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Background: Burnout is known worldwide as a work-related syndrome associated with physical illness and mental health problems. It has a significant impact on doctors' health and patient care. Aim: To assess the prevalence of burnout, its associated risk factors, and its impact on self-reported patient care among the doctors of the Family Medicine Department in King Abdul-Aziz Medical City (KAMC), Riyadh. Method: A cross-sectional study was conducted among 150 physicians. Data were collected using the 22-items Maslach Burnout Inventory (MBI) to measure emotional exhaustion, depersonalization, and personal achievement as well as questions about demographic factors, work characteristics, and impact of burnout on self-reported patient care. Results: A total of 150 physicians responded to the questionnaire. In terms of high burnout, 32 doctors (21.3%) had emotional exhaustion, 57 doctors (38%) had depersonalization, and 41 doctors (27.3%) scored low for personal achievement. Staff physicians had high emotional exhaustion (27.8%, P = 0.028), family medicine residents, however, reported higher depersonalization and low personal achievement (42.9%, 45.7%, P = 0.675, P = 0.009, respectively). Being a staff physician, military, with long years in practice, working more than 8 hours per day, and covering ER shifts were strongly associated with a high level of burnout. High-level burnout demonstrated a statistically significant impact on patient care with suboptimal performance among the doctors of this study. Conclusion: Burnout seems to be a common problem in family medicine doctors at KAMC. It was associated with personal and workload indicators affecting their self-reported patient care significantly.

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OBJECTIVE: The aim of the study was to assess the level of knowledge, attitudes, and current practice of primary healthcare physicians and nurses employed at the National Guard affiliated Primary Care Centers related to child abuse and neglect. METHOD: A cross-sectional study was conducted at four National Guard affiliated Primary Care Centers, Riyadh, Kingdom of Saudi Arabia, from May to September 2019. A total of 308 physicians and nurses participated in the study, using a convenience sampling technique. After obtaining informed consent, data was collected with a self-administered questionnaire. RESULTS: The overall attitude score was excellent in 64.2% of the sample. The majority (90.3%) had an excellent knowledge score. The study indicated that the married group and participants with more than 10 years of experience were more aware of child maltreatment reporting procedures compared to the non-married group and less experienced participants. Almost two-thirds of the sample (67.2%) agreed that child abuse and neglect are underreported in Saudi Arabia. Lack of knowledge was the most frequent reason for underreporting. CONCLUSION: Our study highlighted that most of the primary care physicians and nurses at King Abdulaziz Medical City had excellent knowledge and positive attitudes related to child maltreatment. However, a major knowledge deficit exists in terms of the reporting procedures of suspected child maltreatment cases.

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OBJECTIVES: To assess the presence of vitamin B12 deficiency among metformin users and associated factors in patients with type 2 diabetes mellitus. METHODS: An observational cross-sectional study was conducted with 307 diabetic patients in the primary health care centers at King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia between October 2017 and January 2018. Face-to-face interviews were conducted with the participants, using a designed checklist. RESULTS: The prevalence of vitamin B12 deficiency was (3.6%) and the majority of the sample had borderline B12 levels (66.1%). The vitamin B12 deficiency and borderline levels were strongly associated with the dose of metformin. Patients taking doses of metformin more than 1000 mg had lower levels of vitamin B12. The use of multivitamin and vitamin B complex was assessed, and it was found that there was a marked decrease in the prevalence of vitamin B12 deficiency in patients using vitamin B complex containing more than 200 mcg vitamin B12. CONCLUSION: Our findings show a low prevalence of vitamin B12 deficiency in type 2 diabetic patients taking metformin. The majority of the sample had borderline deficiency; therefore, additional investigation and management are required.

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OBJECTIVES: There is an increasing concern about diagnostic errors and their impact on patient safety. Physicians' diagnostic ability is significantly undermined by certain distractions that can carry potential negative consequences such as diagnostic and management errors. This study aimed to examine the effects of distracting factors for physicians during consultation and their consequent effects on diagnostic accuracy and disease or condition management. METHODS: Family medicine residents at a major training hospital in KSA were randomly assigned to two groups of simulated patients: one group with patients with distracting features and another group with patients without distracting features (the control group). Both groups encountered six simulated patients with different clinical conditions or diseases. The consultation time, accuracy of diagnosis, appropriateness of management, number of outlines of treatment, and simulated patient satisfaction were measured for both groups. RESULTS: A total of 70 simulated physician-patient encounters were conducted with 35 residents. Consultation time was significantly longer for encounters with patients with distracting features, which had a mean time of 7.43 min, compared with encounters with non-distracting patients, which had a mean time of 4.4 min (p value < 0.0001). There were no significant statistical differences in accuracy of diagnosis, appropriateness of management, or patient satisfaction between the two groups. However, residents recommended a higher number of outlines of treatment for patients with distracting features (2.96 for distracting patients versus 2.46 for non-distracting patients; p < 0.011). CONCLUSION: Distracting factors are associated with prolonged consultation time among physicians. Although this study did not demonstrate any effects of distracting factors on accuracy of diagnosis or disease management, these factors are still concerning, especially in complex clinical situations and situations where there is lack of reflective practice. The effects of distracting factors should be minimized to ensure patient safety.

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CONTEXT: Patient satisfaction is of increasing importance and recognized as an important indicator for quality of care. It is influenced by the patients, physicians and practice's characteristics. The literature on diabetes has increasingly focused on the quality of care and its measurement. The relationship between the quality of diabetes care and patient satisfaction is poorly understood and it requires further elaboration. AIMS: The aim of this study is to Identify the underlying factors influencing patient's satisfaction with the diabetes care, to assess whether comprehensive diabetes management that provided in diabetic clinic improves satisfaction and glycemic control. SETTINGS AND DESIGN: Cross-sectional study Family Medicine and Diabetic Clinics at King Abdul-Aziz Medical City. MATERIALS AND METHODS: A total of 230 type two diabetic patients attending their follow-up were requested to fill the questionnaire. The questionnaire identified patients, doctors and practice related factors. STATISTICAL ANALYSIS USED: SPSS 16 with appropriate statistical test. RESULTS: The response rate was 85%. Mean hemoglobin A1c (HbA1c) level was 0.087 ± 0.020. Around half of the patients were having high satisfaction rate of (>60%). Doctor's communication ranked the highest satisfaction level among other factors. However, no association between satisfaction with other patient's characteristics and HbA1c. CONCLUSIONS: Physicians play a major role in promoting higher level of satisfaction by good communication with their patients. More efforts are needed to improve certain aspects of diabetic care such as: Patient's education and periodic physical examination. Although the present study did not show any association between satisfaction and important outcome like HbA1c, more studies are needed to explore such complex relationship. To obtain more significant results a bigger sample size might be needed.