Mack Lipkin, M.D.

Alcoholism in primary care
Lipkin, Mack; Lee, Joshua
Clinical addiction psychiatry New York : Cambridge University Press, 2010,
— id: 5741, year: 2010, vol: , page: ?, stat: Chapter,

Electronic communications with patients: improved safety, improved access, or electronic leash-principles and prospects
Reisman, Anna B; Stevens, David L; Lipkin, Mack
2010 Mar;55(3):545-547, Digestive diseases & sciences
— id: 138442, year: 2010, vol: 55, page: 545, stat: Journal Article,

ASSESSING RESIDENTS COMPETENCE IN TWO CONTEXTS: STANDARDIZED PATIENT EXAMS AND UNANNOUNCED STANDARDIZED PATIENT VISITS
Zabar, S; Lipkin, M; Hanley, K; Burgess, A; Bruno, JH; Adams, J; Kalet, A; Gillespie, C
2010 JUN ;25(9):227-227, Journal of general internal medicine
— id: 111907, year: 2010, vol: 25, page: 227, stat: Journal Article,

Twenty years of fostering the development of caring, balanced practitioners for the underserved: Major results of an in-depth survey of graduates of a humanistic primary care residency program
Laponis, R; Gillespie, C; Zabar, S; Kalet, AL; Adams, JG; Shah, NR; Anderson, M; Lipkin, M
2008 MAR ;23(2):429-429, Journal of general internal medicine
— id: 78177, year: 2008, vol: 23, page: 429, stat: Journal Article,

Two decades of Title VII support of a primary care residency: process and outcomes
Lipkin, Mack; Zabar, Sondra R; Kalet, Adina L; Laponis, Ryan; Kachur, Elizabeth; Anderson, Marian; Gillespie, Colleen C
2008 Nov;83(11):1064-1070, Academic medicine
PURPOSE: To assess 23 years of Health Resources and Services Administration (HRSA) Title VII Training in Primary Care Medicine and Dentistry funding to the New York University School of Medicine/Bellevue Primary Care Internal Medicine Residency Program. The program, begun in 1983 within a traditional, inner-city, subspecialty-oriented internal medicine program, evolved into a crucible of systematic innovation, catalyzed and made feasible by initiatives funded by the HRSA. The curriculum stressed three pillars of generalism: psychosocial medicine, clinical epidemiology, and health policy. It developed tight, objectives-driven, effective, nonmedical specialty blocks and five weekly primary care activities that created a paradigm-driven, community-based, role-modeling matrix. Innovation was built in. Every block and activity was evaluated immediately and in an annual, program-wide retreat. Evaluation evolved from behavioral checklists of taped interviews to performance-based, systematic, annual objective structured clinical examinations. METHOD: The authors reviewed eight grant proposals, project reports, and curriculum and program evaluations. They also quantitatively and qualitatively surveyed the 122 reachable graduates from the first 20 graduating classes of the program. RESULTS: Analysis of program documents revealed recurring emphases on the use of proven educational models, strategic innovation, and assessment and evaluation to design and refine the program. There were 104 respondents (85%) to the survey. A total of 87% of the graduates practice as primary care physicians, 83% teach, and 90% work with the underserved; 54% do research, 36% actively advocate on health issues for their patients, programs, and other constituencies, and 30% publish. Graduates cited work in the community and faculty excitement and energy as essential elements of the program's impact; overall, graduates reported high personal and career satisfaction and low burnout. CONCLUSIONS: With HRSA support, a focused, innovative program evolved which has already met each of the six recommendations for future innovation of the Alliance for Academic Internal Medicine Education Redesign Task Force. This article is part of a theme issue of Academic Medicine on the Title VII health professions training programs
— id: 93382, year: 2008, vol: 83, page: 1064, stat: Journal Article,

Recognizing, managing, and treating bipolar disorder at the interface of primary care and psychiatric medicine. Part 4: Treatment by phase: Pharmacologic management of bipolar disorder
Chung H.; Culpepper L.; De Wester J.N.; Grieco R.L.; Kaye N.S.; Lipkin M.; Rosen S.J.; Ross R.
2007 ;56(11SUPPL.):S19-S27, Journal of family practice
— id: 75137, year: 2007, vol: 56, page: S19, stat: Journal Article,

Recognizing, managing, and treating bipolar disorder at the interface of primary care and psychiatric medicine. Part 5: Recognizing bipolar disorder on initial presentation: A case study with decision points
Chung H.; Culpepper L.; De Wester J.N.; Grieco R.L.; Kaye N.S.; Lipkin M.; Rosen S.J.; Ross R.
2007 ;56(11SUPPL.):S28-S32, Journal of family practice
— id: 75136, year: 2007, vol: 56, page: S28, stat: Journal Article,

Recognizing, managing, and treating bipolar disorder at the interface of primary care and psychiatric medicine: PART 1 - Defining the challenge: Recognizing and treating bipolar disorder wherever patients present
Chung H.; Culpepper L.; De Wester J.N.; Grieco R.L.; Kaye N.S.; Lipkin M.; Rosen S.J.; Ross R.
2007 ;56(11SUPPL.):S3-S4, Journal of family practice
— id: 75140, year: 2007, vol: 56, page: S3, stat: Journal Article,

Recognizing, managing, and treating bipolar disorder at the interface of primary care and psychiatric medicine: PART 2 - Recognizing and understanding bipolar disorder
Chung H.; Culpepper L.; De Wester J.N.; Grieco R.L.; Kaye N.S.; Lipkin M.; Rosen S.J.; Ross R.
2007 ;56(11SUPPL.):S5-S10, Journal of family practice
— id: 75139, year: 2007, vol: 56, page: S5, stat: Journal Article,

Recognizing, managing, and treating bipolar disorder at the interface of primary care and psychiatric medicine: Part 3: Clinical management of bipolar disorder: Role of the primary care provider
Chung H.; Culpepper L.; De Wester J.N.; Grieco R.L.; Kaye N.S.; Lipkin M.; Rosen S.J.; Ross R.
2007 ;56(11SUPPL.):S11-S18, Journal of family practice
— id: 75138, year: 2007, vol: 56, page: S11, stat: Journal Article,

Using bedside rounds to teach communication skills in the internal medicine clerkship
Janicik, Regina; Kalet, Adina L; Schwartz, Mark D; Zabar, Sondra; Lipkin, Mack
2007 ;12(2):1-6, Medical Education Online
Background: Physicians' communication skills, which are linked to important patient outcomes, are rarely explicitly taught during the clinical years of medical school. This paper describes the development, implementation, and evaluation of a communication skills curriculum during the third-year Internal Medicine Clerkship. Methods: In four two-hour structured bedside rounds with trained Internal Medicine faculty facilitators, students learned core communication skills in the context of common challenging clinical situations. In an end-of-clerkship survey students evaluated the curriculum's educational effectiveness. Results: Over the course of a year, 160 third-year students and 15 faculty participated. Of the 75/160 (47%) of students who completed the post-clerkship survey, almost all reported improvement in their communication skills and their ability to deal with specific communication challenges. Conclusions: The curriculum appears to be a successful way to reinforce core communication skills and practice common challenging situations students encounter during the Internal Medicine Clerkship. (journal abstract)
— id: 79111, year: 2007, vol: 12, page: 1, stat: Journal Article,

Using bedside rounds to teach communication skills in the internal medicine clerkship
Janicik, Regina; Kalet, Adina L; Schwartz, Mark D; Zabar, Sondra; Lipkin, Mack
2007 ;12(1):?-?, Medical Education Online
Background: Physicians\' communication skills, which are linked to important patient outcomes, are rarely explicitly taught during the clinical years of medical school. This paper describes the development, implementation, and evaluation of a communication skills curriculum during the third-year Internal Medicine Clerkship. Methods: In four two-hour structured bedside rounds with trained Internal Medicine faculty facilitators, students learned core communication skills in the context of common challenging clinical situations. In an end-of-clerkship survey students evaluated the curriculum\'s educational effectiveness. Results: Over the course of a year, 160 third-year students and 15 faculty participated. Of the 75/160 (47%) of students who completed the post-clerkship survey, almost all reported improvement in their communication skills and their ability to deal with specific communication challenges. Conclusions: The curriculum appears to be a successful way to reinforce core communication skills and practice common challenging situations students encounter during the Internal Medicine Clerkship.
— id: 105275, year: 2007, vol: 12, page: ?, stat: Journal Article,

CT and MR imaging findings following laparoscopic and open nephron sparing surgery
Stifelman, M; Brown, K; Hyams, E; Lipkin, M; Hecht, E; Taneja, S
2007 OCT ;21(1-2):A274-A274, Journal of endourology
— id: 98150, year: 2007, vol: 21, page: A274, stat: Journal Article,

General Health Questions- A Virtual OSCE
Triola, Marc M; Feldman, Henry; Kalet, Adina; Zabar, Sondra; Kachur, Elizabeth; Anderson, Marian; Lipkin, Mack
MedEdPORTAL [sl : AAMC],
CHIP Case: 27 Year-old Korean female suffering from normal anxiety and 'worried well.' - We are looking for collaborators to both create and study the impact of Virtual Patients. At this stage of our development, the VP cases are available (after registering with us) to any faculty from an accredited institution. If that faculty wishes to make it available to students in their institution they may do so. The scripts would be available to any faculty/school with whom we are or would be collaborating
— id: 5650, year: 2007, vol: , page: ?, stat: Chapter,

Migraine Follow-up - A Virtual OSCE
Triola, Marc M; Feldman, Henry; Kalet, Adina; Zabar, Sondra; Kachur, Elizabeth; Anderson, Marian; Lipkin, Mack
MedEdPORTAL [sl : AAMC],
CHIP Case: 22 year old Chinese Female and 23-year-old White (Non-Hispanic) female dealing with bereavment. -We are looking for collaborators to both create and study the impact of Virtual Patients. At this stage of our development, the VP cases are available (after registering with us) to any faculty from an accredited institution. If that faculty wishes to make it available to students in their institution they may do so. The scripts would be available to any faculty/school with whom we are or would be collaborating
— id: 5648, year: 2007, vol: , page: ?, stat: Chapter,

Psychosocial Aspects of Terrorism and Disaster Medicine
Triola, Marc M; Feldman, Henry; Kalet, Adina; Zabar, Sondra; Kachur, Elizabeth; Anderson, Marian; Lipkin, Mack
MedEdPORTAL [sl : AAMC],
Web-based online course (Virtual Patient). Users will be required to complete a registration form on the NYU website before gaining access. Registration is free but is restricted to full-time teaching faculty or administrators affiliated with a recognized educational institution. This online course will provide useful information and tools to address patients' psychosocial responses to terrorist threats or attacks, to help focus responses of health care teams in acute situations, and to fulfill leadership roles in communities. The modules emphasize the most common psychosocial stress responses to bio-terrorism and disasters: 1. Acute Stress Disorder 2. Post-Traumatic Stress Disorder (PTSD)
— id: 5647, year: 2007, vol: , page: ?, stat: Chapter,

Surgical PA - A Virtual OSCE
Triola, Marc M; Feldman, Henry; Kalet, Adina; Zabar, Sondra; Kachur, Elizabeth; Anderson, Marian; Lipkin, Mack
MedEdPORTAL [sl : AAMC],
CHIP Case: 31 year-old White male with Acute Stress Disorder. -We are looking for collaborators to both create and study the impact of Virtual Patients. At this stage of our development, the VP cases are available (after registering with us) to any faculty from an accredited institution. If that faculty wishes to make it available to students in their institution they may do so. The scripts would be available to any faculty/school with whom we are or would be collaborating
— id: 5649, year: 2007, vol: , page: ?, stat: Chapter,

A randomized trial of teaching clinical skills using virtual and live standardized patients
Triola, M; Feldman, H; Kalet, A L; Zabar, S; Kachur, E K; Gillespie, C; Anderson, M; Griesser, C; Lipkin, M
2006 May;21(5):424-429, Journal of general internal medicine
BACKGROUND: We developed computer-based virtual patient (VP) cases to complement an interactive continuing medical education (CME) course that emphasizes skills practice using standardized patients (SP). Virtual patient simulations have the significant advantages of requiring fewer personnel and resources, being accessible at any time, and being highly standardized. Little is known about the educational effectiveness of these new resources. We conducted a randomized trial to assess the educational effectiveness of VPs and SPs in teaching clinical skills. OBJECTIVE: To determine the effectiveness of VP cases when compared with live SP cases in improving clinical skills and knowledge. DESIGN: Randomized trial. PARTICIPANTS: Fifty-five health care providers (registered nurses 45%, physicians 15%, other provider types 40%) who attended a CME program. INTERVENTIONS: Participants were randomized to receive either 4 live cases (n=32) or 2 live and 2 virtual cases (n=23). Other aspects of the course were identical for both groups. RESULTS: Participants in both groups were equivalent with respect to pre-post workshop improvement in comfort level (P=.66) and preparedness to respond (P=.61), to screen (P=.79), and to care (P=.055) for patients using the skills taught. There was no difference in subjective ratings of effectiveness of the VPs and SPs by participants who experienced both (P=.79). Improvement in diagnostic abilities were equivalent in groups who experienced cases either live or virtually. CONCLUSIONS: Improvements in performance and diagnostic ability were equivalent between the groups and participants rated VP and SP cases equally. Including well-designed VPs has a potentially powerful and efficient place in clinical skills training for practicing health care workers
— id: 67849, year: 2006, vol: 21, page: 424, stat: Journal Article,

Psychosocial Aspects of Terrorism and Disaster Medicine
Triola, Mark; Feldman, Henry; Zabar, Sondra; Anderson, Marian; Kalet, Adina; Kachur, Elizabeth; Lipkin, Mack
2006;:- [Web Site], Nov 9, 2006, MedEdPORTAL
Web-based online course (Virtual Patient). Users will be required to complete a registration form on the NYU website before gaining access. Registration is free but is restricted to full-time teaching faculty or administrators affiliated with a recognized educational institution. This online course will provide useful information and tools to address patients' psychosocial responses to terrorist threats or attacks, to help focus responses of health care teams in acute situations, and to fulfill leadership roles in communities. The modules emphasize the most common psychosocial stress responses to bio-terrorism and disasters: Acute Stress Disorder; Post-Traumatic Stress Disorder (PTSD); Depression / Bereavement; Sub-Diagnostic Distress
— id: 150921, year: 2006, vol: , page: , stat: Web Site,

Teaching the psychosocial aspects of care in the clinical setting: practical recommendations
Kern, David E; Branch, William T Jr; Jackson, Jeffrey L; Brady, Donald W; Feldman, Mitchell D; Levinson, Wendy; Lipkin, Mack Jr
2005 Jan;80(1):8-20, Academic medicine
Communication skills and the psychosocial dimensions of patient care are increasingly taught in medical schools and generalist residency programs. Evidence suggests they are not reinforced or optimally implemented in clinical training. The authors present the product of an iterative process that was part of a national faculty development program and involved both experts and generalist teachers concerning teaching psychosocial medicine while precepting medical students and residents in clinical settings. Using scientific evidence, educational theory, and experience, the authors developed recommendations, presented them in workshops, and revised them based on input from other experts and teachers, who gave feedback and added suggestions. The results are practical, expert consensus recommendations for clinical preceptors on how to teach and reinforce learning in this area. General skills to use in preparing the trainee for improved psychosocial care are organized into the mnemonic 'CAARE MORE': Connect personally with the trainee; Ask psychosocial questions and Assess the trainee's knowledge/attitudes/skills/behaviors; Role model desired attitudes/skills/behaviors; create a safe, supportive, enjoyable learning Environment; formulate specific Management strategies regarding psychosocial issues; Observe the trainee's affect and behavior; Reflect and provide feedback on doctor-patient and preceptor-trainee interactions; and provide Educational resources and best Evidence. The preceptor-trainee teaching skills that are recommended parallel good doctor-patient interaction skills. They can be used during both preceptor-trainee and preceptor-trainee-patient encounters. Important common psychosocial situations that need to be managed in patients include substance abuse, depression, anxiety, somatoform disorder, physical and sexual abuse, and posttraumatic stress disorder. For these problems, where high-level evidence exists, specific psychosocial questions for screening and case finding are provided
— id: 95873, year: 2005, vol: 80, page: 8, stat: Journal Article,

Measuring the competence of residents as teachers
Zabar, Sondra; Hanley, Kathleen; Stevens, David L; Kalet, Adina; Schwartz, Mark D; Pearlman, Ellen; Brenner, Judy; Kachur, Elizabeth K; Lipkin, Mack
2004 Jun;19(5 Pt 2):530-533, Journal of general internal medicine
Medical residents, frontline clinical educators, must be competent teachers. Typically, resident teaching competence is not assessed through any other means than gleaning learner's comments. We developed, evaluated, and integrated into our annual objective structured clinical examination a resident teaching skills assessment using 'standardized' students. Faculty observers rated residents using a customized 19-item rating instrument developed to assess teaching competencies that were identified and defined as part of our project. This was feasible, acceptable, and valuable to all 65 residents, 8 students, and 16 faculty who participated. Teaching scenarios have potential as reliable, valid, and practical measures of resident teaching skills
— id: 46163, year: 2004, vol: 19, page: 530, stat: Journal Article,

Medical ground zero: an early experience of the world trade center disaster
Lipkin, Mack
2002 May 7;136(9):704-707, Annals of internal medicine
— id: 39654, year: 2002, vol: 136, page: 704, stat: Journal Article,

The medical interview: Differences between adult and geriatric outpatients
Mann, S; Sripathy, K; Siegler, EL; Davidow, A; Lipkin, M; Roter, DL
2001 JAN ;49(1):65-71, Journal of the American Geriatrics Society
BACKGROUND: There is a perception that primary care physicians spend less time with older patients and little is known about physician and older patient satisfaction during clinical encounters. OBJECTIVE: To determine how primary care interviews of geriatric patients differ from those of other adults. DESIGN: Descriptive, analytic study. SETTING: Ten primary care sites in the United States and one in Canada, including public, voluntary, and private clinics and practices. PARTICIPANTS: Of the 544 patients, 45.6% were 65 and older and 17.8% were 75 or older. There were 127 participating physicians. MEASUREMENTS: Encounters were audiotaped and analyzed. Patients and physicians also completed exit questionnaires. RESULTS: Interview length increased significantly with age for men but not for women. Physician satisfaction did not change as patient age increased. Patient satisfaction, on the other hand decreased with age among women but not for men. Although physicians' and younger patients' perceptions of health were moderately associated, there was no association for men ages 75 and over. CONCLUSIONS: There is no evidence that physicians spend less time or are more uncomfortable with older patients. Both physician and male patient satisfaction remain stable with increasing patient age, despite greater disparity in patient and physician perceptions of health. Older female patients are less satisfied with physician visits than their younger counterparts, in the absence of changes in interview length or disparities between older female patients and their physicians in health perception.
— id: 55113, year: 2001, vol: 49, page: 65, stat: Journal Article,

I can't get no patient or practitioner satisfaction
Lipkin M; Schwartz MD
2000 Feb;15(2):140-141, Journal of general internal medicine
— id: 27867, year: 2000, vol: 15, page: 140, stat: Journal Article,

Be a player or be a victim: Description and evaluation of a health policy curriculum for primary care residents
Rein, S B; Reisman, A; Gany, F; Lipkin, M
1999 Apr 29-May 1;14(SUPPL. 2):152-152, Journal of general internal medicine
— id: 15901, year: 1999, vol: 14, page: 152, stat: Journal Article,

Teaching senior oncologists communication skills: results from phase I of a comprehensive longitudinal program in the United Kingdom
Fallowfield L; Lipkin M; Hall A
1998 May;16(5):1961-1968, Journal of clinical oncology
PURPOSE: To determine the communication difficulties experienced by clinicians in cancer medicine and to develop, implement, and evaluate communication skills training courses. METHODS: One hundred seventy-eight senior clinicians attended 1 1/2- or 3-day residential courses designed to enhance skills development, knowledge acquisition, and personal awareness. Course content included structured feedback, video review of interviews, interactive group demonstrations, and discussion in groups of four led by trained facilitators. The main outcomes were self-rated confidence in key aspects of communication, attitudinal shift toward more patient-centered interviewing, perceived changes in personal practice, and initiation of teaching programs for junior staff. RESULTS: Less than 35% of the participants had received any previous communications training. Time, experience, and seniority had not improved skills; before the course, oncologists expressed difficulty with 998 different communication issues. Primary problems concerned giving complex information, obtaining informed consent, and handling ethnic and cultural differences. Confidence ratings for key communication areas were significantly improved postcourse (P .01). Three months postcourse, 95% of the physicians reported significant changes in their practice of medicine. Seventy-five percent had started new teaching initiatives in communication for junior clinicians. Clinicians showed positive shifts in attitude toward patients' psychosocial needs (P=.0002) and were more patient centered (P=.03). The courses were highly rated and 97% would 'definitely' recommend them to colleagues. CONCLUSION: Oncologists are hampered by inadequate communication skills training and will give up time to correct this. Subjective improvements reported immediately postcourse were maintained at 3 months. Resources for educational initiatives are needed to help both patients and their physicians
— id: 7560, year: 1998, vol: 16, page: 1961, stat: Journal Article,

The Medical Interview
Lipkin, Mack JR
Behavioral medicine in primary care: A practical guide New York, NY : McGraw-Hill, 1997,
(from the chapter) This chapter addresses the structure and function of the medical interview, highlighting the importance of the interview to proper diagnosis and treatment, establishing a positive physician-patient relationship, and increased patient and physician satisfaction.
— id: 4070, year: 1997, vol: , page: 1, stat: Chapter,

Communication patterns of primary care physicians
Roter, DL; Stewart, M; Putnam, SM; Lipkin, M; Stiles, W; Inui, TS
1997 JAN 22 ;277(4):350-356, JAMA
Objectives.-To use audiotape analysis to describe communication patterns in primary care, to relate these to ideal relationship types as described in the literature, and to explore the patterns' relationships with physician and patient characteristics and satisfaction. Design.-Description of routine communication in primary care based on audiotape analysis and patient and physician exit questionnaires. Setting.-A total of 11 ambulatory clinics and private practices. Participants.-The participants were 127 physicians and 537 patients coping with ongoing problems related to disease. Main Outcomes Measures.-Roter Interactional Analysis System (RIAS) and patient and physician exit satisfaction questionnaires. Results.-Cluster analysis revealed 5 distinct communication patterns: (1) ''narrowly biomedical,'' characterized by closed-ended medical questions and biomedical talk occurring in 32% of visits; (2) ''expanded biomedical,'' like the restricted pattern but with moderate levels of psychosocial discussion occurring in 33% of the visits; (3) ''biopsychosocial,'' reflecting a balance of psychosocial and biomedical topics (20% of the visits); (4) ''psychosocial,'' characterized by psychosocial exchange (8% of visits), and (5) ''consumerist,'' characterized primarily by patient questions and physician information giving (8% of visits). Biomedically focused visits were used more often with more sick, older, and lower income patients by younger, male physicians. Physician satisfaction was lowest in the narrowly biomedical pattern and highest in the consumerist pattern, while patient satisfaction was highest in the psychosocial pattern. Conclusions.-Primary care communication patterns range from narrowly biomedical to consumerist patterns and parallel the ideal forms of patient-physician relationships described in the literature
— id: 53343, year: 1997, vol: 277, page: 350, stat: Journal Article,

How should primary care address the problem of psychiatric disorders? Can primary care physicians deliver quality mental healthcare?
Lipkin M
1996 Oct;5(5):48-49 52-3, Behavioral healthcare tomorrow
— id: 12540, year: 1996, vol: 5, page: 48, stat: Journal Article,

Patient education and counseling in the context of modern patient physician family communication
Lipkin, M
1996 JAN ;27(1):5-11, Patient education & counseling
The modern understanding of patient education derives from a robust literature from public health and clinical medicine that started to become empirical and rigorous in the mid-1960s. Patient education is one of three functions of the medical interview, each of which must each be accomplished skillfully if the others are to be maximally effective. This article discusses the new conceptualization of patient education and provides examples of how it works. The rule of patient activation is discussed and implications for future research are presented
— id: 53107, year: 1996, vol: 27, page: 5, stat: Journal Article,

Physician-patient interaction in reproductive counseling
Lipkin, M
1996 SEP ;88(3):S31-S40, Obstetrics & gynecology
Objective: To review the scientific and clinical bases for effective patient counseling in contraceptive care. Data Sources: All articles and chapters in the Annotated Bibliography of Doctor Patient Communication of the Task Force on Doctor and Patient of the American Academy on Physician and Patient were searched and included. This is an expert-derived data base based on MEDLINE review from 1969 to 1994 and including expert-selected additions from PsychLit and a variety of other social science data bases, books, and reviews. Methods of Study Selection: Expert consensus was used from the Committee on Bibliography of the American Academy on Physician and Patient. Tabulation, Integration, and Results: The doctor-patient interaction is the main determinant of the accuracy and completeness of patient data, diagnostic accuracy, efficiency in the encounter, compliance, patient understanding of problems, and patient and physician satisfaction. Yet this critical skill is inadequately taught and practiced, with serious consequences for patient care and physican job satisfaction. Use of the 14 structural elements (preparing the environment, preparing oneself, observation, greeting introduction, detecting and overcoming barriers to communication, surveying problems, negotiating a priority problem, developing a narrative thread, establishing the life context of the patient, establishing a safety net, presenting findings and options, negotiating plans, and closing) and three functions (gathering information, developing a therapeutic relationship, and patient education) and their associated behaviors improves encounter results significantly. Other helpful activities are patient activation, facilitating partnership, review of findings and plans, eliciting and responding to patients' attitudes and emotions about contraception and fertility, and use of empathy and positive regard. Conclusions: The use of scientifically derived, empirically validated interview skills substantially improves outcomes in contraceptive and other patient education and counseling. Use of appropriate structure and functions of the encounter, patient participation and partnership, review of patient understanding and reactions, and relating to the patients' attitudes and emotions about the subject each improve the outcomes of contraceptive care
— id: 52819, year: 1996, vol: 88, page: S31, stat: Journal Article,

Sisyphus or Pegasus? The physician interviewer in the era of corporatization of care
Lipkin, M
1996 MAR 1 ;124(5):511-513, Annals of internal medicine
— id: 53062, year: 1996, vol: 124, page: 511, stat: Journal Article,

The medical interview : clinical care, education, and research
Lipkin, Mack; Putnam, Samuel M.; Lazare, Aaron
New York : Springer-Verlag, c1995,
— id: 511, year: 1995, vol: , page: , stat: ,

UNTITLED - REPLY
FINKLER, SA; HENDRICKSON, G; KNICKMAN, JR; LIPKIN, M; THOMPSON, WG
1994 DEC ;29(5):625-626, Health services research
— id: 87474, year: 1994, vol: 29, page: 625, stat: Journal Article,

A COMPARISON OF WORK-SAMPLING AND TIME-AND-MOTION TECHNIQUES FOR STUDIES IN HEALTH-SERVICES RESEARCH
FINKLER, SA; KNICKMAN, JR; HENDRICKSON, G; LIPKIN, M; THOMPSON, WG
1993 DEC ;28(5):577-597, Health services research
Objective. This study compares results and illustrates trade-offs between work-sampling and time-and-motion methodologies. Data Sources. Data are from time-and-motion measurements of a sample of medical residents in two large urban hospitals. Study Design. The study contrasts the precision of work-sampling and time-and-motion techniques using data actually collected using the time-and-motion approach. That data set was used to generate a simulated set of work-sampling data points. Data Collection/Extraction Methods. Trained observers followed residents during their 24-hour day and recorded the start and end time of each activity performed by the resident. The activities were coded and then grouped into ten major categories. Work-sampling data were derived from the raw time-and-motion data for hourly, half-hourly, and quarter-hourly observations. Principal Findings. The actual time spent on different tasks as assessed by the time-and-motion analysis differed from the percent of time projected by work-sampling. The work-sampling results differed by 20 percent or more of the estimated value for eight of the ten activities. As expected, the standard deviation decreases as work-sampling observations become more frequent. Conclusions. Findings indicate that the work-sampling approach, as commonly employed, may not provide an acceptably precise approximation of the result that would be obtained by time-and-motion observations
— id: 52613, year: 1993, vol: 28, page: 577, stat: Journal Article,

Expansion of the epithelial cell proliferative compartment and frequency of adenomatous polyps in the colon correlate with the strength of family history of colorectal cancer
Gerdes H; Gillin JS; Zimbalist E; Urmacher C; Lipkin M; Winawer SJ
1993 Jan 15;53(2):279-282, Cancer research
Expansion of the proliferative compartment of epithelial cells in colonic crypts and colonic adenomas have been described as phenotypic precursors to colon cancer in individuals affected with hereditary or sporadic colon cancer. This study measured the size of the proliferative compartment in colonic crypts and the frequency of adenomas in asymptomatic members of families having sporadic colorectal cancer. The subjects were divided into 2 groups according to the frequency of colorectal cancer in their families. A shift of the compartment of proliferating epithelial cells toward the lumenal surface of colonic crypts was seen in the group of subjects with a stronger family history of colorectal cancer, with significant differences in the numbers of proliferative cells in the upper and the lower crypt compartments (P < 0.05) and in the fraction of proliferative cells at the highest compartment at the lumenal surface of the crypts (P < 0.05). Cell proliferation patterns in normal-appearing mucosa of the 2 groups revealed no difference in whole crypt [3H]thymidine labeling index. Colonoscopic examination of the 56 subjects revealed an overall prevalence of adenomas of 21%; when stratified by frequency of colorectal cancer in their families, 3 of 22 subjects (14%) with a weaker family history had adenomas, while 9 of 34 (26%) with a stronger family history had adenomas. Thus, parallel abnormalities of colonic epithelial cell proliferation and neoplasia were seen in individuals with a family history of colorectal cancer, both of which were more pronounced with increasing strength of family history. This observation provides further evidence of relationships among these factors in the etiology of 'sporadic' colorectal cancer
— id: 36490, year: 1993, vol: 53, page: 279, stat: Journal Article,

TEACHING INTERVIEWING AND INTERPERSONAL SKILLS - REPLY
NOVACK, DH; VOLK, G; DROSSMAN, DA; LIPKIN, M
1993 SEP 15 ;270(11):1320-1320, JAMA
— id: 52243, year: 1993, vol: 270, page: 1320, stat: Journal Article,

PHYSICIAN SATISFACTION WITH PRIMARY-CARE OFFICE VISITS
SUCHMAN, AL; ROTER, D; GREEN, M; LIPKIN, M; BERTAKIS, K; CHARON, R; COHENCOLE, S; FEIN, O; FLOREK, J; GRAYSON, M; INUI, T; MEDIO, F; PUTNAM, S; QUILL, T; ROST, K; SIMON, D; SIMON, M; STARFIELD, B; STEWART, M; STILES, W; TEMPLETON, B; WILLIAMSON, P
1993 DEC ;31(12):1083-1092, Medical care
To study encounter-specific physician satisfaction we collected exit questionnaires from patients and physicians following 550 primary care office visits. The physicians' questionnaire included 20 items pertaining to satisfaction with the visit, one of which was an assessment of global satisfaction. Using a bootstrap technique, we factor analyzed the satisfaction questions in 10 repeated samples. Four distinct dimensions of physician satisfaction emerged: satisfaction with the patient-physician relationship, with the data collection process, with the appropriateness of the use of time, and with the absence of excessive demands on the part of the patient. Each scale was found to be reliable; global satisfaction was most closely related to the relationship factor. Satisfaction with use of time and the adequacy of data collection tended to be stable for individual physicians across a range of patients whereas global satisfaction and satisfaction with the relationship and the demanding nature of the patient and were more variable, hence most unique to each encounter. This study of physician satisfaction represents an effort to incorporate knowledge about physicians' subjective experiences into a systematic understanding of the dynamics of the medical interview
— id: 52133, year: 1993, vol: 31, page: 1083, stat: Journal Article,

THE CALIFORNIA FAMILY HEALTH PROJECT .1. INTRODUCTION AND A DESCRIPTION OF ADULT HEALTH
FISHER, L; RANSOM, DC; TERRY, HE; LIPKIN, M; WEISS, R
1992 SEP ;31(3):231-250, Family process
Little research has addressed patterns of family and health relationships that reflect both the scope and complexity of family life and the breadth and diversity of health. In the first of a series of articles, we describe the California Family Health Project, a study in which four large 'domains' of family life (Structure/Organization, World View, Problem Solving, and Emotional Management) were mapped, described, and compared with a large battery of adult health measures. We first present a brief critical overview of the literature on family and health research, then explain our rationale, define our approach to the multivariate analysis of family and health data, and describe our sample of 225 community-based families. To prepare for analyses with the family variables, we next present descriptive data based on separate principal components analysis (PCA) and multidimensional scaling analysis (MDS) of 14 self-reported health scores for husbands and for wives. No grouping or clustering of health variables emerged for either husbands or wives in the PCAs. A two-dimensional MDS analysis for husbands and for wives displayed the health variables in a circular pattern in which no predominant descriptive dimension or group of discrete dimensions emerged. Consequently, we decided that all 14 health scores will be used in the analyses, with the family variables to follow
— id: 98472, year: 1992, vol: 31, page: 231, stat: Journal Article,

OPTIMIZING ANTIANGINAL THERAPY - CONSENSUS GUIDELINES
GORLIN, R; METCALF, HL; COHN, PF; PEPINE, CJ; LIPKIN, M; COHN, JN; ELKAYAM, U
1992 NOV 27 ;70(17):G72-G78, American journal of cardiology
— id: 51807, year: 1992, vol: 70, page: G72, stat: Journal Article,

THE POTENTIAL FOR USING NONPHYSICIANS TO COMPENSATE FOR THE REDUCED AVAILABILITY OF RESIDENTS
KNICKMAN, JR; LIPKIN, M; FINKLER, SA; THOMPSON, WG; KIEL, J
1992 JUL ;67(7):429-438, Academic medicine
Both the number of residents and the amount of time existing residents have in which to carry out their activities may soon be decreasing. To consider the potential for alternative ways of staffing teaching hospitals, it is necessary to know how residents spend their time. The authors sought to learn this by conducting a time-motion study of eight internal medicine residents at two urban hospitals in New York City in 1988. The residents' activities were observed and coded by premedical students, and the authors independently classified the possible activities into (1) those that had to be done by a physician, (2) those that were educational only, and (3) those that could be done by a non-physician. A total of 1,726 activities of 67 kinds were coded, averaging 7.75 minutes each. The authors analyze and project their data using two models-the traditional model of care in which the physician is the primary medical manager of the patient, and an alternative model in which a midlevel practitioner, such as a nurse practitioner, would perform the day-today monitoring of patients. For example, the data indicate that in the traditional model, almost half of a resident's time is spent in activities that must be done by a physician, meaning that another kind of physician would be needed to do those activities if the resident were unavailable; but in the midlevel practitioner model, only around 20% of the activities would require a physician. The authors give detailed breakdowns of their data, estimate the kinds and numbers of non-physician health care professionals necessary to substitute for residents in appropriate activities, and review possible difficulties in implementing such substitutions
— id: 51924, year: 1992, vol: 67, page: 429, stat: Journal Article,

INTERNAL-MEDICINE CURRICULUM REFORM
NOVACK, DH; LIPKIN, M
1992 DEC 1 ;117(11):974-974, Annals of internal medicine
— id: 51817, year: 1992, vol: 117, page: 974, stat: Journal Article,

TEACHING GERIATRICS TO HOUSESTAFF AT NYU
MCRAE, TD; FREEDMAN, M; LIPKIN, M
1991 AUG ;39(8):A81-A81, Journal of the American Geriatrics Society
— id: 51565, year: 1991, vol: 39, page: A81, stat: Journal Article,

SEX-DIFFERENCES IN PATIENTS AND PHYSICIANS COMMUNICATION DURING PRIMARY CARE MEDICAL VISITS
Roter, D; Lipkin, M; Korsgaard, A
1991 Nov;29(11):1083-1093, Medical care
This study reports on the analysis of audiotapes of 537 adult, chronic disease patients and their 127 physicians (101 men and 26 women) in a variety of primary care practice settings to explore differences attributable to the effects of the patient's and the physician's sex on the process of communication during medical visits. Compared to male physicians, women conducted longer medical visits (22.9 vs 20.3 minutes; F(1,515) = 7.9, P < .005), with substantially more talk F(1,518) = 19.5, P < .000. Differences were especially evident during the history segment of the visit when female physicians talked 40% more than male physicians (F(1,518) = 20.1, P < .000) and when patients of female physicians talked 58% more than male physicians' patients (F(1,448) = 24.4, P <.000). Compared to male physicians, female physicians engaged in more positive talk, partnership-building question-asking and information-giving. Similarly, when with female compared to male physicians, patients engaged in more positive talk, more partnership-building, question-asking, and information-giving related to both biomedical and psychosocial topics
— id: 32135, year: 1991, vol: 29, page: 1083, stat: Journal Article,

DOCTOR-PATIENT COMMUNICATION - THE TORONTO CONSENSUS STATEMENT
Simpson, M; Buckman, R; Stewart, M; Maguire, P; Lipkin, M; Novack, D; Till, J
1991 Nov 30;303(6814):1385-1387, British medical journal. BMJ (International ed.)
— id: 32202, year: 1991, vol: 303, page: 1385, stat: Journal Article,

ACCESS TO HEALTH-CARE
Gourevitch, M; Lipkin, M; Bryan, JA
1990 Sep 15;113(6):478-478, Annals of internal medicine
— id: 31924, year: 1990, vol: 113, page: 478, stat: Journal Article,

PRIMARY CARE INTERNAL MEDICINE - A CHALLENGING CAREER CHOICE FOR THE 1990S
Lipkin, M; Levinson, W; Barker, R; Kern, D; Burke, W; Noble, J; Wartman, S; Delbanco, TL
1990 Mar 1;112(5):371-378, Annals of internal medicine
— id: 32108, year: 1990, vol: 112, page: 371, stat: Journal Article,

Reactivity of a human monoclonal antibody against carcinomas and other lesions of the colon
Formenti SC; Mitchell MS; Taylor CR; Lipkin M; Jernstrom PH; Kan-Mitchell J
1989 ;28(4):296-300, Cancer immunology immunotherapy
To identify tumor-associated antigens that may be immunogenic to man, human monoclonal antibodies (human mAb) were generated by fusing nonsecreting mouse myeloma cells with lymphocytes from regional mesenteric nodes of patients with adenocarcinomas of the colon. One IgG1 human mAb, designated as 14-31-10, was identified by its reactivity against human tumor xenografts. We have studied the reactivity of mAb 14-31-10 with formalin-fixed, paraffin-embedded specimens of human colon. A total of 86 cases were studied, including normal adult and fetal colons, adenocarcinomas of the colon, and a variety of colonic inflammatory diseases and preneoplastic lesions. Intense reactivity was found in 15 of 18 adenocarcinomas of the colon, but not in 10 specimens of normal adult or 4 specimens of fetal colonic mucosa. Interestingly, in four cases of carcinoma, reactivity was also observed in histologically normal mucosa situated 10 cm or more from the primary lesion. On the other hand, no staining was detected in any of the 16 inflammatory lesions. Of the 38 preneoplastic lesions, only 6 showed staining by the mAb: 1 of 5 benign tubular adenomatous polyps, 3 of 9 villous adenomas and tubovillous polyps, 1 of 5 specimens of ulcerative colitis and 1 of 19 specimens of familial polyposis. However, the intensity of staining was only moderate in those cases. Our data, therefore, suggest that the epitope identified by the human mAb 14-31-10 shows preferential expression in preneoplastic and neoplastic lesions of the colon, and in ostensibly normal mucosa at some distance from a primary colonic carcinoma. In all instances, the staining was cytoplasmic, suggesting a cytoplasmic or internal membrane location of the target antigen. This antigen appeared to be distinct from carcinoembryonic antigen, since staining by 14-31-10 was consistently different from that of a mouse monoclonal antibody to carcinoembryonic antigen in serial sections of the same specimens. The restricted reactivity of 14-31-10 suggests its potential application in immunohistochemistry. Moreover, the epitope identified by mAb 14-31-10 may be expressed during the progression of normal mucosa to neoplasia
— id: 34968, year: 1989, vol: 28, page: 296, stat: Journal Article,

THE INTERVIEW OF THE GERIATRIC-PATIENT IN PRIMARY CARE
Lipkin, M; Roter, D; Putnam, S; Greene, M; Orgel, J; Korsgaard, A
1989 Apr;37(2):A787-A787, Clinical research
— id: 31809, year: 1989, vol: 37, page: A787, stat: Journal Article,

RESIDENT WORK - A PILOT-STUDY OF EXACTLY WHAT RESIDENTS DO
Lipkin, M; Thompson, W; Knickman, J; Finkler, S; Kiel, J
1989 Apr;37(2):A797-A797, Clinical research
— id: 31810, year: 1989, vol: 37, page: A797, stat: Journal Article,

AN INNOVATIVE STUDENT DIRECTED PROGRAM IN COMMUNITY BASED PRIMARY CARE EDUCATION
Ragland, J; Bardack, L; Lipkin, M
1989 Apr;37(2):A813-A813, Clinical research
— id: 31811, year: 1989, vol: 37, page: A813, stat: Journal Article,

PSYCHOMETRIC ASSESSMENT OF THE AMERICAN BOARD OF INTERNAL MEDICINE RESIDENT EVALUATION FORM
Thompson, WG; Lipkin, M; Gilbert, DA; Guzzo, RA; Roberson, L
1989 Apr;37(2):A815-A815, Clinical research
— id: 31812, year: 1989, vol: 37, page: A815, stat: Journal Article,

CAUTION - PHYSICIANS AT OVERWORK
Lipkin, M
1988 Jul-Aug;3(4):410-411, Journal of general internal medicine
— id: 31468, year: 1988, vol: 3, page: 410, stat: Journal Article,

THE MEDICAL INTERVIEW AS CORE CLINICAL SKILL - THE PROBLEM AND THE OPPORTUNITY
LIPKIN, M
1987 SEP-OCT ;2(5):363-365, Journal of general internal medicine
— id: 41655, year: 1987, vol: 2, page: 363, stat: Journal Article,

The care of patients : perspectives and practices
Lipkin, Mack
New Haven : Yale University Press, c1987,
— id: 57, year: 1987, vol: , page: , stat: ,

Evaluation of current criteria used to measure vitamin B12 levels
Thompson, W G; Babitz, L; Cassino, C; Freedman, M; Lipkin, M Jr
1987 Feb;82(2):291-294, American journal of medicine
Because of recent improvements in the serum vitamin B12 assay, literature criteria based on prior assay methods used in measuring B12 levels were evaluated. Of 1,708 B12 levels measured at Bellevue Hospital in a six-month period, 137 in 124 patients were below 200 pg/ml. Contrary to expectations, 81.6 percent of patients with low B12 levels had a mean corpuscular volume (MCV) below 95 fl. Literature-derived criteria missed 30 percent of patients with low B12 levels. Only three of 12 patients with megaloblastic bone marrow or an abnormal Schilling result had B12 levels that were low (below 100 pg/ml), and nine had values in an intermediate range (100 to 200 pg/ml). This suggests that the use of an MCV below 95 fl and a B12 level below 100 pg/ml as abnormal values may not detect clinically important B12 deficiency
— id: 133893, year: 1987, vol: 82, page: 291, stat: Journal Article,

SURVEY OF COURSES OFFERED IN UNITED-STATES MEDICAL-SCHOOLS ON HEALTH-CARE-DELIVERY AND FINANCE
Thompson, WG; Goldstein, BP; Lipkin, M
1987 Sep;62(9):761-763, Journal of medical education
— id: 31352, year: 1987, vol: 62, page: 761, stat: Journal Article,

Proliferation of esophageal epithelial cells among residents of Linxian, People's Republic of China
Yang GC; Lipkin M; Yang K; Wang GQ; Li JY; Yang CS; Winawer S; Newmark H; Blot WJ; Fraumeni JF
1987 Dec;79(6):1241-1246, Journal of the National Cancer Institute
Histopathologic and tritiated thymidine labeling subjects were carried out on esophageal biopsy specimens of 44 human subjects with cytologic evidence of dysplasia from Linxian, People's Republic of China, a high-risk area for esophageal cancer. With the use of histopathologic criteria, 10 cases showed evidence of dysplasia, 20 hyperplasia, and 14 a near-normal morphology when compared with 21 normal cases studied previously from Jiaoxian, a low-risk area for esophageal cancer in the People's Republic of China. Significantly increased labeling indices were found in the esophageal mucosa of the dysplasia and hyperplasia subjects. There was a gradient of increased expansion in the basal layer of proliferating cells progressing from normal to hyperplasia to dysplasia, with the expansion twice as high in the epithelial cell lining in dysplasia when compared with the findings in the normal and near-normal groups. The correlation of proliferative abnormalities with the severity of precancerous lesions of the esophagus indicates that labeling studies may provide a sensitive adjunct to evaluate risk status and any modifications that might result from nutritional intervention
— id: 19727, year: 1987, vol: 79, page: 1241, stat: Journal Article,

Natural antibodies in human sera directed against blood-group-related determinants expressed on colon cancer cells
Knuth, A; Lloyd, K O; Lipkin, M; Oettgen, H F; Old, L J
1983 Aug 15;32(2):199-204, International journal of cancer
Sera from 136 normal males and 33 members of families at high risk for colon cancer were tested for reactivity with six colon cancer cell lines by the protein A-mixed hemadsorption assay. Ninety-one sera had antibodies to colon cancer cell line HT-29. In 89 cases the antibodies were absorbed by human A and B erythrocytes or sheep erythrocytes. Antibodies in the remaining two sera, which were from sisters in the high-risk group, were not absorbed by red cells but could be absorbed by tumor cells expressing A or B blood-group determinants. Their reactivity was inhibited by some soluble blood-group glycoproteins. One serum (No. 4) was inhibited by A-active glycoproteins from human saliva and ovarian cyst fluids and from porcine mucosa, as well as by a polysaccharide derived from gastric cancer; it has an anti-A-like specificity. The other serum (No. 6) was inhibited by A and B glycoproteins, by a blood group precursor glycoprotein and by the same gastric cancer polysaccharide; it seems to have a wider specificity directed towards both A- and B-like structures. It is not known what caused production of these antibodies but it may be significant that they occurred in members of a family at high risk for developing colon cancer
— id: 145285, year: 1983, vol: 32, page: 199, stat: Journal Article,

The Use and abuse of medicine
De Vries, Marten W.; Berg, Robert L.; Lipkin, Mack
New York, N.Y. : Praeger, 1982,
— id: 101, year: 1982, vol: , page: , stat: ,

Population-based medicine
Lipkin, Mack; Lybrand, William Allen
New York : Praeger, 1982,
— id: 91, year: 1982, vol: , page: , stat: ,

Primary care research in .
Lipkin, Mack
[New York, N.Y.] : Rockefeller Foundation, 1981-,
— id: 17, year: 1981, vol: , page: , stat: ,

The care of patients; concepts and tactics
Lipkin, Mack
New York, Oxford University Press, 1974,
— id: 414, year: 1974, vol: , page: , stat: ,

Cellular neurophysiology; a source book. Edited by Ian Cooke [and] Mack Lipkin, Jr
Cooke, I. M.; Lipkin, Mack
New York, Holt, Rinehart and Winston [1972],
— id: 309, year: 1972, vol: , page: , stat: ,

Fee-for-service group practice: Further questions
Lipkin M
1968 Nov;44(11):1304-1306, Bulletin of the New York Academy of Medicine
— id: 105640, year: 1968, vol: 44, page: 1304, stat: Journal Article,