Primary care physicians who felt "called" to practice medicine were more likely to be satisfied helping patients with difficult-to-treat conditions such as as nicotine and alcohol addiction as well as obesity, researchers found.

A survey of primary care physicians found that those who were happy with their medical careers were more likely to report "some or a lot" of satisfaction treating nicotine dependence (62%), obesity (57%), and alcoholism (50%), according to Kenneth Rasinski, PhD, of the University of Chicago, and colleagues.

However, primary care professionals who were unhappy in their careers were less likely to be satisfied treating these disorders, especially if they said they held their patients responsible, the authors reported in a research letter in the August 27 issue of the Archives of Internal Medicine.

All three conditions have been shown to respond to treatment by primary care physicians, but research also has suggested that established treatment protocols are rarely used in the primary care setting. "It may be that physicians shy away from addressing these multifaceted, often obdurate conditions because they find that treating them is unsatisfying," the authors stated. They mailed a survey to 1,504 U.S. primary care doctors (general internal medicine, family medicine, or general practice with no secondary specialty) who were 65 years or younger. The survey was conducted from 2009 to 2010 and the overall response rate was 63%.

They found a significant association with personal feelings of practicing medicine as a calling, and personal satisfaction with treating patients with nicotine dependence, (adjusted odds ratio 1.9, 95% CI 1.2 to 2.9), obesity (aOR 1.9, 95% CI 1.2 to 3.0), and alcoholism (aOR 1.6, 95% CI 1.1 to 2.6). Those who said they were dissatisfied with a medical career were significantly less likely to report satisfaction treating nicotine dependence (aOR 0.7) and alcoholism (aOR 0.6).

Similarly, physicians were less inclined to report satisfaction treating patients for alcoholism if they felt patients were "a lot" responsible for their alcoholism -- versus not at all -- at an aOR of 0.3 (95% CI 0.1 to 0.8).

The authors noted that the study was limited by self-report, bias due to nonresponders. Also, a cross-sectional study cannot determine causation, they said. They added that follow-up studies could analyze satisfaction and responsibility measures against implementation of treatment for the three conditions.

Source.

Nine national medical groups are launching a campaign called Choosing Wisely to get U.S. doctors to back off on 45 diagnostic tests, procedures and treatments that often may do patients no good.

Many involve imaging tests such as CT scans, MRIs and X-rays. Stop doing them, the groups say, for most cases of back pain, or on patients who come into the emergency room with a headache or after a fainting spell, or just because somebody's about to undergo surgery.

A child with low belly pain and suspected appendicitis? Don't rush her to the CT scanner. Do an ultrasound first. That will give the answer 94 percent of the time, is cheaper and doesn't expose the child to radiation.

Don't put heartburn patients on high doses of acid-suppressing drugs when lower doses and shorter courses will do, they say. You might just be making their symptoms worse when they try to stop the medicine.

An apparently healthy middle-aged guy with few cardiac risk factors comes in for a yearly exam and wants to know how his ticker is. Don't give him a full cardiac workup, with a treadmill test and fancy imaging. This kind of patient accounts for almost half of unnecessary cardiac screening.

Postpone repeat colonoscopies for 10 years if the first one is negative, or if it found and removed one or two early-stage colon polyps, the guidelines state. And stop prescribing antibiotics for mild-to-moderate sinus infections.

And here's one that raises some tricky questions: Most patients who are debilitated with advanced cancer shouldn't get more chemotherapy.

"When somebody is literally bed-bound and unable to walk or take care of himself, it's almost futile to use cancer-directed treatment and will probably have negative consequences," says Dr. Lowell Schnipper, a Boston cancer specialist who helped develop the new guidelines.

Schnipper tells Shots many cancer patients are getting chemotherapy in the last weeks of their lives. He says that does no good, makes patients miserable and may shorten their life.

The Choosing Wisely project was launched last year by the foundation of the American Board of Internal Medicine. It recruited nine medical specialty societies representing more than 376,000 physicians to come up with five common tests or procedures "whose necessity ... should be questioned and discussed."

More.

After decades of steady but low-key growth, the use of medical simulation as a training tool has exploded in recent years. This article in Infocus highlights approaches to simulation training in use by several New York–area medical centers. Some have chosen to construct central, multidisciplinary training centers with dedicated managers. Others are pursuing a less centralized approach, operating a number of education sites within their institutions, while hospitals with limited resources may arrange to train staff offsite, or utilize mobile simulation facilities.

With high-risk specialties like emergency medicine, anesthesiology, obstetrics, and surgery leading the way, computerized patient simulators and surgical trainers (devices that simulate a certain type of surgical procedure, typically either a laparoscopic or endoscopic procedure or a drilling procedure) have evolved from a luxury to a necessity, especially for teaching hospitals. A number of specialties now require simulation training for residents, and many hospitals are making simulation courses a core component of their residency training programs.

To read the entire article, click here.
To access all the articles related to simulation training in the Infocus Winter 2011 issue, click here.