Encouraging patient participation in general practice consultations: Effect on consultation length and content,patient satisfaction and health

Abstract

Following the evidence from earlier research that one-to-one interventions can increase the patient's contribution to the consultation, this paper reports the results from a randomised control trial which assessed the effects of a leaflet designed to enhance patient participation in consultations. A random sample of patients (aged 16 to 74) waiting to see a general practitioner were given either an intervention leaflet, which encouraged the patient to take an active role in the consultation, or a control leaflet which gave dietary advice. The effects of the intervention were assessed by measuring length of consultation, number of questions asked by the patient, patient satisfaction score, doctor's feelings about the consultation, the change in patients' health in the 4 weeks following the consultation (measured by the SF-36 Health Survey) and the number of patient visits to a GP in the following year. The results showed that patients in the intervention group had significantly longer consultations than those in the control group and tended to ask more questions but there was no significant effect on patient satisfaction. The doctor tended to feel that he had a better understanding of patients in the intervention group. Overall there was no significant effect on SF-36 scores but, for patients under the age of 40, and for those in higher social classes the scores of patients in the intervention group improved to a significantly greater degree than did those for the control group. The intervention did not have any effect on the number of GP visits made by patients in the subsequent year. The study results show that a relatively simple leaflet can have an impact on patients' behaviour during the consultation, even though there were no effects on patient satisfaction with the consultation or in the number of GP visits in the following year.     

Diagnosis and treatment of respiratory tract infections in primary health care by the nurse versus the physician: Efficacy and patient attitudes

Abstract

Five district physicians and one registered nurse were compared regarding their effectiveness in diagnosing and treating acute upper respiratory tract infections in patients (n=186) at a Swedish community health centre. Attitudes and views of the patient, or of the accompanying adult when the patient was a child, regarding the consultation itself, as well as more general aspects of health care were investigated (n=99) using a questionnaire. The questionnaire included 42 propositions of a “fuzzy” type to be judged on a 100-point truth-value scale, 18 of them concerning the consultation and 24 the more general aspects. No differences between the physicians and the nurse were found in their efficacy of diagosis and treatment. Subjects' overall attitudes were found to be positive toward both the physicians and the nurse. Results of multivariate analyses of variance performed for the consultation and general aspects of health care items separately and concerning type of persons providing health care (physician/nurse), treatment (antibiotics/no antibiotics) and patient age (child/adult), revealed overall differences in questionnaire response as regards patient age in relation to the consultation items.     

Babyface effects: A double‐edged sword in healthcare service evaluations

We examine how a doctor's baby‐like facial appearance affects people's perceptions and judgments before and after a medical fraud occurs. A 2 (face type: babyfaced vs maturefaced) × 2 (doctor's gender: male vs female) × 2 (doctor's specialty: internal medicine vs surgery) between‐subjects experiment was conducted. The results indicate that a babyfaced doctor fares better than a maturefaced doctor in terms of patients' expectations, satisfaction and intended loyalty. However, having baby‐like facial features may work against a doctor who is involved in a medical fraud. The severity of a medical fraud is perceived to be greater when it involves either a babyfaced female doctor of internal medicine or a babyfaced male surgeon. After the medical fraud, this altered perception of the fraud's severity leads to reduced patient loyalty. Service evaluations based on the doctor‐patient relationship show that the doctor's baby face is a double‐edged sword.     

Information giving and involvement in treatment decisions: Is more really better? Psychological effects and relation with adherence

Objectives : The aim of this study is to improve our understanding of the ways in which a medical consultation style relates to satisfaction and adherence.

Design : Participants completed questionnaires about preferred and perceived consultation styles; psychological variables such as satisfaction, anxiety and depression; and questions about taking medication. Questionnaires were completed prior to the consultation, immediately after, three months later and one year later. Doctors also completed a scale on completion of the consultation. The decisions in question related to women seeking advice about Hormone Replacement Therapy (HRT) and decisions about pain management.

Results : Patients expressed preferences for information about the treatment options and for active involvement in the decision process. The extent to which patients perceived themselves as having received information about the treatment options was a particularly consistent predictor of satisfaction. The extent to which patients perceived themselves as having been prepared for the side effects of HRT was a consistent predictor of anxiety.

Conclusions : Perceptions of the amount of information received about medical options, including information preparing individuals for potential side effects of medication, appears to be more important to satisfaction and anxiety, than actual involvement in the decision.     

« Docteur,pourrais-je avoir une copie du certificat ? » Étude pluricentrique concernant l’application des décrets du 31 mars 2021 et du 23 novembre 2021

On 31 March 2021, a decree was published in the Official Journal concerning the procedures for the delivery of medical certificates to victims of violence. These victims can now obtain a copy of the certificate drafted by the doctor required by the judicial authorities, particularly as regards medical examiners.PurposeThe aim of our study was to assess the impact of the March 31, 2021 decree on victims’ requests to the medical examiner for a copy of the medical certificate.MethodsThis prospective study was conducted among three forensic services receiving victims in consultation, using a paper questionnaire linked to Medlé data, over a three-month period.ResultsOf the 1,492 consultations conducted during the study period, a copy of the certificate was only given to the victim in 13.1 % of the consultations. It was requested spontaneously by the victim in 15.2 % of cases, most often to exercise his right (46.4 %). These were primarily consultations following an accident, psychological abuse, and assault. This copy was requested spontaneously by less than 3 % of victims of domestic violence. There was some disparity between the three centres regarding the minor victim.ConclusionThis study is a small sample over a short period. The information of the victims, especially of domestic violence, on access to the copy of the medical-legal certificate seems still insufficient, and the principle of surrender, when it can help the victim in his efforts, can also be a source of confusion.     

Genetic counselling: Predicting patient outcomes

Abstract

With the rapid development of genetic testing, the demand for genetic counselling is increasing. Yet there is little known about what makes for effective or efficient genetic counselling. The aim of the current study is to determine the main factors influencing outcomes of genetic consultations. One hundred and thirty one routine consultations conducted in a regional genetics centre were audiotaped, transcribed and coded. The main predictors of outcome tested were pre-interview patient and counsellor expectations; pre-interview patient concerns; length of consultations; counsellor directiveness; and the extent to which social and emotional issues are addressed in the consultation. The main outcomes were the patient's view of the extent to which their expectations were met, their satisfaction with information provided, and concern about the problem they were referred with.

Although there were six significant correlations between the process of consultation and outcome variables, multivariate analyses revealed no significant predictors of any of the outcomes. Using multiple regression analyses, small amounts of variance in patient outcomes were predicted by patient and counsellor variables assessed before the consultation, but none was predicted by any of the process measures made of the consultation. Various explanations are considered to explain the lack of influence of process variables upon outcomes. One possible explanation for these findings is that the consultation has a minimal effect upon patient outcomes. Alternatively, the study, in design or analysis, was not sufficiently sensitive to detect the influential aspects of the consultation.     

Women's views about intimate examinations and sexually inappropriate practices by their general practitioners

Abstract

The aim of this survey of 472 adult women was to assess women patients' feelings about intimate examinations and their perceptions and experiences of sexually inappropriate medical practice. Two-thirds of women preferred a women doctor for intimate examinations. Slightly more than two-thirds found intimate examinations embarrassing and stressful, and strongly expressed the need for information and on-task, health-related comments during these examinations. General personal comments or non-medical touching were not particularly welcomed, even for the purpose of comforting the patient. There was a range of views about patients' personal relationships with doctors, with the lines between acceptable and unacceptable behaviour somewhat ambiguous. A small but significant number of women perceived that they had been sexually harassed (5%) or abused (3%) by a doctor, with this experience more common for non-English speaking women. Results were discussed in terms of implications for improved doctor practice, particularly during intimate examinations and with vulnerable patients.     

Dehumanizing but competent: The impact of gender,illness type,and emotional expressiveness on patient perceptions of doctors

This study is the first attempt to investigate men's and women's anticipated reactions to a consultation with a doctor holding either a dehumanizing or humanistic approach to patient treatment. Participants (N = 375) read a vignette depicting a doctor's treatment philosophy—emphasizing either the metaphor of the body as a machine (dehumanizing condition) or emphasizing individual humanness (humanizing condition). They then imagined consulting the doctor about a psychological or physical illness. Although, medical dehumanization had undesirable consequences, some men rated the dehumanizing doctor as more competent than the humanizing doctor. These were men who were (a) emotionally expressive and seeking help for a psychological illness, and (b) men low in emotional expressiveness seeking help for a physical illness.     

Physician Burnout and Patient Satisfaction with Consultation in Primary Health Care Settings: Evidence of Relationships from a one-with-many Design

Physician burnout, as a prolonged response to chronic emotional and interpersonal stressors on the job, has been associated with suboptimal patient care and deterioration in the patient?Cprovider relationship. Although prior studies have identified a range of factors associated with decreased patient satisfaction, most have been conducted in tertiary care settings, with staff burnout examined at the hospital unit-level. To examine the impact of physician burnout on patient satisfaction from consultation in the primary care setting, a cross-sectional survey was conducted in Western Greece. Using a one-with-many design, 30 physicians and 300 of their patients, randomly selected, responded to the survey. Results showed that patient satisfaction correlated significantly with physician emotional exhaustion (r = ?.636, p < .01) and physician depersonalization (r = ?.541, p < .01). Mixed-effects multilevel models indicated that 34.4% of total variation in patients?? satisfaction occurred at the physician level, after adjustment for patients?? characteristics. Moreover, physician emotional exhaustion and depersonalization remained significant factors associated with patient satisfaction with consultation, after controlling for patient and physician characteristics. Patients of physicians with high-exhaustion and high-depersonalization had significantly lower satisfaction scores, compared with patients of physicians with low-exhaustion and low-depersonalization, respectively. Future studies need to explore the mechanisms by which physician burnout affects patient satisfaction.     

Expanding Technical Assistance Consultation to Public Schools: District-Wide Evaluation of Instructional and Behavior Support Practices for Students with Developmental Disabilities

SUMMARY

We describe consultation to a public school district in the form of a systems-wide evaluation of instructional and behavior support practices for students with developmental disabilities. The evaluation targeted (1) the financial costs of educating students out-of-district, (2) an analysis of a representative sample of Individualized Educational Plans, and (3) interviews with and a questionnaire completed by teachers. The primary objective of the evaluation was to determine practice standards in the public school district and to make recommendations to improve service delivery. The format of the evaluative model, respective findings, suggested remedies, and implications for large-scale public school consultation are presented.     

Genetic Counselors' Judgments of Patient Concerns: Concordance and Consequences

The aims of this prospective study were to determine (a) the concordance between patient concerns and genetic counselors' judgments of these concerns, (b) the predictors of patient and counselor judgments, and (c) the relationship between concordance and patient outcomes. Patients' and counselors' views were sought before and after 131 routine genetic consultations. Before consultations, there was concordance about level of patient concern to within one point in 63% (82/131) of consultations and about type of patient concern in 60–84% of consultations. Lack of concordance in judging level and type of concern was associated with lower satisfaction with information and higher anxiety after the consultation. The biggest predictor of counselor judgment of concern was professional background: doctors judged patients to be more concerned than did nurses. Concordance of concern was predicted by counselors' experience in genetics: less experienced counselors overestimated patient concern. Future research needs to determine whether improving judgment of concern improves patient outcome.     

Developing a Psychoanalytic Practice

Abstract

This paper examines two methods of developing a psychoanalytic practice. The first is an “internal” approach that helps a patient make the transition from therapy to analysis with the same analyst. This may be accomplished by attenuating the patient's unconscious fears of analysis as a facilitator of an anticipated regressive loss of control and as a reactivator of feared desires and impulses. Increased motivation for analysis may also result from a therapy that leads the patient to an awareness that an ongoing level of distress is internal, together with the experience of a deepened therapy and of the analyst as safe and potentially providing relief. The second method of developing an analytic practice is an “external” approach that provides others, such as analytic, mental health, medical, and academic colleagues, an experience of the analyst as person and some idea of the type of work he or she does.     

A Comparison of Patient Satisfaction with Telehealth and On-Site Consultations: A Pilot Study for Prenatal Genetic Counseling

Many different fields of medicine are now utilizing video conferencing as a means to offer consultations to individuals in rural communities. However, there is a lack of published literature regarding the use of telehealth in clinical genetics and, specifically, in genetic counseling. Those experiences that have been reported mostly centered on cancer genetic counseling, sickle cell anemia consultation and care, or pediatric/adult genetic assessment. In these studies, the patients reported an overall satisfaction with telehealth, signifying that this type of communication may play an important role in the future of medicine. This pilot study compared patient satisfaction with prenatal genetic counseling performed via video conferencing versus that performed on-site. The results show that there was a high level of patient satisfaction when video conferencing was used to conduct prenatal genetic counseling consultations, suggesting that telehealth can be utilized as a means to offer this service to underserved populations. Telehealth refers to any type of communication technology in health care, distance education, transmission of radiological images, etc. The actual screening, diagnosis, treatment, management, etc., using distance technology is referred to as telemedicine.The term on-site indicates that genetic counseling was performed in person, rather than using telehealth.     

The role of attitudes and beliefs in differential health care utilisation among Chinese in Singapore

Abstract

One hundred and twenty-eight Chinese patients at two Western medical practices and two Chinese medical practices in Singapore completed a questionnaire regarding perceptions of illnesses. Health beliefs and attitudes towards different medical practitioners. Results indicate significant differences between those who consult only allopathic physicians (Western doctors) and those who consult both practitioners of traditional Chinese medicine (sinsehs) and Western doctors. Individuals consulting both Western doctors and sinsehs perceived a smaller proportion of “general” illness attributes (those found in both Western and Chinese medicine) to be relevant to specific diseases and showed greater endorsement of Chinese health beliefs than did individuals seeking help only from Western doctors. Also individuals consulting both types of practitioners expressed less satisfaction with the doctor's treatment than did those consulting only Western doctors and also rated sinsehs as more concerned with patient well-being and as listening more to their patients.     

La décision médicale et la relation médecin–patient en oncologie

The announcement of the cancer diagnosis and his treatment is an important moment in the set up of the doctor–patient relationship. The law of contracts has long governed the relationship between the doctor and the patient. But the legislature clearly demonstrated its will to consider the patient as full actor of his health, leaving the regime of medical decision, the shared decision. This shared decision is based on an obligation to inform the patient on his health and knows many exceptions (minor patients or adults under guardianship, emergency). In Oncology, the medical decision is a decision coordinated between doctors in the multidisciplinary consultation meetings. This decision is considered as a guarantee of the quality of the medical care. It does not preclude the time of the doctor–patient relationship.     

癌症患者临床决策倾向性的研究

为了解癌症患者对医生、自己和家属意见的临床决策倾向性,采取问卷调查和半结构访谈相结合的方法,调查120例住院癌症患者的临床决策倾向性。结果显示,(1)生活习惯相关决策,实际和理想的患者自己倾向性构成比值最高,为40%和33%;求医行为方面家属最高,实际和理想均为50%;常规检查、总体治疗方案、手术、化疗和放疗相关决策方面均为医生最高,分别为100%、90%、100%、90%和100%;(2)癌症患者理想和实际的临床决策倾向性构成比值均无差异(P0.05),但访谈显示29.17%的患者认为目前决策状态不理想。提示:(1)癌症患者在不同方面的临床决策倾向性有所不同。(2)癌症患者对临床决策状态基本满意,但有患者希望医生参与沟通更多或自己参与更多。     

Strategic Maneuvering in Treatment Decision-Making Discussions: Two Cases in Point

Over the past decade, the ideal model of shared decision-making has been increasingly promoted as the preferred standard of doctor-patient communication in medical consultation. The model advocates a treatment decision-making process in which the doctor and his patient are considered coequal partners that carefully negotiate the treatment options available in order to ultimately reach a treatment decision that is mutually shared. Thereby, the model notably leaves room for—and stimulates—argumentative discussions to arise in the context of medical consultation. A paradigm example of a discussion that often emerges between doctors and their patients concerns antibiotics as a method of treatment for what is presumed to be a viral infection. Whereas the doctor will generally not encourage treatment with antibiotics, patients oftentimes prefer the medicine to other methods of treatment. In this paper, two cases of such antibiotic-related discussions in consultation are studied using insights gained in the extended pragma-dialectical theory to argumentation. It is examined how patient and physician maneuver strategically in order to maintain a balance between dialectical reasonableness and rhetorical effectiveness, as well as an equilibrium between patient participation and evidence-based medication, while arguing a case for and against antibiotics respectively.     

Validity of the trait emotional intelligence questionnaire in sports and its links with performance satisfaction

ObjectiveThis research project consisted of two studies aimed at validating the trait emotional intelligence questionnaire (TEIQue) in a sports sample.DesignStudy 1 used a confirmatory factor analysis (CFA) to investigate if the original 4-factor structure of the TEIQue could be replicated in a sample of athletes. In addition, we explored the relationship between trait emotional intelligence (trait EI) and the demographic variables age, sex, type of sport (individual vs. team), expertise, and years of training. Study 2 used a path analysis approach to explore if trait EI is related to performance satisfaction through stress appraisal and coping behaviors.MethodIn Study 1, 973 athletes completed the TEIQue and a demographic questionnaire. In Study 2, 291 athletes completed the TEIQue. Moreover, with a recent competition in mind, they completed the Coping Inventory for Competitive Sports, as well as items on perceived intensity of stress, perceived controllability of stress, challenge and threat appraisals, coping effectiveness, and performance satisfaction.ResultsStudy 1 showed with a CFA that the original 4-factor structure of the TEIQue could be replicated in a sports sample. Of the demographic variables, only age showed a significant positive relationship with trait EI. Study 2 showed that trait EI was related to performance satisfaction through stress appraisal and coping variables.ConclusionsThis research showed that the TEIQue can be used with athletes and that trait EI is useful for understanding certain aspects of sports performance satisfaction.