Physician Expression of Empathy and Positiveness to Hispanic and Non-Hispanic White Patients During Medical Encounters
Betsy Sleath, PhD; Richard H. Rubin, MD; Angela Arrey-Wastavino, PhD

Background: This study examined the extent to which physicians expressed empathy and positiveness to Hispanic and non-Hispanic white patients during primary care visits.

Methods: Twenty-seven family practice and internal medicine resident physicians at the University of New Mexico Health Sciences Center were audiotaped in 1995 with 427 adult patients who were fluent in English or Spanish. The tapes were reviewed and organized to measure how frequently physicians expressed empathy and positiveness to patients.

Results: Physicians expressed empathy at equal rates to Hispanic and non-Hispanic white patients. When examining only Hispanic patients, physicians were significantly more likely to express empathy to patients who they knew better. Physicians expressed positiveness to non-Hispanic white patients more often than to Hispanic patients. When examining only Hispanic patients, physicians were more likely to express positiveness to patients who they knew better, who rated their health better, and who were more educated. When examining only non-Hispanic white patients, physicians were more likely to express positiveness to older and male patients than to younger and female patients. Also, female and younger physicians were significantly more likely to express positiveness to non-Hispanic white patients than male and older physicians were.

Conclusions: Our findings illustrate that the resident physicians expressed empathy equally well to Hispanic and non-Hispanic white patients but that resident physicians need further training on how to express positiveness to patients from different ethnic backgrounds, especially Hispanic patients.

Residency Education
(Fam Med 2000;32(2):91-6.)

Surgical Practice of Primary Care Physicians in a Rural State: Implications for Curriculum Design
Myriam J. Curet, MD; Martha C. McGrew, MD

Background: We surveyed practicing primary care physicians to help determine surgical practice patterns of primary care physicians in a rural state. The information obtained can be used to make surgical curriculum decisions for generalist medical students and primary care residents.

Methods: We developed a questionnaire in which practicing primary care physicians were asked to rate, on a 5-point Likert scale, the importance of 145 areas of surgical knowledge and 48 areas of clinical skills to their practice. Responses were rank ordered by the mean ratings for each individual item. The questionnaire was sent to all 876 primary care physicians in the home state of the institution.

Results: The survey response rate was 61% (n=534). The most highly ranked items and procedures included acute otitis media, sinusitis, gastroesophageal reflux disease, pharyngitis, urinary tract infection, performance of abdominal exam, history and physical, daily progress notes, ear canal cleaning, and ability to write admission orders. The lowest ranked items included transplantation, infertility, amputations, performance of tracheostomy, venous cutdown, and cricothyrotomy.

Conclusions: Information regarding the surgical practice patterns of practicing primary care physicians can be used to develop a surgical curriculum for medical students and primary care residents.

Residency Education
(Fam Med 2000;32(2):97-101.)

Student Religiosity and Attitudes Toward Religion in Medicine at a Private Catholic Medical School
John T. Chibnall, PhD; Conley B. Call, MSIV; Joseph M. Jeral, MSIV; Christopher Holthaus, MSIV

Background and Objectives: This study examined attitudes of medical students at a private Catholic medical school toward religion in medical education and practice and the relationship of these attitudes to medical student religiosity.

Methods: Surveys were mailed to first- and second-year medical students at Saint Louis University. The survey concerned attitudes about the integration of religious issues into the medical school curriculum and clinical practice and the personal importance of religion in the student’s life (ie, religiosity).

Results: The response rate was 61% (188/308). Nearly half of the students supported the introduction of religious studies into the medical curriculum, primarily through electives and modeling during clinical clerkships. Students with a higher level of personal religiosity were more likely to advocate training and participation in religious inquiry and behavior in the medical clinic.

Conclusions: A significant minority of medical students at this Catholic university supported attention to religious issues in the medical school curriculum. The percentage might be lower at medical schools with no religious affiliation. The data indicate that students’ religiosity is associated with their support for religious inquiry with patients and for the inclusion of religious issues in the medical school curriculum.

Medical Student Education
(Fam Med 2000;32(2):102-8.)

An Analysis of Trends, Perceptions, and Use Patterns of Electronic Medical Records Among US Family Practice Residency Programs
James G. Lenhart, MD; Karen Honess; Deborah Covington, DrPH; Kevin E. Johnson, MD

Background and Objectives: This study intended to quantify electronic medical record (EMR) use in family practice residencies, associate program characteristics with EMR use, and identify perceptions and issues about the use of EMRs.

Methods: A survey was mailed to all 454 US family practice residency programs, with a 72% response rate. The survey, which was pretested and revised, was designed to identify benefits, problems, perceptions, and trends regarding the use of EMRs.

Results: Fifty-five of 329 programs (17%) were using an EMR, while 10 (3%) had used an EMR but discontinued. Programs in the South reported the highest EMR use (21%, 21/99), and those in the North Central region reported the lowest use (11%, 11/102). EMR use was highest in university settings (19%, 15/81), programs offering fellowships (26%, 24/92), new programs (36%, 18/48), and programs that require research (22%, 20/91). Of the 329 programs that responded, 43% (143 programs) reported having information systems (IS) committees. Of the 55 programs currently using EMRs, 78% had at least one full-time equivalent IS technician. Of programs that discontinued use, software inadequacy was the most frequently cited reason (40%, 4/10). Programs that had never used EMR systems (n=264) were more likely than those that had used EMRs (n=65) to favorably perceive EMRs with respect to 1) meeting program requirements (44% versus 34%), 2) documenting improved patient care (65% versus 43%), 3) providing a reliable research database (94% versus 55%), and 4) documenting resident experience (92% versus 53%). Of the 264 (80%) programs that had never used an EMR, 172 (65%) plan to implement one.

Conclusions: EMR use is low among US family practice residency programs, but some success in implementation of EMRs has been achieved. Based on the responses to this survey, use will likely increase from 55 of 329 programs (17%) to 153 of 329 (47%) by 2000.

Medical Informatics
(Fam Med 2000;32(2):109-14.)

Using Handheld Computers To Document Family Practice Resident Procedure Experience
Roger Garvin, MD; Frank Otto, MD; Deanna McRae, MA

Background and Objectives: We examined the use of inexpensive handheld computers in documenting resident procedures. With a handheld computer, data is entered at the time of the procedure, eliminating the problem of double entry.

Methods: Connectivity and ease of use were important factors considered when choosing a handheld computer. All residents received a handheld computer for data entry. Residency staff downloaded the data to a desktop computer. At the same time, data useful to residents was placed on their devices. The process of generating individual and program reports required 2 hours of staff time each month. Survey data regarding use and acceptance by residents was collected.

Results: Eighty-eight percent of residents collected data on their handheld computer. Those residents responding to a survey felt that the handheld computer was “very useful,” and 73% reported daily use. Initial costs were $310 per resident.

Conclusions: Handheld computers streamlined the collection of procedure data for family practice residents. Handheld computers assisted in producing timely and useful procedural reports for both residents and the residency program. Additional uses of handheld computers were beneficial to the program and the residents.

Medical Informatics
(Fam Med 2000;32(2):115-8.)

German Family Physicians’ Attitudes Toward Care of Involuntarily Childless Patients
Edith Ittner, PhD; Wolfgang Himmel, PhD; Michael M. Kochen, MD, MPH, PhD, FRCGP

Background and Objectives: Many family physicians regard fertility counseling out of their scope of practice, although key elements in the care of involuntarily childless couples fall within the theoretical framework of family practice. This study analyzed the doctors’ value system concerning the care of infertile patients and whether a personal interview leads to a greater sensitivity toward fertility issues.

Methods: We conducted 57 baseline and 51 follow-up interviews with family physicians in the area of Göttingen, Germany. We performed quantitative and qualitative analyses.

Results: During the baseline interview, all family physicians placed involuntary childlessness within the domain of fertility special- ists or regarded it as patients’ private matter. Fourteen family physicians (27%) considered fertility counseling more important at the follow-up interview than at the time of the baseline interview. Judgmental views of infertile couples could be detected in both interviews. More than one third of the family physicians assumed a connection between the patients’ childlessness and their personal behav- ior or way of living. Although the majority (73%) of the family physicians regarded involuntary child-lessness as a disease and considered assisted conception techniques as legitimate, a recommendation for fee reimbursement for fertility services was rejected by more than half of the physicians.

Conclusions: Most German family physicians do not consider that care of involuntarily childless couples is within or appropriate to their scope of practice.

Clinical Research and Methods
(Fam Med 2000;32(2):119-25.)

Family Practice Training in Nepal
Lani Ackerman, MD; Prakash Karki, MBBS

Background: This article describes the health care system in Nepal and the only existing family practice (general practice) training program in that country. The majority of doctors in Nepal still have no residency training, and a specialist focus pervades. The efforts of some leading educators in Nepal led to establishment of a family practice training program in 1982, and the program now enrolls 12 residents per year, half of whom are from India. Major obstacles in education, financing, and policy must be addressed before family practice can
have a meaningful presence or effect on the health care in Nepal.

International Family Medicine
(Fam Med 2000;32(2):126-8.)