Adaptive Appointment Systems with Patient Preferences

Patients\u27 satisfaction with an appointment system when they attempt to book a nonurgent appointment is affected by their ability to book with a doctor of choice and to book an appointment at a convenient time of day. For medical conditions requiring urgent attention, patients want quick access to a familiar physician. For such instances, it is important for clinics to have open slots that allow same-day (urgent) access. A major challenge when designing outpatient appointment systems is the difficulty of matching randomly arriving patients\u27 booking requests with physicians\u27 available slots in a manner that maximizes patients\u27 satisfaction as well as clinics\u27 revenues. What makes this problem difficult is that booking preferences are not tracked, may differ from one patient to another, and may change over time. This paper describes a framework for the design of the next generation of appointment systems that dynamically learn and update patients\u27 preferences and use this information to improve booking decisions. Analytical results leading to a partial characterization of an optimal booking policy are presented. Examples show that heuristic decision rules, based on this characterization, perform well and reveal insights about trade-offs among a variety of performance metrics important to clinic managers

A double-blind taste comparison of pediatric antibiotic suspensions

This study examined the palatability of 22 antimicrobial suspensions by using five independent categories for scoring: appearance, smell, texture, taste, and aftertaste. The likely overall influence on patient compliance was also evaluated. Drugs were compared within their respective classes. The only antibiotics judged to be so unpalatable as to potentiallyjeopardize compliance were dicloxacillin, oxacillin, erythromycin/sulfisoxazole, and cefpodoxime. Among the penicillins, amoxicillin and ampicillin were preferred. Azithromycin was slightly superior to erythromycin and clarithromycin within the macrolide class. Many cephalosporins were ranked quite high, the best being loracarbef, cefadroxyl, cefprozil, and cefixime

Appropriate spiritual care by physicians: A theological perspective

It is argued that when spiritual care by physicians is linked to the empirical research indicating the salutary effect on health of religious beliefs and practices an unintended degradation of religion is involved. It is contended that it is much more desirable to see support for the patient’s spirituality as part of holistic care. A proposal for appropriate spiritual care by physicians is offered. © Blanton-Peale Institute 200

Telephone Medicine for Internists

The role of the telephone in medical practice is important, but often problematic. Mistakes in telephone diagnosis and triage can have severe consequences. An effective office system can reduce liability risks, and in some cases telephone contact can substitute for office visits. Internists feel unprepared to provide telephone care. Therefore, residency education needs to focus on documentation, consultant availability, and performance feedback. Research should focus on improving outcomes, reimbursement issues, and technologic advances. This article describes internists' telephone interactions with ambulatory patients, preparation for telephone medicine, and aspects of office telephone systems and makes comparisons with other primary care fields