Careprovider and obstetrical interventions--a comparative study of four European countries

Physicians' opinions on patients' requests for specific treatments and examinations

OBJECTIVE

The number of technologies used in health care is growing, patients' educational level has risen, health and drug information is increasingly available and patients today are actively looking for information from different sources. The aim of the study was to investigate physicians' opinions on patients' requests for specific treatments and examinations.

DESIGN

The data were gathered as part of an annual physician's survey sent to all Finnish physicians (n=16,698) by the Finnish Medical Association in March 2002. The response rate was 85% (n=14,157). Physicians involved in clinical work were selected for this study (n=12,255).

RESULTS

Half (53%, n=6,521) of the clinicians reported either 'very often', or 'often' receiving requests from patients for specific treatments or examinations, and of them, 76% (n=4,972) reported an increase in such requests. The younger clinicians received more often patient requests. Women physicians, those working in health centres, and non-specialized clinicians reported more experience of, and an increase in patients making requests. Of those clinicians who received patient requests 'very often' or 'often', 24% (n=1,595) considered such requests as having a positive, and 43% (n=2,808) a negative, effect on patient care and interaction; clinicians who did not receive many patient requests had similar opinions. Older, men, those working in private practice and specialized clinicians had a more positive attitude towards such requests than other clinicians. The reasons given for the positive and negative opinions were varied.

CONCLUSIONS

Active patients (consumer patients) are a reality in the Finnish health care system. Physicians have varying opinions on this phenomenon.

Finnish physicians' attitudes towards preconsultation information: menopausal treatment practices as an example

The purpose of this study was to investigate Finnish physicians' attitudes towards consumer groups provision of information about physicians' treatment practices, using menopause as a specific example. A questionnaire to be used to make a public brochure listing physicians by their menopausal and postmenopausal treatment practice was sent by consumer organizations to 812 physicians [gynecologists and general practitioners (GPs)] in 1995, after contacting the physicians' associations for support for this activity. The gynecological association had a negative attitude towards the study while that of the GPs' association was more favorable. The response rate was 38% (n = 307). Only 5% of the physicians who got the questionnaire wanted to participate in the planned brochure and only 21% of those responding considered preconsultation information a good idea. The most common reasons for not wanting to participate were that preconsultation information is medically unfeasible and that it would be incompatible with physician's current working practice. Approaches other than public brochures about physicians' treatment patterns are needed if we want to increase patients' participation in decision-making.

Physicians' gender and clinical opinions of reproductive health matters

The purpose of this study was to investigate the effect of physicians' gender when sex-specific conditions are being treated in a country where almost half of the physicians are women. Five Finnish surveys originally conducted for other purposes were reanalyzed. Two surveys examined physicians' and medical students' views about hormone therapy during and after menopause, one survey examined medical students' attitudes about medicines, one survey examined physicians' obstetric practices, and one examined contraceptive counselling. All the surveys showed more similarities than differences in the clinical decision-making of women and men physicians. In opinions about menopause the physician's medical specialty was more important than gender. Physicians' obstetrical practices were also similar in five cases out of six, but in one situation where medical factors were not a deciding issue, women physicians acted differently. These results suggest that socialization into the medical profession makes physicians' practices more alike and diminishes gender differences.