Promoting clinical autonomy in medical learners

2019 ◽  
Vol 16 (5) ◽  
pp. 454-457 ◽  
Author(s):  
Alexander R Carbo ◽  
Grace C Huang
Keyword(s):  
Clinical Autonomy

BMA chairman criticises erosion of clinical autonomy

BMJ ◽  
2003 ◽  
Vol 327 (7405) ◽  
pp. 8-a-8 ◽  
Author(s):  
L. Beecham
Keyword(s):  
Clinical Autonomy

scholarly journals Corporate management and clinical autonomy: The ethical dilemma in mental health

1997 ◽  
Vol 20 (2) ◽  
pp. 83 ◽  
Author(s):  
Ben Nielsen ◽  
Philip Ward
Keyword(s):  
Mental Health ◽  
Health Policy ◽  
Health Services ◽  
Intellectual Capital ◽  
Management Practices ◽  
Mental Health Policy ◽  
Public Mental Health ◽  
Management Approach ◽  
Corporate Management ◽  
Clinical Autonomy

Funding constraints and management practices are increasing pressure on clinicalautonomy within Australian mental health services. The introduction of total qualitymanagement, output-based funding and changes to public mental health policy havepromoted business-like efficiency and increased control of resources. It is argued thatsuch moves significantly circumscribe the discretionary authority that mental healthprofessionals have previously enjoyed. This paper attempts to highlight the ethical andmoral tension inherent within a corporate management approach, and calls formental health services to acknowledge the value of intellectual capital, creativity andinnovation.

scholarly journals A survey of memory clinic practice in Scotland

2008 ◽  
Vol 32 (12) ◽  
pp. 467-469 ◽  
Author(s):  
Jane Foy
Keyword(s):  
Memory Clinic ◽  
National Guidelines ◽  
Common Component ◽  
Prescribing Practice ◽  
Memory Clinics ◽  
Assessment Techniques ◽  
Old Age Psychiatry ◽  
Clinical Autonomy ◽  
Clinic Practice ◽  
The Cost

Aims and MethodA questionnaire survey of all memory clinics in Scotland to obtain information about clinic characteristics, assessment techniques and prescribing practice.ResultsMemory clinics are a common component of old age psychiatry services within Scotland. There is variability in clinic characteristics, assessment techniques and treatment approaches. Most clinicians appear to rely on their own clinical judgement rather than national guidelines when making decisions about investigations and the prescription of anti-dementia medications.Clinical ImplicationsThere is considerable variation in memory clinic practice across the country. Would standardisation of practice ensure equity in service provision/patient care? However, would such standardisation be at the cost of clinical autonomy?

Clinical autonomy and contractual space*

2001 ◽  
Vol 2 (1) ◽  
pp. 36-41 ◽  
Author(s):  
Keith Cash
Keyword(s):  
Clinical Autonomy

scholarly journals Selective Consent and Dissent: Professional Response to Reform in the Post-Crisis Greek NHS

2018 ◽  
Vol 33 (2) ◽  
pp. 262-279 ◽  
Author(s):  
Sharon C Bolton ◽  
Vasilis Charalampopoulos ◽  
Lila Skountridaki
Keyword(s):  
Qualitative Data ◽  
Medical Profession ◽  
Economic Recession ◽  
Analytical Framework ◽  
Welfare States ◽  
Distinct Form ◽  
Clinical Autonomy ◽  
Hospital Doctors ◽  
State Relations

Utilising the sociology of the professions as an analytical framework, the article explores the response of the Greek medical profession to state-imposed managerialism during times of economic recession and socio-political turbulence. It is argued that the case of southern welfare states, permeated by clientelism and corruption, underpins a distinct form of professional–state relations, currently missing from relevant theoretical discussions. Rich qualitative data collected from practising hospital doctors in Greece reveal a willingness to concede elements of clinical autonomy in exchange for the minimisation of the role of a corrupt state in the organisation of the Greek National Health Service.

scholarly journals Factors that influence rheumatologists’ anti-tumor necrosis factor alpha prescribing decisions: a qualitative study

2019 ◽  
Vol 3 (1) ◽  
Author(s):  
Sean P. Gavan ◽  
Gavin Daker-White ◽  
Katherine Payne ◽  
Anne Barton
Keyword(s):  
Rheumatoid Arthritis ◽  
Clinical Practice ◽  
Tumor Necrosis Factor ◽  
Tumor Necrosis Factor Alpha ◽  
Regional Variation ◽  
Tumor Necrosis ◽  
Necrosis Factor Alpha ◽  
Factor Alpha ◽  
Clinical Autonomy ◽  
Necrosis Factor

Abstract Background Treatment decisions for any disease are usually informed by reference to published clinical guidelines or recommendations. These recommendations can be developed to improve the relative cost-effectiveness of health care and to reduce regional variation in clinical practice. Anti-tumor necrosis factor alpha (anti-TNF) treatments are prescribed for people with rheumatoid arthritis according to specific recommendations by the National Institute for Health and Care Excellence in England. Evidence of regional variation in clinical practice for rheumatoid arthritis may indicate that different factors have an influence on routine prescribing decisions. The aim of this study was to understand the factors that influence rheumatologists’ decisions when prescribing anti-TNF treatments for people with rheumatoid arthritis in England. Methods Semi-structured one-to-one telephone interviews were performed with senior rheumatologists in different regions across England. The interview schedule addressed recommendations by the National Institute for Health and Care Excellence, prescribing behavior, and perceptions of anti-TNF treatments. Interviews were recorded digitally, transcribed verbatim, and anonymized. Data were analyzed by thematic framework analysis that comprised six stages (familiarization; coding; developing the framework; applying the framework; generating the matrix; interpretation). Results Eleven rheumatologists (regional distribution - north 36%; midlands: 36%; south: 27%) participated (response rate: 24% of the sampling frame). The mean duration of the interviews was thirty minutes (range: 16 to 56 min). Thirteen factors that influenced anti-TNF prescribing decisions were categorized by three nested primary themes; specific influences were defined as subthemes: (i) External Environment Influences (National Institute for Health and Care Excellence Recommendations; Clinical Commissioning Groups; Cost Pressures; Published Clinical Evidence; Colleagues in Different Hospitals; Pharmaceutical Industry); (ii) Internal Hospital Influences (Systems to Promote Compliance with Clinical Recommendations; Internal Treatment Pathways; Hospital Culture); (iii) Individual-level Influences (Patient Influence; Clinical Autonomy; Consultant Experience; Perception of Disease Activity Score-28 (DAS28) Outcome). Conclusions Factors that influenced anti-TNF prescribing decisions were multifaceted, seemed to vary by region, and may facilitate divergence from published clinical recommendations. Strategic behavior appeared to illustrate a conflict between uniform treatment recommendations and clinical autonomy. These influences may contribute to understanding sources of regional variation in clinical practice for rheumatoid arthritis.

Magnet hospital staff nurses describe clinical autonomy

2003 ◽  
Vol 51 (1) ◽  
pp. 13-19 ◽  
Author(s):  
Marlene Kramer ◽  
Claudia E. Schmalenberg
Keyword(s):  
Hospital Staff ◽  
Staff Nurses ◽  
Magnet Hospital ◽  
Hospital Staff Nurses ◽  
Clinical Autonomy
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