What to wear today? Effect of doctor's attire on the trust and confidence of patients.

PURPOSE: There are very few studies about the impact of physicians' attire on patients' confidence and trust. The objective of this study was to determine whether the way a doctor dresses is an important factor in the degree of trust and confidence among respondents. METHODS: A cross-sectional descriptive study using survey methodology was conducted of patients and visitors in the waiting room of an internal medicine outpatient clinic. Respondents completed a written survey after reviewing pictures of physicians in four different dress styles. Respondents were asked questions related to their preference for physician dress as well as their trust and willingness to discuss sensitive issues. RESULTS: Four hundred respondents with a mean age of 52.4 years were enrolled; 54% were men, 58% were white, 38% were African-American, and 43% had greater than a high school diploma. On all questions regarding physician dress style preferences, respondents significantly favored the professional attire with white coat (76.3%, P <.0001), followed by surgical scrubs (10.2%), business dress (8.8%), and casual dress (4.7%). Their trust and confidence was significantly associated with their preference for professional dress (P <.0001). Respondents also reported that they were significantly more willing to share their social, sexual, and psychological problems with the physician who is professionally dressed (P <.0001). The importance of physician's appearance was ranked similarly between male and female respondents (P=.54); however, female physicians' dress appeared to be significantly more important to respondents than male physicians' dress (P <.001). CONCLUSION: Respondents overwhelmingly favor physicians in professional attire with a white coat. Wearing professional dress (ie, a white coat with more formal attire) while providing patient care by physicians may favorably influence trust and confidence-building in the medical encounter.

Thyroid disorders in elderly patients.

Thyroid disorders are common in the elderly and are associated with significant morbidity if left untreated. Typical symptoms may be absent and may be erroneously attributed to normal aging or coexisting disease. Physical examination of the thyroid gland may not be helpful, as the gland is often shrunken and difficult to palpate. Usually only myxedema coma requires levothyroxine parenterally; all other forms of hypothyroidism can be treated with oral levothyroxine. Low-dose levothyroxine should be initiated and increased gradually over several months. In unstable elderly patients with hyperthyroidism, antithyroid medication can quickly produce a euthyroid state. Radioactive iodine therapy is more definitive and is well tolerated, effective, and preferred. Surgical thyroid ablation may be necessary in patients who fail to respond to radioactive iodine therapy and in patients with multinodular goiter. If there is a suspicion of malignant disease, early biopsy or fine needle aspiration for cytology should be considered.

Evaluating concordance to American Diabetes Association standards of care for type 2 diabetes through group visits in an uninsured or inadequately insured patient population.

OBJECTIVE: To evaluate the effectiveness of a managed care approach to health care delivery, group visits, in the management of uninsured or inadequately insured patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: A total of 120 patients with uncontrolled type 2 diabetes were randomly assigned to receive their care in group visits or usual care for 6 months. After 6 months, concordance with 10 process-of-care indicators recommended by the American Diabetes Association (ADA) standards of care was evaluated through chart abstraction. The 10 items evaluated were up-to-date HbA(1c) levels and lipid profiles, urine for microalbumin, appropriate use of ACE inhibitor or angiotensin receptor blockers, use of lipid-lowering agents where indicated, daily aspirin use, annual foot examinations, annual referrals for retinal examinations, and immunizations against streptococcal pneumonia and influenza. RESULTS: Patients who received care in group visits showed statistically significant improvement in concordance with these 10 process-of-care indicators (P < 0.001). Of the patients, 76% who received care in group visits had at least 9 of these 10 items up to date, as compared with 23% of control patients; 86% of patients in group visits had at least 8 of the 10 indicators compared with 47% of control patients. CONCLUSIONS: Group visits proved more effective in promoting concordance with ADA standards of care than usual care in the treatment of uninsured or inadequately insured patients with type 2 diabetes.

Evaluating group visits in an uninsured or inadequately insured patient population with uncontrolled type 2 diabetes.

PURPOSE: This study was conducted to evaluate the feasibility and acceptability of a managed-care approach (group visits) on delivering care to uninsured or inadequately insured patients with type 2 diabetes. METHODS: One hundred twenty patients with uncontrolled type 2 diabetes were randomly assigned to receive care in group visits or usual care for 6 months. At baseline, 3 months, and 6 months, the feasibility and acceptability of this model of healthcare delivery were assessed through the patients' responses to the Primary Care Assessment Tool and the Trust in Physician Scale. Attendance records were kept for each group. RESULTS: Patients who received care in group visits showed an improved sense of trust in their physician compared with patients who continued to receive usual care. There was a tendency for patients in groups to report better coordination of their care, better community orientation, and more culturally competent care. Patient attendance at the groups also indicated good acceptance of this form of healthcare delivery. CONCLUSIONS: Group visits were feasible and acceptable to these uninsured and inadequately insured patients with uncontrolled type 2 diabetes and fostered an improved sense of trust in their physician.

Metastatic gastroesophageal adenocarcinoma to skeletal muscle: a unique event.

Skeletal muscle is rarely the site of metastatic cancer, though a few such cases have been reported. Esophageal adenocarcinoma metastasic to skeletal muscle has not previously been reported in the literature. We describe the case of 71-year-old African American male with stage IV adenocarcinoma of the gastroesophageal junction. He had severe and disabling pain in the right thigh, which was tender to palpation. The pain was unresponsive to nonsteroidal anti-inflammatory drugs and full-dose narcotics. Plain x-ray films and bone scan were nondiagnostic. Magnetic resonance imaging showed a soft tissue mass involving the thigh muscles, anterior and medial to the right femur. Computed tomography (CT)-guided biopsy revealed that the thigh mass was metastatic adenocarcinoma consistent with the primary gastroesophageal cancer. Metastasis to muscle is rare, but physicians should be aware of the possibility because detection requires specific tests. We discuss the role of these tests, as well as available treatment options.