Publications by authors named "Neil Farber"

Objectives: Anti-obesity bias is pervasive among medical professionals, students, and trainees. Stigmatization of patients leads to suboptimal care and clinical outcomes. Educational strategies in medical training are needed to reverse these attitudes.

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Spurred on by recent health care reforms and the Triple Aim's goals of improving population health outcomes, reducing health care costs, and improving the patient experience of care, emphasis on population health is increasing throughout medicine. Population health has the potential to improve patient care and health outcomes for individual patients. However, specific population health activities may not be in every patient's best interest in every circumstance, which can create ethical tensions for individual physicians and other health care professionals.

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Background: Evidence is mixed regarding how physicians' use of the electronic health record (EHR) affects communication in medical encounters.

Objective: To investigate whether the different ways physicians interact with the computer (mouse clicks, key strokes, and gaze) vary in their effects on patient participation in the consultation, physicians' efforts to facilitate patient involvement, and silence.

Design: Cross-sectional, observational study of video and event recordings of primary care and specialty consultations.

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Purpose: Few studies have quantitatively examined the degree to which the use of the computer affects patients' satisfaction with the clinician and the quality of the visit. We conducted a study to examine this association.

Methods: Twenty-three clinicians (21 internal medicine physicians, 2 nurse practitioners) were recruited from 4 Veteran Affairs Medical Center (VAMC) clinics located in San Diego, Calif.

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Objective: Electronic health records (EHRs) have great potential to improve quality of care. However, their use may diminish "patient-centeredness" in exam rooms by distracting the healthcare provider from focusing on direct patient interaction. The authors conducted a qualitative interview study to understand the magnitude of this issue, and the strategies that primary care providers devised to mitigate the unintended adverse effect associated with EHR use.

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The care of Very Important Patients (VIPs) is different from other patients because they may receive greater access, attention, and resources from health care staff. Although the term VIP is used regularly in the medical literature and is implicitly understood, in practice it constitutes a wide and heterogeneous group of patients that have a strong effect on health care providers. We define a VIP as a very influential patient whose individual attributes and characteristics (eg, social status, occupation, position), coupled with their behavior, have the potential to significantly influence a clinician's judgment or behavior.

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Background: There is increased emphasis on practicing humanism in medicine but explicit methods for faculty development in humanism are rare.

Objective: We sought to demonstrate improved faculty teaching and role modeling of humanistic and professional values by participants in a multi-institutional faculty development program as rated by their learners in clinical settings compared to contemporaneous controls.

Design: Blinded learners in clinical settings rated their clinical teachers, either participants or controls, on the previously validated 10-item Humanistic Teaching Practices Effectiveness (HTPE) questionnaire.

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Objective: The computer with the electronic health record (EHR) is an additional 'interactant' in the medical consultation, as clinicians must simultaneously or in alternation engage patient and computer to provide medical care. Few studies have examined how clinicians' EHR workflow (e.g.

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Background: Accountable care organizations (ACOs) are proliferating as a solution to the cost crisis in American health care, and already involve as many as 31 million patients. ACOs hold clinicians, group practices, and in many circumstances hospitals financially accountable for reducing expenditures and improving their patients' health outcomes. The structure of health care affects the ethical issues arising in the practice of medicine; therefore, like all health care organizational structures, ACOs will experience ethical challenges.

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Purpose: There have been no studies to date that examine physicians' decisions to withdraw life-sustaining treatment for patients based on their surrogates' financial gain. The authors' objective was to ascertain physician attitudes about withdrawing life-sustaining treatment when financial considerations are involved.

Methods: A survey was developed and pretested containing eight scenarios in which a terminally ill patient's spouse had a decision to make regarding withdrawal of the ventilator, which was deemed medically futile.

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Purpose: To examine residents' attitudes about prescribing medication for erectile dysfunction in ethically challenging scenarios.

Method: In 2009, the authors surveyed internal medicine and family medicine residents at the University of California, San Diego, School of Medicine, asking them to indicate how likely they would be to prescribe sildenafil citrate to patients in 10 hypothetical scenarios. Eight scenarios had three nested variables: sexual identity, HIV status, and risk level.

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Background: Although pay-for-performance (P4P) compensation is widespread, questions have arisen about its efficacy in improving health care quality and consequences for vulnerable patients.

Objective: To assess perceptions of general internists and P4P program leaders regarding how to implement fair and effective P4P.

Methods: Qualitative investigation using in-depth interviews with P4P program leaders and focus groups with general internists.

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Objective: Despite ethical implications, there are anecdotal reports of health practitioners withholding services from patients who do not pay their bills. We surveyed physicians about their attitudes and experiences regarding nonpaying patients.

Design: A cross-sectional mailed survey.

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Background: Pay-for-performance is proliferating, yet its impact on key stakeholders remains uncertain.

Objective: The Society of General Internal Medicine systematically evaluated ethical issues raised by performance-based physician compensation.

Results: We conclude that current arrangements are based on fundamentally acceptable ethical principles, but are guided by an incomplete understanding of health-care quality.

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Conventional wisdom and professional ethics generally dictate that physicians should avoid doctoring family members because of potential conflicts of interest. Nevertheless, cross-sectional surveys find that the practice is commonplace. Physicians have unique opportunities to influence their family member's care because they possess knowledge and status within the health care system; however, when physicians participate in the care of family members, they must not lose objectivity and confuse their personal and professional roles.

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Objective: There are few data available about factors which influence physicians' decisions to discharge patients from their practices. To study general internists' and family medicine physicians' attitudes and experiences in discharging patients from their practices.

Design: A cross-sectional mailed survey was used.

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Purpose: The purpose of this study was to identify the parameters by which oral and maxillofacial surgeons and anesthesiologists make decisions as to the safety for proceeding with surgery and anesthesia in cocaine-positive patients and to determine a national consensus of opinion, if possible.

Methods: Questionnaires were mailed to all known oral and maxillofacial surgery training programs and anesthesiology training programs in the United States (n = 241). Programs were queried as to screening, testing, parameters, and outcomes.

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Background: Who provides health care to resident physicians is not well studied.

Objective: To determine whether residency program directors (PDs)provide health care to their own residents and residents' families.

Design: An anonymous survey mailed to 1,345 PDs in Emergency Medicine, Family Medicine, Internal Medicine, Medicine-Pediatrics,and Obstetrics-Gynecology in the United States in 2003.

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Background: Few data are available about physicians' decisions in regard to withholding or withdrawing life-sustaining measures. We therefore studied internists' views on this subject.

Methods: We surveyed 1000 generalist and subspecialist internists about their views on withholding or withdrawing life-sustaining treatment.

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Surgeons may face a dilemma in which their obligations to their patients and their obligations to others or society may conflict. One way of examining these conflicts is through a model as depicted in Fig. 1.

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Objectives: To learn what family practice and internal medicine physicians understand about the scope of practice of physical medicine and rehabilitation (PM&R) and to study what effect that understanding and various demographic variables have on their intention to refer to physiatrists.

Design: Survey-based.

Setting: National survey.

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We surveyed physicians to determine what factors were associated with their reporting of impaired colleagues to Physician Health Programs (PHPs). We conducted a cross-sectional mail survey of 1000 randomly selected practicing physicians in the United States. A survey instrument asked the physicians whether they would report 10 hypothetical impaired colleagues to a PHP.

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We surveyed primary care physicians about their involvement and perceived skills in palliative care. A survey instrument asked how frequently internal medicine and family practice physicians performed 10 palliative care items. Subjects rated their skills in each area.

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