Journal of general internal medicine
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The Institute of Medicine calls for physicians to engage patients in making clinical decisions, but not every patient may want the same level of participation. ⋯ This population-based study demonstrates that people vary substantially in their preferences for participation in decision making. Physicians and health care organizations should not assume that patients wish to participate in clinical decision making, but must assess individual patient preferences and tailor care accordingly.
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To determine whether phlebotomy contributes to changes in hemoglobin and hematocrit levels in hospitalized general internal medicine patients. ⋯ Phlebotomy is highly associated with changes in hemoglobin and hematocrit levels for patients admitted to an internal medicine service and can contribute to anemia. This anemia, in turn, may have significant consequences, especially for patients with cardiorespiratory diseases. Knowing the expected changes in hemoglobin and hematocrit due to diagnostic phlebotomy will help guide when to investigate anemia in hospitalized patients.
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To examine how primary care physicians respond to ambiguous patient symptom presentations. ⋯ Primary care physicians respond to ambiguity by either ignoring the ambiguity and becoming more directive (UC) or, less often, by acknowledging the ambiguity and attempting to explore symptoms and patient concerns in more detail (HP). Future areas of study could address whether physicians can learn HP behaviors and whether HP behaviors positively affect health outcomes.
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While the majority of adults are attempting weight loss at any given time, few engage in optimal diet and exercise. We examined factors associated with being in advanced stages of behavior change for weight loss, diet, and exercise. ⋯ A large proportion of primary care patients are at advanced stages of readiness to lose weight, improve diet, and increase exercise. Future studies should examine the effectiveness of primary care interventions to help patients optimize weight-related behavior.
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Multicenter Study
Perceived preparedness to provide preventive counseling: reports of graduating primary care residents at academic health centers.
To assess the perceived preparedness of residents in adult primary care specialties to counsel patients about preventive care and psychosocial issues. ⋯ Physicians completing residencies in adult primary care did not feel very well prepared to counsel patients about preventive and psychosocial issues. Significant differences exist among specialties, even after adjusting for differences in time spent in ambulatory settings. Increasing residency time in ambulatory settings may not alone be sufficient to ensure that residents emerge with adequate counseling skills.