A Tale of Two Countries: How I Saw More Patients With More Joy in Internal Medicine Practice
Notice bibliographique
Résumé
Ideas and Opinions2 May 2017A Tale of Two Countries: How I Saw More Patients With More Joy in Internal Medicine PracticeDawn E. DeWitt, MD, MScDawn E. DeWitt, MD, MScFrom Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M17-0244 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail After 14 years in Australia and Canada, I dreaded my return to practice in the United States. In 2003, after 10 years of academic practice in Seattle, I moved to Australia to develop rural and regional clinical training for the University of Melbourne. Practicing and teaching internal medicine in Australia was much easier and more rewarding than in the United States. My experience reinforces that complexity, fragmentation, and unnecessary documentation are driving physician burnout, patient dissatisfaction, high costs, and suboptimal outcomes in this country. Simplifying our system could save money, preserve patient choice, and improve outcomes.The data are clear—countries ...References1. Macinko J, Starfield B, Shi L. The contribution of primary care systems to health outcomes within Organization for Economic Cooperation and Development (OECD) countries, 1970-1998. Health Serv Res. 2003;38:831-65. [PMID: 12822915] CrossrefMedlineGoogle Scholar2. Goss E, Fletcher J, Lechuga C, Meissner P, Blank A, Lounsbury D, et al. Teamwork and working at “top of license” among physicians, nursing, and non-professional staff at teaching and non-teaching ambulatory practices. J Gen Int Med. 2011;26 Suppl 1 211. Google Scholar3. Shanafelt TD, Boone S, Tan L, Dyrbye LN, Sotile W, Satele D, et al. Burnout and satisfaction with work–life balance among US physicians relative to the general US population. Arch Intern Med. 2012;172:1377-85. [PMID: 22911330] CrossrefMedlineGoogle Scholar4. Sinsky C, Colligan L, Li L, Prgomet M, Reynolds S, Goeders L, et al. Allocation of physician time in ambulatory practice: a time and motion study in 4 specialties. Ann Intern Med. 2016;165:753-60. [PMID: 27595430]. doi:10.7326/M16-0961 LinkGoogle Scholar5. Wenger N, Méan M, Castioni J, Marques-Vidal P, Waeber G, Garnier A. Allocation of internal medicine resident time in a Swiss hospital: a time and motion study of day and evening shifts. Ann Intern Med. 2017. [Epub ahead of print]. [PMID: 28135724] doi:10.7326/M16-2238 LinkGoogle Scholar6. Erickson SM, Rockwern B, Koltov M; Medical Practice and Quality Committee of the American College of Physicians. Putting patients first by reducing administrative tasks in health care: a position paper of the American College of Physicians. Ann Intern Med. 2017;166:659-61. doi:10.7326/M16-2697 LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-0244.Corresponding Author: Dawn E. DeWitt, MD, MSc, Spokane Academic Center, PO Box 1495, Spokane, WA 99210-1495; e-mail, dawn.[email protected]edu.Author Contributions: Conception and design: D.E. DeWitt.Analysis and interpretation of the data: D.E. DeWitt.Drafting of the article: D.E. DeWitt.Critical revision of the article for important intellectual content: D.E. DeWitt.Final approval of the article: D.E. DeWitt.Collection and assembly of data: D.E. DeWitt.This article was published at Annals.org on 28 March 2017. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoPutting Patients First by Reducing Administrative Tasks in Health Care: A Position Paper of the American College of Physicians Shari M. Erickson , Brooke Rockwern , Michelle Koltov , Robert M. McLean , and A Tale of Two Countries Dawn E. DeWitt A Tale of Two Countries Vaibhav Kumar Metrics Cited byOath to Self-Care and Well-BeingPhysician Burnout in the Electronic Health Record EraN. Lance Downing, MD, David W. Bates, MD, MSc, and Christopher A. Longhurst, MD, MSThe Potential Impact of Scribes on Medical School Applicants and Medical Students with the New Clinical Documentation GuidelinesONE-YEAR TIME ANALYSIS IN AN ACADEMIC DIABETES CLINIC: QUANTIFYING OUR BURDENA Tale of Two CountriesVaibhav Kumar, MD 2 May 2017Volume 166, Issue 9Page: 669-670KeywordsComputersDisclosureElectronic medical recordsHealth carePatientsPrimary care physiciansResidencySub-specialty careSurgeryUrticaria ePublished: 28 March 2017 Issue Published: 2 May 2017 Copyright & PermissionsCopyright © 2017 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,015 | 0,041 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,002 |
| Bibliométrie | 0,002 | 0,002 |
| Études des sciences et des technologies | 0,010 | 0,009 |
| Communication savante | 0,020 | 0,020 |
| Science ouverte | 0,002 | 0,011 |
| Intégrité de la recherche | 0,010 | 0,030 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,026 | 0,011 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».