Public perceptions of physician-pharmaceutical industry relationships and trust in physicians.

BACKGROUND: In Japan, as elsewhere, physicians meet with and receive gifts from pharmaceutical representatives (PRs). This study aimed to clarify the Japanese public perceptions of physicians' relationships with PRs, examine the association between these perceptions and their trust in physicians, and compare the public's and physicians' awareness, acceptance, and perceptions of the influence of physician-PR relationships. METHODS: A cross-sectional, self-administered, anonymous, internet-panel survey was conducted involving 1,000 participants from the general public. The survey implementation was contracted to Cross Marketing Inc. RESULTS: The mean age of the 1000 participants was 44.8 years (standard deviation 18.3). Forty-eight percent were female. Many of our participants were unaware of certain physician-PR relationships. The public was more acceptable with physicians' receiving stationery and/or medical textbooks and attending promotional drug seminars at their workplaces compared with receiving meals at restaurants. Many thought that physicians' involvement in promotional activities influenced their prescribing habits and estimated that the majority of physicians received office stationery and meals from PRs. They were divided as to whether they would like to know about their physicians' relationships with the industry. Factors associated with higher trust in physicians included participants being 65 years or older, having a primary care physician, being in better health, the belief that physicians' involvement in promotional activities is acceptable, and their high estimate that physicians are not receiving gifts from PRs. Compared to the physicians, the public had lower awareness of and was more accepting of physicians' involvement in promotional activities. Meanwhile, the public believed that physician-PR relationships influenced physicians' prescribing habits more than the physicians themselves. CONCLUSION: Our survey provided insights into Japanese public perceptions of physician-pharmaceutical industry relationships and their impact on trust in physicians. Physicians should be aware of these perceptions and carefully consider how to foster appropriate relationships with the industry.

Changes in Japanese physicians' relationships with the pharmaceutical industry between 2008 and 2021: A national survey.

BACKGROUND: A national survey we conducted in 2008 showed that many Japanese physicians interacted with and received gifts from pharmaceutical representatives (PRs) and had a positive attitude toward relationships with PRs. The revised promotion code of the Japan Pharmaceutical Manufacturers Association in 2019 prohibited the provision of non-educational promotional aids including sticky notes, mouse pads, and calendars. During the COVID-19 pandemic in 2020, face-to-face meetings were socially restricted. This study assessed the extent of current Japanese physicians' involvement in pharmaceutical promotional activities and their attitudes toward relationships with PRs and to ascertain any changes between 2008 and 2021. We also examined the factors that predicted positive attitudes toward gifts from PRs. METHODS: From January to March 2021, we conducted a national mail survey of Japanese physicians in seven specialties: internal medicine, surgery, orthopedics, pediatrics, obstetrics-gynecology, psychiatry, and ophthalmology. RESULTS: There were 1636 participants and the response rate was 63.2%. Most physicians met face-to-face with PRs (78.8%), whereas only a minority received meals outside the workplace (4.5%). PRs were thought to have an important role in continuing medical education (66.1%) and to provide accurate information about new drugs (74.2%). Opinions were divided on the appropriateness of gifts from PRs. Most thought that stationery and meals provided by the industry did not affect prescribing behavior (89.7% and 75.8%, respectively). Factors that predicted a positive attitude toward gifts from PRs were male, orthopedic specialty vs. internal medicine, more interactions with PRs, a positive attitude toward informational value, and no rules banning meetings with PRs. CONCLUSION: Involvement in pharmaceutical promotional activities is still common among practicing physicians in Japan, although the extent of the involvement had declined. Rules banning meetings with PRs appear to continue being effective at limiting a physician's involvement with promotional activities and their critical attitudes toward gifts from PRs.

Graves' Disease after Adrenalectomy for Cushing's Syndrome.

A 44-year-old woman presented with a 3-month history of back pain, gait disturbance, and insomnia. She had moon face and central obesity but no goiter. Cushing's syndrome due to left adrenal adenoma was diagnosed. She also had low triiodothyronine syndrome and central hypothyroidism. Treatment involved adrenalectomy followed by 30 mg/day of hydrocortisone. Inappropriate secretion of thyroid-stimulating hormone occurred postoperatively. She developed Graves' disease nine months postoperatively and was treated with methimazole. Excess glucocorticoids followed by their withdrawal may influence the hypothalamic-pituitary-thyroid axis and immune system. Therefore, a careful evaluation of the thyroid function and antibodies is important after surgery for Cushing's syndrome.

Chronological changes in Japanese physicians' attitude and behavior concerning relationships with pharmaceutical representatives: a qualitative study.

BACKGROUND: Recent qualitative studies indicated that physicians interact with pharmaceutical representatives depending on the relative weight of the benefits to the risks and are also influenced by a variety of experiences and circumstances. However, these studies do not provide enough information about if, when, how and why their attitudes and behaviors change over time. METHODS AND FINDINGS: A qualitative study using semi-structured face-to-face individual interviews was conducted on 9 Japanese physicians who attended a symposium on conflicts of interest held in Tokyo. Interviews were designed to explore chronological changes in individual physicians' attitude and behavior concerning relationships with pharmaceutical representatives and factors affecting such changes. Their early interaction with pharmaceutical representatives was passive as physicians were not explicitly aware of the meaning of such interaction. They began to think on their own about how to interact with pharmaceutical representatives as they progressed in their careers. Their attitude toward pharmaceutical representatives changed over time. Factors affecting attitudinal change included work environment (local regulations and job position), role models, views of patients and the public, acquisition of skills in information seeking and evidence-based medicine, and learning about the concepts of professionalism and conflict of interest. However, the change in attitude was not necessarily followed by behavioral change, apparently due to rationalization and conformity to social norms. CONCLUSIONS: Physicians' attitudes toward relationships with pharmaceutical representatives changed over time and factors affecting such changes were various. Paying attention to these factors and creating new social norms may be both necessary to produce change in behavior consistent with change in attitude.

Can Japanese students embrace learner-centered methods for teaching medical interviewing skills? Focus groups.

BACKGROUND: Students' perceptions of learner-centered methods for teaching medical interviewing skills have not been fully explored. AIM: To explore Japanese students' perceptions of learner-centered methods for teaching medical interviewing skills such as role play with student-created scenarios, peer-assisted video reviews, and student-led small group debriefing. METHODS: We conducted three focus groups with a total of 15 students who participated in the learner-centered seminars on medical interviewing skills at the Nagoya University School of Medicine. The transcripts were analyzed by two authors independently. Keywords and concepts were identified and a thematic framework was developed. RESULTS: Overall, students valued the experience of writing their own scenarios for role play, but some questioned their realism. Many students commented that peer-assisted video reviews provided them with more objective perspectives on their performance. However, some students expressed concerns about competitiveness during the video reviews. While students appreciated teachers' minimum involvement in the group debriefing, some criticized that teachers did not explain the objectives of the seminar clearly. Many students had difficulties in exchanging constructive feedback. CONCLUSION: We were able to gain new insights into positive and negative perceptions of students about learner-centered methods for teaching medical interviewing skills at one medical school in Japan.

Japanese practicing physicians' relationships with pharmaceutical representatives: a national survey.

BACKGROUND: Previous surveys on the relationship between physicians and pharmaceutical representatives (PRs) have been of limited quality. The purpose of our survey of practicing physicians in Japan was to assess the extent of their involvement in pharmaceutical promotional activities, physician characteristics that predict such involvement, attitudes toward relationships with PRs, correlations between the extent of involvement and attitudes, and differences in the extent of involvement according to self-reported prescribing behaviors. METHODS AND FINDINGS: From January to March 2008, we conducted a national survey of 2621 practicing physicians in seven specialties: internal medicine, general surgery, orthopedic surgery, pediatrics, obstetrics-gynecology, psychiatry, and ophthalmology. The response rate was 54%. Most physicians met with PRs (98%), received drug samples (85%) and stationery (96%), and participated in industry-sponsored continuing medical education (CME) events at the workplace (80%) and outside the workplace (93%). Half accepted meals outside the workplace (49%) and financial subsidies to attend CME events (49%). Rules at the workplace banning both meetings with PRs and gifts predicted less involvement of physicians in promotional activities. Physicians valued information from PRs. They believed that they were unlikely to be influenced by promotional activities, but that their colleagues were more susceptible to such influence than themselves. They were divided about the appropriateness of low-value gifts. The extent of physician involvement in promotional activities was positively correlated with the attitudes that PRs are a valuable source of information and that gifts are appropriate. The extent of such involvement was higher among physicians who prefer to ask PRs for information when a new medication becomes available, physicians who are not satisfied with patient encounters ending only with advice, and physicians who prefer to prescribe brand-name medications. CONCLUSIONS: Involvement in pharmaceutical promotional activities is widespread among practicing physicians in Japan. The extent of such involvement varies according to certain physician characteristics. As a group, they are at risk for influence by promotional activities.

Clinical needs of patients attending a women's health center in Japan.

BACKGROUND: Many women's health centers (WHC) in Japan use female obstetrician-gynecologists, not trained in primary care medicine, as providers. It is not known whether the clinical needs of patients at WHC are met by these providers. OBJECTIVE: To identify the clinical needs of patients attending a WHC in Japan by examining their presenting problems and diagnoses. METHODS: We performed a case-series study of 53 patients at a WHC in a public medical center in Chiba Prefecture, Japan. Charts were reviewed for the presenting problems and diagnoses. RESULTS: The most common presenting complaints were related to the female genital system or the breast (42%) and psychological problems (13%). At discharge, the most common diagnoses were psychological (42%). The next most common diagnoses were related to the female genital system or the breast (36%). The remainder (22%) were related to a variety of organ systems. CONCLUSION: Patients at the WHC presented with not only gynecological but also general medical and psychological problems and had discharge diagnoses involving a variety of organ systems. Physicians at WHCs should be trained in primary care medicine to meet the clinical needs of patients.

Attitudes of Japanese primary care physicians toward publicly endorsed periodic health examinations: a cross sectional survey.

BACKGROUND: Despite the lack of evidence for efficacy, an annual health examination has been advocated for the general population by the Japanese government. We conducted a cross-sectional survey to understand the attitudes of Japanese physicians toward the annual examinations. METHODS: In October 2003, a questionnaire was mailed to 1971 physicians registered with Aichi Prefecture Medical Association as internists. The survey was designed to determine their opinions about the effectiveness of the periodic health examination and each of its components. RESULTS: The response rate was 37%. Eighty-five percent believed that a periodic health examination was effective. Nearly 80% believed that height and weight should be measured, and more than 90% supported blood pressure measurements. Nearly 70% supported a physical examination of chest and abdomen. About half believed that vision and hearing tests should be performed for all ages. More than 90% considered performing a variety of laboratory tests valuable. Three-quarters supported hepatitis B surface antigen and hepatitis C antibody determinations. Seventy to eighty percent valued the screening tests for lung, stomach, colon, breast and cervical cancer. CONCLUSIONS: Most Japanese primary care physicians believe that a comprehensive annual health examination as currently endorsed by public health authorities is effective.

Follow the patient: process and outcome evaluation of medical students' educational experiences accompanying outpatients.

BACKGROUND: To instill patient-centred attitudes in medical students, several medical schools in Japan have recently started to offer educational experiences in which medical students accompany outpatients throughout entire visits to hospitals. OBJECTIVE: To evaluate the processes and outcomes of the educational experience of Year 5 medical students accompanying outpatients at Nagoya University Hospital. METHODS: An integrated, multimethod approach was adopted using a written survey with open-ended questions for students, focus groups with students, and a written evaluation survey for patients. In all, 99 students completed the survey, 19 students participated in 3 focus groups, and 46 patients participated in the evaluation. RESULTS: Many students were sceptical about the objectives of the exercise. We were able to gain insight into student perceptions about facets of the exercise such as the ratio of students to patients and whether or not students should wear white coats. In particular, there was consensus among students about the importance of the debriefing session after the experience. Students achieved different learning outcomes depending on their particular individual experiences. In the student survey, 49% were satisfied with this experience, 6% were dissatisfied, and 43% were neither. In contrast, patients were highly satisfied with the experience (mean score 4.2 out of 5.0 on a Likert scale). Some students expressed concern about being a burden to patients, while many patients reported feeling emotionally supported by being accompanied by students. CONCLUSION: An integrated approach to programme evaluation, using quantitative and qualitative methods, was useful in the process and outcome evaluation of this new educational experience. The results have been taken into consideration for quality improvement of this curricular element.

Electronic delivery of research summaries for academic generalist doctors: a randomised trial of an educational intervention.

OBJECTIVE: To determine whether weekly e-mails of structured, critically appraised summaries of new articles, within the format of a Weekly Browsing Journal Club (WBJC), would encourage use of evidence in practice. DESIGN: Randomised controlled trial. METHOD: A sample of 107 academic general internists were randomly assigned to receive either the WBJC (n = 54) or a health news website (n = 53) by e-mail on a weekly basis for 3 months. Participants completed a pre- and post-intervention questionnaire that measured their use of evidence in practice, attitudes about the role of evidence in practice, critical appraisal ability and reading habits. RESULTS: Of 107 participants, 90% completed the trial. At baseline, when faced with questions, they found answers on which to base their clinical decisions 67% of the time. Participants incorporated evidence into patient care for 60% of patients and read evidence to help make decisions for 25%. After 3 months, the groups did not differ in the use of evidence in practice. Changes in attitudes toward the role of evidence in practice and in self-perceived critical appraisal ability were also similar. The subjects spent 2.2 hours reading 4.3 journals per week. Weekly reading time decreased by 10 minutes in the WBJC group, but increased by 26 minutes in the control group (P = 0.02). At study completion, 82% of the WBJC group were satisfied with the intervention and 90% asked to continue. CONCLUSION: While doctors appreciated these summaries, which improved their reading efficiency, the intervention had little impact on their use of research evidence in practice.

Evaluation of a communication skills seminar for students in a Japanese medical school: a non-randomized controlled study.

BACKGROUND: Little data exist for the effectiveness of communication skills teaching for medical students in non-English speaking countries. We conducted a non-randomized controlled study to examine if a short intensive seminar for Japanese medical students had any impact on communication skills with patients. METHODS: Throughout the academic year 2001-2002, a total of 105 fifth-year students (18 groups of 5 to 7 students) participated, one group at a time, in a two-day, small group seminar on medical interviewing. Half way through the year, a five-station objective structured clinical examination (OSCE) was conducted for all fifth-year students. We videotaped all the students' interaction with a standardized patient in one OSCE station that was focused on communication skills. Two independent observers rated the videotapes of 50 students who had attended the seminar and 47 who had not. Sixteen core communication skills were measured. Disagreements between raters were resolved by a third observer's rating. RESULTS: There was a statistically significant difference in proportions of students who were judged as 'acceptable' in one particular skill related to understanding patient's perspectives: asking how the illness or problems affected the patient's life, (53% in the experimental group and 30% in the control group, p = .02). No differences were observed in the other 15 core communication skills, although there was a trend for improvement in the skill for asking the patient's ideas about the illness or problems (60% vs. 40%, p = .054) and one of the relationship building skills; being attentive and empathic nonverbally (87% vs. 72%, p = .064). CONCLUSION: The results of this study suggest that a short, intensive small group seminar for Japanese medical students may have had a short-term impact on specific communication skills, pertaining to understanding patient's perspectives.