What Can We Ask of Hospitals? Conceptual Foundations for an Ethics of Healthcare Organizations

The American Journal of Bioethics · 2026-02-27

obligations of organizations that provide patient care.

Debt by Design — Navigating the Hazards of Medical Credit Cards

New England Journal of Medicine · 2026-02-28

Clinician Persuasion in Shared Decision-Making: A Qualitative Analysis of Patient-Physician Discussions About the Benefits and Tradeoffs of Heart Failure Medications

Journal of Cardiac Failure · 2026-01-01

Qualitative Analysis of Patient-Physician Discussions About the Benefits and Tradeoffs of Heart Failure Medications

Journal of Cardiac Failure · 2025-09-01

BACKGROUND: How physicians frame medication benefits and tradeoffs while engaging in shared decision-making with patients is not well described in the management of heart failure with reduced ejection fraction (HFrEF). METHODS: This qualitative, secondary analysis of recorded encounters between clinicians and patients with HFrEF sought to identify major themes regarding the communication of medication benefits and tradeoffs. Encounters occurred in 6 clinics within 2 academic health systems. English-speaking adult patients with a diagnosis of HFrEF (ejection fraction ≤40%) were enrolled. RESULTS: A total of 247 patient encounters were analyzed. Patients' mean (standard deviation) age was 62.9 (13.9) years; 70.5% were male; 64.0% were White, 26.3% Black, and 3.2% Hispanic/Latinx. Overall, 70% of encounters contained a discussion involving medication benefits. Substantial variability was observed, and 4 main themes emerged. (1) Primary benefits (increased survival, reduced hospitalizations, better quality of life) were commonly discussed, but clinicians described the magnitude in only 2 cases. (2) Adjunctive drug benefits (improved physiology, tolerability, affordability) were described nonspecifically. (3) Persuasive forms of communication were common, including direct appeals to authority/guidelines, references to pharmaceutical advertisements, and emotive language. (4) Significant heterogeneity was present in the content and character of benefit tradeoff discussions. CONCLUSIONS: Rare inclusion of medication benefit magnitude, variability in the presentation of benefits, and use of persuasive and emotive communication all challenge traditional notions of shared decision-making but are commonly encountered in clinical interactions for heart failure. Recognizing these contextual factors and evaluating which are consistent with effective decision-making in HFrEF and other chronic conditions is important and needed.

Who’s Deciding? A Study of Patient-Surgeon Discussions About Contralateral Prophylactic Mastectomy

The American Surgeon · 2025-09-19

BackgroundDespite rising rates of contralateral prophylactic mastectomy (CPM), little is known about how surgeons and patients communicate about the procedure. This study is among the first to use real-time audio recordings of CPM discussions, link conversations to treatment choice, and include multiple institutions. We assessed surgeon-patient discussions, focusing on how often CPM was addressed, who initiated it, and how decisions were made.MethodsWe recruited surgeons and patients from three academic centers and audio-recorded the first surgical consultation for patients with (1) early-stage unilateral breast cancer or ductal carcinoma in situ and (2) no strong family history or BRCA mutation. Transcripts were analyzed using an inductive, qualitative approach to generate themes and detect patterns.ResultsTwenty-seven patients and eight surgeons participated. In 14 cases, neither patient nor surgeon mentioned CPM. In the remaining 13, surgeons initiated the topic in 10, typically while introducing surgical options. Of the four patients who received CPM, each had a strong initial preference for CPM and was undeterred by the surgeon's cautionary statements against it. When patients lacked strong preferences for CPM, they generally followed surgeon recommendations to forego CPM or to delay the decision until tests (eg, genetics and MRI) were complete.DiscussionSurgeons, not patients, most commonly initiated CPM discussions. Initial patient preference strongly influenced surgical decisions. Surgeon recommendations to wait for additional information shaped decision making only when patients were initially undecided. Future research should explore how patients form preferences prior to consultation and how best to address them during clinical conversations.

Nurturing Future Health Care Leadership With Student-Run Clinics—Reply

JAMA Internal Medicine · 2025-04-28 · 1 citations

Out of Pocket Getting Out of Hand — Reducing the Financial Toxicity of Rapidly Approved Drugs

New England Journal of Medicine · 2025-02-15 · 3 citations

How Anticipation of Agent-Regret Can Undermine Clinical Decision-Making

The American Journal of Bioethics · 2025-01-29

Patients’ Perceptions of Their Physicians’ Interpersonal Manner and Technical Competence: A Qualitative Study of Online Written Reviews

Medical Care Research and Review · 2025-12-19

Patients increasingly use online rating and review websites to share their clinical experiences, yet few studies have taxonomized how patients perceive their physicians. We developed a theoretical framework identifying the factors comprising patients' perceptions of their physicians' interpersonal manner and technical competence. We conducted a qualitative content analysis of 2,000 online reviews sampled from distinct physicians across the United States, balanced to represent primary care physicians and surgeons, males and females, and low- and high-star rated reviews. Reviews were received between 2015 and 2020 on a large commercial rating and review website. Our theoretical framework identifies 16 interpersonal manner factors and 10 technical competence factors. Interpersonal manner factors were grouped by physicians' attitude and character, behavior, and communication; technical competence factors were grouped by physicians' expertise, treatment approach, and outcomes. This framework may help physicians and health systems seeking to improve care quality, delivery, and patient satisfaction.

Physician Gender and Patient Perceptions of Interpersonal and Technical Skills in Online Reviews

JAMA Network Open · 2025-02-14 · 10 citations

Importance: Prior studies have revealed gender differences in workplace assessments of physicians, but little is known about differences by physician gender in patients' online written reviews. Objective: To analyze whether patients' perceptions of their physicians' interpersonal manner and technical competence differ by physician gender and practicing specialty and are associated with review star ratings. Design, Setting, and Participants: This cross-sectional study sampled written reviews submitted by patients between October 16, 2015, and May 27, 2020, for physicians across the US from a commercial physician rating and review website. Physicians included primary care physicians (PCPs) listed under family medicine, internal medicine, and pediatrics and surgeons listed under general surgery; orthopedic surgery; and cosmetic, plastic, and reconstructive surgery. Hand-coded reviews were used to fine-tune a natural language processing algorithm to classify all reviews for the presence and valence of patients' comments of physicians' interpersonal manner and technical competence. Statistical analyses were performed from July 2022 to December 2024. Exposure: Female or male physician gender. Main Outcomes and Measures: Outcomes included the presence and valence of interpersonal manner and technical competence comments and receipt of high star ratings. Multilevel logistic regressions analyzed differences by female or male physician gender in interpersonal manner and technical competence comments and whether those comments were associated with review star ratings. Results: The analysis included 345 053 written reviews of 167 150 physicians (mean [SD] age, 55.16 [11.40] years); 60 060 physicians (35.9%) were female, and 36 132 (21.6%) were surgeons. Female physicians overall had higher odds than males of receiving any (odds ratio [OR], 1.19; 95% CI, 1.16-1.22) or negative (OR, 1.22; 95% CI, 1.18-1.26) patient comments for their interpersonal manner. Among PCPs, females had higher odds than males of receiving a negative comment for interpersonal manner (OR, 1.22; 95% CI, 1.18-1.27) and, when receiving that negative comment, had disproportionately lower odds of receiving a high star rating (OR, 0.62; 95% CI, 0.53-0.73). Female physicians overall (OR, 1.09; 95% CI, 1.05-1.13) and female PCPs (OR, 1.08; 95% CI, 1.04-1.13) had higher odds than their male counterparts of receiving a negative comment for their technical competence. When receiving a negative comment for technical competence, both female PCPs (OR, 0.60; 95% CI, 0.50-0.73) and female surgeons (OR, 0.67; 95% CI, 0.50-0.89) had disproportionately lower odds of receiving a high star rating compared with their male counterparts. Female PCPs also had lower odds than male PCPs of receiving a high star rating when receiving a positive comment for technical competence (OR, 0.82; 95% CI, 0.70-0.96). Conclusions and Relevance: In this cross-sectional study of online written reviews, female and male physician gender were differently associated with patients' perceptions of their physicians' interpersonal manner and technical competence. The findings suggest that patients harbored negative gender biases about the interpersonal manner of female physicians, especially female PCPs, and also assessed disproportionate penalties related to technical competence for both female PCPs and female surgeons.