyzing their data for doctors' effects. Positive and negative doctor outliers appear regularly. Therefore, it can matter which doctor is chosen.
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Objective: To find and review published papers researching surgeons' effects on patients' physical health. Clinical outcomes of surgery patients with similar prognoses cannot be fully explained by surgeon skill or experience. Just as there are "hospital" and "psychotherapist" effects, there may be "surgeons" effects that persist after controlling for known variables like patient health and operation riskiness. Methods: Cohort studies and randomized controlled trials (RCTs) of any surgical intervention, which, after multivariate adjustment, either showed proportion of variance in patients' physical health outcomes due to surgeons (random effects) or graded surgeons from best to worst (fixed effects). Studies with <15 surgeons or only ascribing surgeons' effects to known variables excluded. Medline, PubMed, Embase, and PsycINFO were used for search until June 2020. Manual search for papers referring/referred by resulting studies. Risk of bias assessed by Cochrane risk-of-bias tool and Newcastle-Ottawa Scale. Results: Included studies: 52 cohort studies and three RCTs of 52,436+ surgeons covering 102 outcomes (33 unique). Studies either graded surgeons from best to worst or calculated the intra-class correlation coefficient (ICC), the percentage of patients' variation due to surgeons, in diverse ways. Sixteen studies showed exceptionally good and/or bad performers with confidence intervals wholly above or below the average performance. ICCs ranged from 0 to 47%, median 4.0%. There are no well-established reporting standards; highly heterogeneous reporting, therefore no meta-analysis. Discussion: Interpretation: There is a surgeons' effect on patients' physical health for many types of surgeries and outcomes, ranging from small to substantial. Surgeons with exceptional patient outcomes appear regularly even after accounting for all known confounding variables. Many existing cohort studies and RCTs could be reanalyzed for surgeons' effects especially after methodological reporting guidelines are published. Conclusion: In terms of patient outcomes, it can matter which surgeon is chosen. Surgeons with exceptional patient outcomes are worth studying further.
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OBJECTIVE: Doctors have a varying effect on patients' physical health. This means that there are doctors that are more effective than others. Even though the doctor is a part of very many medical interactions, it is not known in which way exceptionally good doctors differ from their peers. After authoring two systematic and one methodological review on identifying exceptional doctors, the authors in this qualitative interview-based study take a bottom-up, inductive approach to answer the question of what makes an exceptionally good doctor. METHODS: About 10-15 semi-structured interviews of medical doctors of any specialty who speak English will be conducted. Recruitment will be through the authors' network and their referrals. Questions will be whether they have an opinion on what makes an exceptionally good doctor, whether they have met such a person and how did this doctor differ from other doctors. The interviews will be done by a 62-year old PhD student who is not a clinician but has extensive experience in having personal conversations as a financial adviser. This could be helpful as the interviewer is only aware that there are exceptionally good doctors but has no notion how exceptionally good doctors differ from their colleagues. ANALYSIS: A six-phase thematic analysis in an experiential framework as per Braun and Clarke will be implemented with the aim to find out what the doctors think and have experienced. This is an inductive approach using a realist epistemological position under the assumption that it is possible to acquire truthful knowledge on what makes exceptionally good doctors. DISCUSSION: Previous qualitative research on exceptionally good doctors consisted of interviewing author-selected exceptionally good doctors. This study takes a step back from this approach by asking the peers of exceptionally good doctors how they define being exceptionally good and how they experience such doctors.
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BACKGROUND: At least six communities with unusually good health and longevity have been identified, but their lifestyles aren't adopted widely. Informal evidence suggests that women associated with Universal Medicine (UM), a complementary medicine health care organization in Eastern Australia and the United Kingdom with normal lifestyles, also have several unusual health indicators. OBJECTIVE: Our objective was to determine how UM participants compared with women in the Australian population at large on a variety of health indicators. METHODS: In an Internet survey conducted July to September 2015, a total of 449 female UM participants from 15 countries responded to 43 health indicator questions taken from the Australian Longitudinal Study on Women's Health (ALSWH). RESULTS: Survey responses revealed large positive differences in mental and physical health when compared with the ALSWH respondents, except for abnormal Pap test and low iron history. Differences and corresponding effect size estimates (Cohen d; ≥0.8 is a high difference, ≥0.5 a medium and ≥0.2 a small one with P<.001 except where indicated) included body mass index (BMI; 1.11), stress level (0.20, P=.006), depression (0.44), summary physical (0.31) and mental health (0.37), general mental health (0.39), emotional (0.15, P=.009) and social functioning (0.22), vitality (0.58), and general health (0.49), as well as lower incidences of diabetes, hypertension, and thrombosis (P<.001 each). Neither education levels nor country of residence had predictive value. Neither education levels nor country of residence had predictive value. Age did not predict BMI. CONCLUSIONS: The women's responses notably claim substantially lower levels of illness and disease than in the general Australian population. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12617000972325; https://www.anzctr. org.au/Trial/Registration/TrialReview.aspx?id=373120&isReview=true (Archived by WebCite at http://www.webcitation.org/ 6wEDDn45O). INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR2-10.2106/7993.
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BACKGROUND: Longitudinal studies of women's health often seek to identify predictors of good health. Research has shown that following simple guidelines can halve women's mortality. The ongoing Australian Longitudinal Study of Women's Health (ALSWH) shows that Australian women are getting better at reducing their smoking and alcohol use, and are generally diligent about attending recommended health screenings, but are becoming less successful at dealing with obesity. There are communities of women who live unusually healthy lives (Rosetans, Seventh-Day Adventists, traditional Japanese women), but their lifestyles are unlikely to be adopted widely. Universal Medicine (UM) is a complementary-to-medicine approach that emphasizes personal empowerment and the importance of menstrual health symptoms. OBJECTIVE: This survey investigates whether the approximately 500 women associated with UM exhibit health status significantly above the norm. As part of this investigation, questions for a newly developed menstrual attitudes questionnaire will also be evaluated. METHODS: A quantitative cross-sectional survey of women in a UM cohort was designed with the help of three focus groups of women at three life stages: in menses, peri-menopausal, and menopausal. The menstrual attitudes portion of the survey incorporates the insights of these women regarding female health issues. The survey also includes 41 questions taken from the ALSWH. Focus groups generated additional questions about symptoms experienced and attitudes toward female health issues. ALSWH questions, including a range of health scales like the Short Form 36 (SF-36), Center for Epidemiologic Studies Depression Scale, Perceived Control Scale, Kessler Psychological Distress Scale, and the Multi-Item Summed Score for Perceived Stress, along with questions about experienced major health events, were investigated and incorporated if considered suitable. At the time of publication of this protocol, data collection has been completed. RESULTS: The validity of the menstrual attitudes questionnaire will be evaluated with Cohen's kappa. ALSWH respondents and UM participants will be compared, using unweighted regression or regression weighted or normalized by age, education, and interest in alternative treatments (to increase comparability), as appropriate. Analyses will determine whether UM-related variables (being a UM participant, length of UM participation, number of UM events attended) are associated with: differences in the number of major health events and health symptoms experienced; SF-36 physical and mental health scores; body mass index; and consumption of alcohol, tobacco, sugar, salt, caffeine, and dairy. CONCLUSIONS: If women in the UM cohort are truly in substantially better health than the norm, further investigations may be worthwhile to see whether UM plays a causal role, and whether the women's practices are generalizable. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/7993.
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BACKGROUND: Low back pain causes more global disability than any other condition. Once the acute pain becomes chronic, about two-thirds of sufferers will not fully recover after 1-2 years. There is a paucity of effective treatments for non-specific, chronic low back pain. It has been noted that low back pain is associated with changes in the connective tissue in the affected area, and a very low-impact treatment, Esoteric Connective Tissue Therapy (ECTT), has been developed to restore flexibility in connective tissue. ECTT uses patterns of very small, circular movements, to the legs, arms, spine, sacrum and head, which anecdotally are effective in pain relief. In an unpublished single-arm phase I/II trial with chronic pain patients, ECTT showed a 56% reduction in pain after five treatments and 45% and 54% improvements at 6 months and 7-9 years of follow-up respectively. METHODS: The aim of this randomised controlled trial is to compare ECTT with physiotherapy for reducing pain and improving physical function and physical and mental well-being in patients with chronic low back pain. The trial will be held at two hospitals in Vietnam. One hundred participants with chronic low back pain greater than or equal to 40/100 on the visual analogue scale will be recruited and randomised to either ECTT or physiotherapy. Four weekly treatments will be provided by two experienced ECTT practitioners (Treatment Group, 40 minutes each) and hospital-employed physiotherapy nurses (Control Group, 50 minutes). The primary outcomes will be changes in pain, physical function per the Quebec Pain Functionality Questionnaire and physical and mental well-being recorded by the Short Form Health Survey (SF-36), with mixed modelling used as the primary statistical tool because the data are longitudinal. Initial follow-up will be at either 4 or 8 months, with a second follow-up after 12 months. DISCUSSION: The trial design has important strengths, because it is to be conducted in hospitals under medical supervision, because ECTT is to be compared with a standard therapy and because the assessor and analyst are to be blinded. The findings from this trial will provide evidence of the efficacy of ECTT for chronic low back pain compared with standard physiotherapy treatment. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry, ACTRN12616001196437 . Registered on 30 August 2016.
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Chronic Pain/therapy , Low Back Pain/therapy , Musculoskeletal Manipulations/methods , Physical Therapy Modalities , Chronic Pain/diagnosis , Chronic Pain/physiopathology , Clinical Protocols , Connective Tissue , Disability Evaluation , Humans , Low Back Pain/diagnosis , Low Back Pain/physiopathology , Mental Health , Musculoskeletal Manipulations/adverse effects , Pain Measurement , Physical Therapy Modalities/adverse effects , Quality of Life , Research Design , Surveys and Questionnaires , Time Factors , Treatment Outcome , VietnamABSTRACT
The incidence of oropharyngeal squamous cell carcinomas (SCCs) is increasing and is believed to reflect changing sexual practices in recent decades. For this case-case comparative study, we collected medical and life-style information and data on sexual behavior from 478 patients treated at the head and neck clinic of a tertiary hospital in Brisbane, Australia. Patients were grouped as (i) oropharyngeal SCC (n = 96), (ii) oral cavity, larynx and hypopharynx SCC ("other HNSCCs," n = 96), (iii) other SCCs (n = 141), and (iv) other diagnoses (n = 145). We fitted multivariable logistic regression models to estimate odds ratios (ORs) and 95% confidence intervals (CIs) associated with lifestyle factors and sexual behaviors. Compared to the other three patient groups, the oropharyngeal SCC patients had overall more sexual lifetime partners (kissing, oral sex and sexual intercourse). Oropharyngeal SCC patients were significantly more likely to have ever given oral sex compared to the other three patient groups-93% of oropharyngeal SCC patients, 64% of other HNSCC patients, and 58% of patients with other SCC or other diagnoses. Oropharyngeal SCC patients were significantly more likely to have given oral sex to four or more partners when compared to patients with other HNSCC (odds ratio [OR] 11.9; 95% CI 3.5-40.1), other SCC (OR 16.6; 95% CI 5.3-52.0) or patients with other diagnoses (OR 25.2; 95% CI 7.8-81.7). The very strong associations reported here between oral sex practices and risks of oropharyngeal SCC support the hypothesis that sexually transmitted HPV infections cause some of these cancers.
