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PubMed1999

Association of air pollution with daily GP consultations for asthma and other lower respiratory conditions in London.

BACKGROUND: Very few published studies have looked at the effects of air pollution on health in the primary care setting. As part of a large study to examine the association between air pollution and a number of health outcomes, the relationship between daily GP consultations for asthma and other lower respiratory diseases (LRD) and air pollution in London was investigated. METHODS: Time-series analysis of daily numbers of GP consultations controlling for time trends, seasonal factors, day of week cycles, influenza, weather, pollen levels, and serial correlation was performed. Consultation data were available from between 268 718 and 295 740 registered patients from 45-47 London practices contributing to the General Practice Research Database during 1992-4. RESULTS: Positive associations, weakly significant and consistent across lags, were observed between asthma consultations and nitrogen dioxide (NO2) and carbon monoxide (CO) in children and particulate matter of less than 10 microm in diameter (PM10) in adults, and between other LRD consultations and sulphur dioxide (SO2) in children. A consistently negative association with ozone in children was observed in both disease categories. The effect estimates of most pollutants were much larger when analysed separately by season, particularly in the children: percentage change in asthma consultations during the warm season (April-September) for a 10-90th percentile increase in 24 hour NO2 lagged by one day = 13.2% (95% CI 5.6 to 21.3), with CO = 11.4% (95% CI 3.3 to 20.0), and with SO2 = 9.0% (95% CI 2.2 to 16.2). In adults the only association consistent over different lag periods was with PM10 = 9.2% (3.7 to 15.1). The associations of pollution and consultations for LRD were increased mainly in the winter months: percentage change in consultations by children in winter with NO2 = 7.2% (95% CI 2.8 to 11.6), CO = 6.2% (95% CI 2.3 to 10.2), and SO2 = 5.8% (95% CI 1.6 to 10.2). CONCLUSIONS: There are associations between air pollution and daily consultations for asthma and other lower respiratory disease in London. The most significant associations were observed in children and the most important pollutants were NO2, CO, and SO2. In adults the only consistent association was with PM10.

Adolescent↗
PubMed2005

Empowering the cancer patient or controlling the tumor? A qualitative study of how cancer patients experience consultations with complementary and alternative medicine practitioners and physicians, respectively.

OBJECTIVES: The authors describe how patients with cancer, who have had consultations with both a conventional physician and a complementary and alternative medicine (CAM) practitioner, experience these consultations. The theoretical background of this study is inspired by a description of 2 models of principles of treatment. In the first model, the instrumental intervention (eg, the medicine) is defined as the causal factor for outcome. In the second model, the patient is defined as the causal factor; the outcomes of the treatment are dependent on the resources of the patient (eg, the body's ability to heal itself) and the impact of the patient's situation. METHODS: Semistructured, in-depth interviews were conducted with 17 Norwegian cancer patients who had visited both a CAM practitioner and a physician. The patients were recruited from both an oncology department at a university hospital and a newspaper advertisement in the area of Trondheim in central Norway. Methods of data analysis used were open coding, relational coding, and categorizing of themes. RESULTS: The cancer patients have experienced 2 different modes of consultations: one characterized by practitioners focusing on controlling the tumor and another characterized by practitioners focusing on the patient. The patients' accounts of these 2 modes of consultation differ in a number of ways: which issues are discussed during the consultation, who is in control of the consultation agenda, what are the patients' perceptions of the practitioners' health and disease understanding (ontology), what are the practitioners' communication skills, and how empowered the patient feels during the consultation. CONCLUSIONS: Patients in this study ask for a consultation style that conveys a focus on both the disease and the whole patient. The results of this study point to a possible connection between the practitioners' understanding of health and disease and the content and form of the consultations. Future research should test this connection.

Adult↗
PubMed2007

Medical communication and technology: a video-based process study of the use of decision aids in primary care consultations.

BACKGROUND: Much of the research on decision-making in health care has focused on consultation outcomes. Less is known about the process by which clinicians and patients come to a treatment decision. This study aimed to quantitatively describe the behaviour shown by doctors and patients during primary care consultations when three types of decision aids were used to promote treatment decision-making in a randomised controlled trial. METHODS: A video-based study set in an efficacy trial which compared the use of paper-based guidelines (control) with two forms of computer-based decision aids (implicit and explicit versions of DARTS II). Treatment decision concerned warfarin anti-coagulation to reduce the risk of stroke in older patients with atrial fibrillation. Twenty nine consultations were video-recorded. A ten-minute 'slice' of the consultation was sampled for detailed content analysis using existing interaction analysis protocols for verbal behaviour and ethological techniques for non-verbal behaviour. RESULTS: Median consultation times (quartiles) differed significantly depending on the technology used. Paper-based guidelines took 21 (19-26) minutes to work through compared to 31 (16-41) minutes for the implicit tool; and 44 (39-55) minutes for the explicit tool. In the ten minutes immediately preceding the decision point, GPs dominated the conversation, accounting for 64% (58-66%) of all utterances and this trend was similar across all three arms of the trial. Information-giving was the most frequent activity for both GPs and patients, although GPs did this at twice the rate compared to patients and at higher rates in consultations involving computerised decision aids. GPs' language was highly technically focused and just 7% of their conversation was socio-emotional in content; this was half the socio-emotional content shown by patients (15%). However, frequent head nodding and a close mirroring in the direction of eye-gaze suggested that both parties were active participants in the conversation CONCLUSION: Irrespective of the arm of the trial, both patients' and GPs' behaviour showed that they were reciprocally engaged in these consultations. However, even in consultations aimed at promoting shared decision-making, GPs' were verbally dominant, and they worked primarily as information providers for patients. In addition, computer-based decision aids significantly prolonged the consultations, particularly the later phases. These data suggest that decision aids may not lead to more 'sharing' in treatment decision-making and that, in their current form, they may take too long to negotiate for use in routine primary care.

Aged↗
PubMed2005

Determinants of consultation length in Australian general practice.

OBJECTIVE: To measure the independent effect on length of general-practice consultations of a range of characteristics of the general practitioner (GP), practice, patient and consultation, as a basis for considering future GP workforce needs. DESIGN: Secondary analysis of data from the BEACH (Bettering the Evaluation and Care of Health) study. SETTING AND PARTICIPANTS: Data were obtained from 1904 GPs Australia-wide on 70,758 consultations between 1 January 2001 and 31 December 2002; all consultations that were claimable from the Australian Government's Medicare system as General Practice Attendances and had recorded start and finish times were included. MAIN OUTCOME VARIABLES: Characteristics of the GP, practice, patient and consultation that were significantly related to consultation length, determined by multiple regression analysis. RESULTS: The following variables had an independent positive effect on consultation length: GP female, older, graduated in Australia, FRACGP-qualified, and in rural practice; patient female, older, new to practice, with higher socioeconomic status, no health concession card, more reasons for encounter, and more problems managed; and management of specific problem types (social, psychological and female genital problems), management of chronic disease, and provision of clinical treatments. CONCLUSION: The independent relationship of some GP, practice, patient and consultation characteristics with length of consultation may affect future GP supply. These factors should be considered in modelling future general practice workforce needs.

Adolescent↗
PubMed1999

The patient-centredness of consultations and outcome in primary care.

BACKGROUND: There is general support for general practitioners (GPs) using patient-centred styles. However, there is limited British evidence of beneficial outcomes for patients from such styles. AIM: To explore whether, for patients presenting for new episodes of care, the GP's consulting style, specifically the patient-centredness of the consultation, is related to five generic outcomes. METHOD: General practitioners in South Wales were recruited, and one surgery consulting session was audiotape recorded for each participating clinician. Questionnaires were given to consenting patients before their consultations, immediately afterwards, and, by post, at two weeks to measure the following outcomes: doctor-patient agreement (on the nature of the problem and management), patient satisfaction, resolution of symptoms, resolution of concerns, and functional health status. From the patients consulting for a new episode of care and completing all three questionnaires, one patient was selected at random for each GP and the audiotape of their consultation rated for patient-centredness. Statistical analysis employed correlation coefficients and t-tests, followed by multiple regression and logistic regression to control for potential confounders. RESULTS: In total, 143 patients consulting 143 GPs were studied. The patient-centred score was positively and statistically significantly associated with patient satisfaction (Pearson correlation = 0.28; P = 0.002). No other associations were found with the other outcomes measured. CONCLUSION: The study presents evidence that patient-centred styles of consulting produce benefits in terms of increased patient satisfaction for patients consulting for new episodes of care in Britain.

Adolescent↗
PubMed2000

Do the attitudes and beliefs of young teenagers towards general practice influence actual consultation behaviour?

BACKGROUND: Teenagers are believed to have health concerns that are not adequately addressed in primary care because of perceived barriers that inhibit them from consulting a general practitioner (GP). We report the results of a study examining links between potential attitudinal barriers and actual help-seeking behaviour. AIM: To determine whether the attitudes of teenagers towards general practice are associated with differences in consultation patterns. METHOD: Results of a postal questionnaire survey of attitudes to general practice, performed among teenage patients aged 13 to 15 years registered with five general practices in the East Midlands, were analysed in relation to consultation data from retrospective casenote analysis for the preceding 12 months. RESULTS: Matched questionnaire and consultation data were available for 678 teenagers. We found few significant differences in overall consultation rates between teenagers expressing differing attitudes about aspects of general practice. Differences did exist in relation to perceived difficulty in getting an appointment, feeling able to confide in a GP, and perception of adequate time being given in the consultation. Fear of embarrassment was associated with lower consultation rates for gynaecological problems and contraception. CONCLUSIONS: Negative perceptions of general practice by teenagers may have less of an influence on actual consultation behaviour than previously believed. However, there are some aspects of care that merit further attention if teenagers are to feel able to consult their GP more easily.

Adolescent↗
PubMed2002

[Prenatal control related to the number of consultations as hyperglycemia diagnostic method].

INTRODUCTION: The impaired in the metabolism of the carbohydrates in a previously healthy woman who develops hyperglycemia during the pregnancy is know as gestational diabetes, the maternal-fetal mortality and morbility is almost the same one that a pregnant normal woman, if the metabolic dysfunction is appropriately controlled, the complications can be treated with success if the pregnant one attends prenatal control. OBJECTIVE: The aim of this study was to know the relationship between number of consultations and the hyperglycemia frequency to settle down. METHODS: 304 pregnant patients were studied that who request childbirth attention at emergency room of the gynecology and obstetrics service were studied; two groups were formed. The first group, 176 patients with term pregnancy in inadequate control with four or less prenatal consultations. The second group, 128 patients with five or more prenatal consultations. All had a fast of at least 4 hours, to take them a sample of blood and to determine the glucose during their entrance with initial childbirth labor. RESULTS: There was difference in the number of consultations that received each group with 1.4 +/- 1.0 consultations for the irregular group and 6.5 +/- 1.1 for the group with regular control. The pregnant ones with no prenatal consultation presented the biggest hyperglycemia percentage, but this percentage diminished as the pregnant ones attended to a bigger number of consultations, since they were detected the dysfunction of glucose on time and they could be treated appropriately. The glycemia was normal in all the patients that had more than 6 prenatal consultations because hyperglycemia was detected in 55 (31.2%) patients of the group with irregular prenatal control, in comparison with 4 (3.1%) of those with appropriate control (p < or = 0.001). CONCLUSION: It is shown that pregnant ones without an appropriate prenatal control with a smaller number of prenatal consultations, they have the biggest hyperglycemia percentage, because it was not possible to detect this dysfunction in an opportune way, this situation demonstrates the importance of identifying the causes of the faulty prenatal control, as well as to identify risk factors for the development of impaired in the metabolism of the carbohydrates.

Adult↗
PubMed2003

[Reasons why musicians consult hand surgeons].

PURPOSE OF THE STUDY: Musicians occasionally consult orthopedic surgeons, particularly upper limb specialists. We wanted to learn more about the reasons why musicians attend orthopedic clinics. MATERIAL AND METHODS: We analyzed retrospectively 227 case files of musicians who consulted our center between 1994 and 2001. We noted patient related factors (age, gender, musical experience, level of performance, daily practice schedule) and their reasons for consulting (pain, discomfort, advice). We studied the medical history of the patients and searched for predisposing or triggering elements. We also recorded therapeutic options proposed. RESULTS: Our series included 119 men (52%) and 108 women, mean age 35 years with 27 years of musical experience on the average. Instruments played were mainly the piano (41%), the violin (19%), and the guitar (15%). Patients playing wind instruments, who consult more often for ENT problems, were exceptional. On the average, the patients played their instrument 4 hours daily. One-third of the patients were high-level amateurs, one-third were professionals, and one-quarter were lower-level amateurs. There was a small proportion of soloists or professors. Two-thirds of the musicians presented disorders of the musculoskeletal system, particularly trauma sequelae. Signs of overuse were present in 18% of the patients, mainly women, signs of misuse due to inappropriate or defective technique in 8.8%, and dystonia in 5.7%. Psychological problems were noted in 4 patients. More than one half of the patients had obtained medical advice prior to consulting an orthopedic surgeon and the very large majority had been referred by specialized physical therapists. A surgical procedure was proposed for only 19% of the patients presenting an orthopedic disorder. DISCUSSION: This study presents a diversified panel of musicians consulting orthopedic surgery clinics. Practicing schedules varied in the study population from one to five hours daily. More than half the patients complained of pain but 18% consulted because they perceived a problem when playing and 17% consulted simply for advice. Our findings recall that musicians comprise a sensitive population requiring careful overall management. Unlike series published to date, we had a majority of men. Problems involving an orthopedic disorder or trauma and trauma sequelae predominated. In the literature, diagnosis has been oriented by the specialty of the consulting physician. We found that our patients who suffered from overuse had often recently changed their habitual practicing methods or conditions. The diagnosis of misuse was facilitated when the patient was examined with his/her instrument. The low rate of dystonic disorders was probably related to the fact that nearly half of our patients were followed regularly by a physical therapist. We did not observe any case of excessive laxity or Linburg Comstock syndrome which exceptionally have functional impact. The very large majority of our patients were referred by physical therapists and when surgery was necessary, the procedure was performed in accordance with accepted rules concerning the therapeutic management of musicians.

Adolescent↗
PubMed1992

Reasons for consultation in irritable bowel syndrome: symptoms and patient characteristics.

This study compared the characteristics of patients with symptoms of irritable bowel syndrome who had either consulted or not consulted a general practitioner in the preceding two years. The subjects were identified by questionnaire in a community survey of irritable bowel syndrome symptoms and samples of 24 consulting and 24 non-consulting patients were interviewed. The groups were well matched for demographic characteristics, although those who consulted for irritable bowel syndrome also consulted more frequently for other problems. The only significant differences in the pattern, frequency and severity of a range of symptoms, which included the Manning criteria, were that more of the consulting patients experienced visible abdominal distension and had a higher mean score for severity of pain than the non-consulters. Mean negative life event scores and anxiety and depression scores were higher in the group who consulted and more of these patients were concerned about the possible serious nature of their symptoms, including fear of cancer, emphasizing the importance of eliciting patients' beliefs and anxieties about the meaning of their symptoms.

Adult↗
PubMed2004

Communicating about expected course and re-consultation for respiratory tract infections in children: an exploratory study.

Acute respiratory tract infection is the commonest reason for children consulting, and about one-fifth re-consult for the same illness episode. Fifty-nine audiotape recordings from nine general practitioners (GPs) consulting with children with acute respiratory tract infections were examined. Prognosis was mentioned in only 22 consultations, with GPs predicting a brief course in 11, a possibly longer than expected course in six, and with predicted duration not made explicit in five. Carers were invited to re-consult if they were 'unhappy' with the child's condition in 11 consultations, and specific triggers to re-consult were provided in 15. A patient information leaflet was given out only once. Providing carers with an evidence-based account of the likely clinical course and communicating specific triggers to re-consult may help them manage more of these illness episodes without re-consulting.

Acute Disease↗
PubMed2004

The burden of rheumatic disorders in general practice: consultation rates for rheumatic disease and the relationship to age, ethnicity, and small-area deprivation.

AIMS: To estimate the burden of rheumatic disorders in the New Zealand population by calculating general-practice consultation rates--as well as the influence of age, gender, ethnicity, and small-area deprivation on these consultation rates. METHODS: Cases were identified from the Royal New Zealand College of General Practitioners database using search-strings of typical words used in consultation notes (for each of 10 rheumatic disorders). Rates were calculated from a denominator of the number of people attending at least once over a 12-month period to any of 22 contributing general practices. The independent effect of age, sex, ethnicity, and small-area deprivation was modelled using multiple logistic regression. RESULTS: Of 29,152 people attending their general practitioner, 20.4% consulted with a rheumatic disorder. Older people, males, people who lived in more deprived areas, and Europeans were more likely to consult with a rheumatic disorder. With all rheumatic disorders, age was a significant influence upon consultation--especially osteoarthritis, gout, osteoporosis, and joint surgery. Maori were more likely than Europeans to consult with gout, but they were slightly less likely to consult with back pain or regional pain disorders. Small-area deprivation had small influences upon people consulting with gout, regional pain, and back pain. CONCLUSIONS: Rheumatic disorders form a significant part of the workload of general practitioners and this is significantly influenced by local demographic factors. Most of these conditions seen in general practice are non-inflammatory and non-surgical. If a community-needs approach was taken, it is likely that the workload and associated costs would be even greater.

Adolescent↗
PubMed2006

A prospective study of the consulting behaviour of older people with knee pain.

BACKGROUND: Knee pain is common among older adults but only a minority consult their doctor about it. AIM: To determine predictors of new episodes of consultation in primary care among older people with knee pain. DESIGN OF STUDY: Population-based prospective cohort study linking baseline survey to primary care medical records. SETTING: Three general practices in North Staffordshire, UK. METHOD: Subjects were 1797 people aged > or =50 years who responded to a general population survey, reported knee pain in the previous 12 months and had no record of a knee disorder consultation in the 18 months prior to the survey. The main outcome measure was a record of a knee disorder consultation in the 18 months following the survey. RESULTS: The incidence of a new episode of general practice care was approximately 10% per year. Apart from chronicity (odds ratio [OR] = 1.5; 95% confidence interval [CI] = 1.1 to 2.1), measures of pain severity were not strong influences on future consultation. No social support (measured by having no partner) increased likelihood of future consultation (OR = 1.3; 95% CI = 1.0 to 1.8). Among those with chronic and severe pain, main predictors were previous experiences of health care (use of non-GP services OR = 1.8; previous knee injury OR = 1.7). Current depression reduced likelihood of consulting about the knee problem (OR = 0.6; 95% CI = 0.3 to 0.9). CONCLUSIONS: Knee pain is common in the older population but a minority consult their doctor about it. Severity of pain and disability is not a strong influence on consultation. For those more severely affected, depression may act as a barrier to healthcare use.

Aged↗
PubMed2006

Involve the patient and pass the MRCGP: investigating shared decision making in a consulting skills examination using a validated instrument.

BACKGROUND: Shared decision making is an important aspect of patient centredness. Lack of this consulting behaviour is a common reason for failure in the Membership of the Royal College of General Practitioners (MRCGP) consulting skills examination. AIM: To investigate candidates' performance in shared decision making and overall performance in the MRCGP consulting skills assessment compared with an independently validated measure, the OPTION ('observing patient involvement') scale. DESIGN: Cross-sectional study. SETTING: MRCGP examination, UK. PARTICIPANTS: Two hundred and fifty-two consultations submitted by 36 GPs submitting seven consultations per videotape. METHOD: A stratified sample of 63 candidates, 21 each from fail, pass and merit selected from candidates in the MRCGP consulting skills examination, were approached for participation. Participants' examination videotapes were independently assessed for shared decision making using the OPTION scale by two non-clinical raters. RESULTS: Thirty-six candidates (of 63; 57%) who participated were no different from non-participants. Candidates who passed the 'sharing management options' in the MRCGP had significantly higher OPTION scores than those who did not (35.4 versus 27.3; mean difference = 8.1, P = 0.044). There was a significant difference between OPTION scores of MRCGP candidates with 'fail' and 'pass' (including pass with merit): 28.6 versus 36.1, 95% confidence interval CI = 1.13 to 13.87. Scores decreased as clinician age increased but were not significantly associated with sex of GP, age or sex of patient or consultation duration. The probability of passing the MRGCP increased as OPTION scores increased. CONCLUSION: This study demonstrated concurrent validity of the MRCGP consulting skills assessment of sharing management options against an independent validated instrument for shared decision making, the OPTION scale. Candidates who performed best in the MRCGP exhibited high scores with OPTION. This study provides the basis for further work to demonstrate evidence for the potential of training for professional assessment to improve consulting competence.

Adult↗
PubMed1996

Changes in payments for general practice consultations 1989-93.

AIMS: Information generated by the computer systems of general practitioners was examined to determine whether general practitioners fee structures during 1993 were different from those reported in 1989. METHODS: Copies of the general medical services (GMS) claims and actual consultation charges to patients were examined to determine whether patients had been charged the doctors' regular fee or an amount greater or less than this, in 1993. These data were compared with results from a previous study describing charging data in 1989. RESULTS: Information on 59,215 consultations was collected in 1993 and compared with information on 97,869 consultations collected in 1989. The proportion of consultations which resulted in a regular fee being charge had reduced from 47.0% in 1989 to 34.1% in 1993 (p < 0.001). The proportion of cases in which a less than normal fee was charged had risen 7.9 times from 3.5% in 1989 to 27.5% in 1993 (p < 0.001). The contribution of Accident Compensation (ACC) funding for general practitioner consultations had reduced from 17.5% of consultations in 1989 to 10.1% of 1993 consultations (p < 0.001). Excluding consultations in which a maternity or immunisation claim was made, 19.4% of consultations in 1993 generated no fee to the patient. CONCLUSION: In the 4 years between these two data collections, changes in the contribution of different agencies funding general practice care is marked. Public agencies have diminished input and both patients and practitioners are carrying more of the financial burden for access to primary care.

Adult↗
PubMed1996

Use of the consultation satisfaction questionnaire to examine patients' satisfaction with general practitioners and community nurses: reliability, replicability and discriminant validity.

BACKGROUND: Primary health care services are the most frequently used in the health care system. Consumer feedback on these services is important. Research in this area relates mainly to doctor-patient relationships which fails to reflect the multidisciplinary nature of primary health care. AIM: A pilot study aimed to examine the feasibility of using a patient satisfaction questionnaire designed for use with general practitioner consultations as an instrument for measuring patient satisfaction with community nurses. METHOD: The questionnaire measuring patient satisfaction with general practitioner consultations was adapted for measuring satisfaction with contacts with a nurse practitioner, district nurses, practice nurses and health visitors. A total of 1575 patients in three practices consulting general practitioners or community nurses were invited to complete a questionnaire. Data were subjected to principal components analysis and the dimensions identified were tested for internal reliability and replicability. To establish discriminant validity, patients' mean satisfaction scores for consultations with general practitioners, the nurse practitioner, health visitors and nurses (district and practice nurses) were compared. RESULTS: Questionnaires were returned relating to 400 general practitioner, 54 nurse practitioner, 191 district/practice nurse and 83 health visitor consultations (overall response rate 46%). Principal components analysis demonstrated a factor structure similar to that found in an earlier study of the consultation satisfaction questionnaire. Three dimensions of patient satisfaction were identified: professional care, depth of relationship and perceived time spent with the health professional. The dimensions were found to have acceptable levels of reliability. Factor structures obtained from data relating to general practitioner and community nurse consultations were found to correlate significantly. Comparison between health professionals showed that patients rated satisfaction with professional care significantly more highly for nurses than for general practitioners and health visitors. Patients' rating of satisfaction with the depth of relationships with health visitors was significantly lower than their ratings of this relationship with the other groups of health professionals. There were so significant differences between health professional groups regarding patients' ratings of satisfaction with the perceived amount of time spent with health professionals. CONCLUSION: The pilot study showed that it is possible to use the consultation satisfaction questionnaire for both general practitioners and community nurses. Comparison between health professional groups should be undertaken with caution as data were available for only a small number of consultations with some of the groups of health professionals studied.

Community Health Nursing↗
PubMed1992

Political and interpersonal aspects of ethics consultation.

Previous papers on ethics consultation in medicine have taken a positivistic approach and lack critical scrutiny of the psychosocial, political, and moral contexts in which consultations occur. This paper discusses some of the contextual factors that require more careful research. We need to know more about what prompts and inhibits consultation, especially what factors effectively prevent house officers and nonphysicians from requesting consultation despite perceived moral conflict in cases. The attitudes and institutional power of attending medical staff seem important, especially where innovative interventions raise ethical questions. Ethics consultants also need to address the thorny problems of the origin(s) of the consultant's authority, whistleblowing, conflicts of interest that affect the consultant, persistently poor communications in hospitals, systemic inequity in the availability or quality of services for some, and the standing of the consultant's recommendations, including their appearance in the patient's medical record.

Bioethical Issues↗
PubMed1988

Impact of medical ethics consultations on physicians: an exploratory study.

PURPOSE AND METHODS: Despite the increasing availability of medical ethics consultations, little research addresses the impact of these consultations on physicians. Therefore, we surveyed physician-requesters and reviewed medical charts to evaluate the 44 ethics consultations concerning individual patients at our university medical center over an 18-month period. RESULTS: The physicians who requested these consultations said 14 consultations identified previously unrecognized ethical issues, and 18 changed patient management considerably. The medical charts showed that the most frequently overlooked issue was inappropriate family decisions for incompetent adult patients (five consultations) and the most frequent management changes involved withholding cardiopulmonary resuscitation (12 consultations). CONCLUSIONS: Ethics consultations appeared to have considerable impact on physicians in conducting patient care.

Aged↗
PubMed1996

Evaluation of an ethics consultation service: patient and family perspective.

PURPOSE: The purpose of this study was to determine whether patients and their families found ethics consultations to be helpful and whether they were satisfied with the treatment decisions that were made in those cases where ethics consultation was requested. METHODS: Interviews were conducted with each patient (or surrogate) concerning whom an ethics consultation had been provided during a 1-year period at Loma Linda University Medical Center, excepting those who met exclusion criteria. The interview was done by telephone a few weeks after hospital discharge. It included multiple choice and open-ended questions. A content analysis was done on the solicited and spontaneous comments. RESULTS: Eighty-six ethics consultations were provided and interviews were completed for 56 of them (65%). Fifty-seven percent of interviewees found the ethics consultation to have been helpful, and only 4% found them to have been detrimental. Interviewees were more likely to have found the consultation helpful when they perceived that it had resulted in a significant change in treatment, and were less likely to have found it helpful when the patients were more seriously ill. In addition, 77% were satisfied with the treatment decisions made, and 11% showed some degree of dissatisfaction. CONCLUSIONS: Patients and families found ethics consultation provided by clinical ethicists at Loma Linda University Medical Center to be helpful in a majority of instances, and rarely found them detrimental. Based on an analysis of their comments, we believe ethics consultations were perceived as helpful in 7 ways: increased clinical clarity, increased moral or legal clarity, motivation to do what they believe is right, facilitation of the process of decision-making, implementation of a decision, interpretation of technical language, and consolation and support.

Adolescent↗