The Physician in the 21st Century

Ours is an age of unprecedented levels of environmental alteration and biodiversity loss. Beyond the exposure to environmental hazards, conditions such as environmental degradation, biotic impoverishment, climate change, and the loss of ecosystem services create important health threats by changing the ecology of many pathogens and increasing the incidence and/or severity of certain noncommunicable conditions. They also threaten health in the future by weakening the Earth's life support systems.Although physicians remain one of the most often accessed and most trusted sources of information about the environment, there is currently little emphasis on educating medical professionals about these environmental issues. This lack of training reduces the ability of most physicians to be efficient science-public interfaces and makes them ineffective at contributing to address the fundamental causes of environmental problems or participate in substantive environmental policy discussions. This is an important challenge facing medical education today.To turn medical students into effective physician-citizens, an already-overwhelmed medical school curriculum must make way for a thoughtful exploration of environmental stressors and their impacts on human health. The overarching question before medical educators is how to develop the competencies, standards, and curricula for this educational endeavor. To this end, the authors highlight some of the critical linkages between health and the environment and suggest a subset of key practical issues that need to be addressed in order to create environmental education standards for the physician of the future.

IntroductionThe ability to utilize the electronic health record (EHR) without compromising the doctor-patient relationship (DPR) is an essential skill of all physicians and trainees, yet little time is spent on educating or assessing learners on needed techniques. To address this gap, we developed a conventional OSCE station coupled with a simulated patient chart within the Epic program in order to assess our students' skills utilizing the EHR during a patient encounter.MethodsOf third-year medical students, 119 were given full access to the patient's simulated chart 24 hours in advance of their OSCE to review clinical data. During an in-person OSCE with a standardized patient (SP), students performed a focused history and physical, using the EHR to verify allergies and medications. Students completed an electronic patient note graded by faculty. SPs evaluated the students on communication and interpersonal skills with specific rubric elements. Faculty graded the students' notes to evaluate their expression of clinical reasoning in the assessment and plan.ResultsTraining SPs and faculty to assess students on EHR skills was feasible. After implementation of a comprehensive curriculum focused on EHR and DPR, there was a significant difference on EHR-related communication skills (M = 76.4, SD = 17.6) versus (M = 37, SD = 28.9) before curriculum enhancement t (117.9) = −12.4, p <.001.DiscussionThe EHR OSCE station provided a standardized method of assessing students' EHR skills during a patient encounter. Challenges still exist in the technological requirements to develop and deliver cases in today's EHR platform.

A healthy lifestyle is fundamental for the prevention and treatment of cardiovascular disease and other noncommunicable diseases (NCDs). Investment in primary prevention, including modification of health risk behaviors, could result in a 4-fold improvement in health outcomes compared with secondary prevention based on pharmacological treatment. The American Heart Association (AHA) emphasized the importance of lifestyle in its 2020 goals for cardiovascular health promotion and disease reduction. In addition to defining “cardiovascular health” based on criteria for blood pressure and biochemical markers (lipids and glycemia), the AHA Strategic Planning Committee further identified lifestyle characteristics of central importance: nutrition, physical activity, smoking, and maintenance of a healthy body weight.1 The World Health Organization estimated that ≈80% of NCDs could be prevented if 4 key lifestyle practices were followed: a healthy diet, being physically active, avoidance of tobacco, and alcohol intake in moderation.2 To support healthy lifestyle initiatives, major changes are necessary at the societal level to improve population health. Numerous strategies might help to create a culture that promotes and facilitates healthy behaviors, including creating laws and regulations, mounting large-scale public awareness and education campaigns, implementing local community programs, and providing individual counseling.3 Physicians are uniquely positioned to encourage individuals to adopt healthy lifestyle behaviors: Approximately 80% of Americans visit their primary care physician at least once a year. Physicians directly communicate with their patients during clinical encounters across numerous settings, and research indicates that patients highly value recommendations provided by their physicians.4,5 However, data further indicate that lifestyle counseling does not routinely occur in physicians’ offices, thereby representing a lost opportunity. Physicians report that they perform lifestyle counseling during ≈34% of clinic visits.4 Patients, in turn, report an even lower frequency of physician lifestyle counseling. For example, obese patients reported receiving physical activity and …

With the intensification of social aging, the implementation of integrated medical and elderly care services has attracted increasing attention. Guangzhou, as the birthplace of Western medicine in China, is also the starting point for the development of modern Western medicine hospitals in the country. However, current research on the integration of medical and nursing care facilities primarily remains at the theoretical level, with a significant gap in historical research on such buildings in Guangdong province. Yiyang Garden, constructed in the 1920s on Ersha Island in Guangzhou, China, stands out as the first privately established medical and elderly care facility in the city. This article explores the development process, design concepts, planning layout, architectural features, and landscape layout of Yiyang Garden through methods such as current situation exploration and analysis, inductive classification, and comparative analysis. Compared with other medical and nursing care facilities established in China since the 21st century, it is evident that while Yiyang Garden has incorporated advanced Western medical technologies, it has also retained a substantial influence from traditional Chinese healing theories. The overall design of Yiyang Garden is a representative example of medical and nursing care architecture that focuses on the environment and patients&amp;rsquo; feelings. As a modern sanatorium in Guangzhou, Yiyang Garden reflects the city&amp;rsquo;s approach to integrating medical and elderly care in the modern era. This study fills a significant gap in the historical research on Guangzhou&amp;rsquo;s medical and nursing care architecture and provides fundamental reference materials for exploring recuperation principles and architectural practices represented by Yiyang Garden during that period.

Biotechnological advancements have engendered great expectations in patients, changing the very conception of health, which has come to be construed as psycho-physical well-being rather than a mere absence of diseases. The doctor-patient relationship is affected by the dearth of funds allocated for health care. Doctors, however, should make the most out of the meager resources available, while tackling any form of discrimination in access to health care.

Annals of Surgery: September 2005 - Volume 242 - Issue 3 - p 462 doi: 10.1097/01.sla.0000180397.43643.c6

Quantitative Aspects of the Economic Growth of Nations: VIII. Distribution of Income by Size

Is Nephrology Fellowship Training on the Right Track?

Abass Alavi: A giant in Nuclear Medicine turns 80 and is still going strong!

The General Rules of the Civil Law of the People′s Republic of China(hereinafter the General Rules)shall officially come into effect as of July 1 of 2017.In this consideration, the paper probed into the legal attributes of the doctor-patient relationship in China in view of the relationship management in line with the General Rules.Also analyzed are the basic principles to be observed by both parties as regulated by the General Rules and patient rights protection.These efforts aim at elevating China′s medical service, protecting legitimate rights of both parties, and encourage a healthy and harmonious doctor-patient relationship. Key words: General Rules of the Civil Law; Doctor-patient relationship; Legal relationship; Civil capacity

Big Data Focus on Physicians: Start-up Profiles Physicians’ Pharma Friendliness

Introduction: The world, particularly India, is in the midst of one of the worst pandemics ever. The second wave of the COVID-19 pandemic has hit the country like a tsunami, taking a toll on life. A robust health-care industry with competent, productive, and positive manpower is needed like never before. The productivity of doctors is directly related to the fulfillment they experience in their jobs. Aims and Objectives: The study will try to explore the satisfaction level of doctors working in Haryana. It will also delve into major determinants of satisfaction and dissatisfaction. Materials and Methods: The cross-sectional survey-based analysis was conducted in FMHS SGTU on doctors employed in Haryana. The prevalidated questionnaire was administered via Google Forms. Results: A total of 515 filled pro forma were obtained. 71.6% of doctors were found to be satisfied in their chosen profession. Discussion: The discontentment among doctors is now globally acknowledged. It stems from a wide array of issues such as the growing incidents of workplace violence, lack of security measures, deteriorating doctor–patient relationship, erratic work hours, monumental workload in stressful environment, inadequate infrastructure, and pitiful pay. Conclusion: There is marked diminution in doctors' morale who regret being in this profession more and more. However, with the joint efforts of society and competent authorities, this grim situation can be rectified. Steps should be taken to build a strong doctor–patient relationship based on trust and boost infrastructure so that medical profession can be made alluring in the 21st century.

To investigate whether the physician-encounter interval for patients with type 2 diabetes (T2D) can be optimized from 2-3 to 4-6 months among those with a calculated 10-year cardiovascular disease (CVD) risk score of less than 20% without compromising their long-term outcomes. Using territory-wide public electronic medical records in Hong Kong, we emulated a target trial to compare the effectiveness of the physician-encounter intervals of 4-6 versus 2-3 months for T2D patients without prior CVDs and with a predicted risk for CVDs of less than 20% (i.e. those patients not in the high-risk category). Propensity score matching was used to emulate the randomization of participants at baseline, where 42 154 matched individuals were included for analysis. The marginal structural model was applied to estimate the hazard ratio (HR) for CVD incidence and all-cause mortality, the incidence rate ratio of secondary and tertiary care utilization, as well as the between-group differences in HbA1c, blood pressure and cholesterol levels. During a follow-up period of up to 12 (average: 5.1) years, there was no significantly increased risk of CVD in patients with physician-encounter intervals of 4-6 months compared with those patients with physician-encounter intervals of 2-3 months (HR [95% confidence interval {CI}]: 1.01 [0.90, 1.14]; standardized 10-year risk difference [95% CI]: -0.1% [-0.7%, 0.6%]), nor for all-cause mortality (HR: 1.00 [0.84, 1.20]; standardized 10-year risk difference: -0.1% [-0.5%, 0.3%]). Additionally, there was no observable difference in the utilization of secondary and tertiary care or key clinical parameters between these two follow-up frequencies. For T2D patients with a calculated 10-year CVD risk of less than 20%, the interval of regular physician encounters can be optimized from 2-3 to 4-6 months without compromising patients' long-term outcomes and saving substantial service resources in primary care.

THE main purpose of this paper is to present empirical estimates of a model of the disposition of claims through the courts. Landes, Gould, Posner, and others have developed a theoretical model of the disposition process, in which the decision to settle and the size of settlement depend on the defendant's maximum offer (expected award at verdict plus litigation costs) relative to the plaintiff's minimum ask (expected award at verdict minus litigation costs).' Variants of this model have been applied in several contexts, but so far it has not been tested empirically with data on individual claims.2 The obstacles to estimation by standard econometric techniques are twofold. First, the hypothesized determinants of the outcome-the potential verdict, ask, offer, and litigation costs-are all unobserved in the data available. Second, if the theory is correct, claims closed at each stage of disposition are not random samples but are "selfselected" on the basis of those case characteristics whose effect we wish to measure. Therefore, analysis of the observed outcome-size and probability of payment to the plaintiff, at verdict and in out-of-court settlement-cannot be generalized to the universe of claims as a whole. Param-

From the Editor's Desk: Systems Science 2010-2020, and Post-COVID-19.