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PubMed2001

[Consensus conference on consultation times in neurology. Recommendations on consultation times in neurology outpatients care in Spain].

INTRODUCTION: Developing recommendations about consultation times in neurology helps plan the endowment of human resources and can contribute to homogenize and improve quality of health-care. OBJECTIVES: To elaborate recommendations on the consultation times needed to obtain enough quality neurology visits. MATERIAL AND METHOD: We used consensus search techniques, in particular the Community Impression technique. An ad hoc committee developed a preliminary proposal which was later discussed during a unlimited attendance working meeting and eventually voted by members of the Spanish Society of Neurology. The committee drew up a final consensus report after analysing the debate results and counting the ballots. FINAL RECOMMENDATION: "It is necessary that the Spanish Society of Neurology establishes and recommends standardized consultation times for neurology outpatients visits in Spain. These standardized values refer to consultation time per patient, both in the first and follow-up visits, in a General Neurology Outpatients Clinic. Moreover, there must be considered 'recommendable times' on one hand, and 'minimal required times' on the other hand. Any time value below the minimal required time means that the consultation duration does not fulfill the minimal requirements needed to warrant a care with acceptable quality for the patient". These recommendations are: Time for first consultation. Recommendable time: 45 minutes (Minimal required time: 25 minutes). Time for follow-up consultation. Recommendable time: 20 minutes (Minimal required time: 15 minutes).

Humans↗
PubMed1984

Child consultation patterns in general practice comparing "high" and "low" consulting families.

All children's consultations with their general practitioner over a 12 month period in a small urban practice were analysed. Overall consultation rates ranged from 2.2 per child a year for 8 to 11 year olds, to 6.8 for those under 2. Families were grouped according to their average rate of new consultation for children, standardised for age. Families with higher consulting rates scored higher on an index of economic disadvantage, with mothers who scored higher on a test of "tendency to consult" and who were less educated than those in lower consulting families. The presence of any doctor-defined "significant disease" in any child was highly correlated with the family's consultation rate.

Age Factors↗
PubMed1986

Consultation-liaison psychiatry and clinical ethics: a model for consultation and teaching.

The consultation-liaison psychiatrist is often expected to perform the role of clinical ethicist or moral arbiter in the course of responding to psychiatric consultations. This article develops the idea that certain aspects of good consultation-liaison skills make this appropriate and consultation-liaison psychiatrists ought not to shy away from helping with difficult ethical problems. However, a systematic approach to clinical ethics is usually not part of consultation-liaison training. Two simple conceptual models can provide such a systematic approach and can be used in any clinical setting. The two models can also be easily taught and lend themselves to use in structuring teaching or case conferences about clinical ethics. The first model comes from formal philosophy (summarized by Veatch) and is a four-step hierarchy of levels of moral discourse. The other model comes from clinical medicine, based on work by Siegler, and provides another four-point checklist, this time of areas that must be considered in each decision. This article presents each of these four-point frameworks, alludes to the large amount of work that underpins these ostensibly simple models, and offers a case for demonstration/discussion of how the consultation-liaison psychiatrist use the models for structuring clinical ethical decision making and teaching.

Aged↗
PubMed1985

Data-based psychiatric consultation: applying mainframe computer capability to consultation.

Critical, intertwined objectives for consultation psychiatry include 1) the development of data-based clinical practices, and 2) heightening the effectiveness of consultation. Toward these ends, the Consultation Psychiatry Service at the University of Minnesota has previously conducted systematic studies of consultation and established an ongoing data collection system for consultations. Both steps have relied extensively upon mainframe computer capability. This primary application of computer capability to the field of psychiatric consultation is reviewed by the authors.

Computers↗
PubMedDate not supplied

Psychiatric consultations and ethics consultations. similarities and differences.

Although consultation-liaison psychiatry and clinical ethics both developed largely in response to the problems engendered by the new medical technology and the dilution of the traditional doctor-patient relationship, they represent distinct fields that rely on different, but overlapping, domains of expertise. To be effective, ethics consultants often need to augment their own background with psychiatric knowledge and skills. Consultation-liaison psychiatrists are well prepared to contribute to clinical ethics but cannot serve effectively as ethics consultants without additional education and training. Several case examples are presented to elucidate these points and to illustrate the similarities and differences between psychiatric consultations and ethics consultations.

Aged↗
PubMed2002

Audiotapes of oncology consultations: only for the first consultation?

BACKGROUND: Patients value audiotapes of their oncology consultations and letters summarising the discussion, and report improved recall and satisfaction when they receive them. However, studies to date have provided these interventions only after the initial or 'bad news' consultation. This study aimed to evaluate the utility of audiotaping routine follow-up oncology consultations. PATIENTS AND METHODS: This was a prospective study following a cohort of consecutive patients attending routine follow-up at oncology outpatient appointments with one oncologist. Patients were approached when they attended their appointment and offered the opportunity to be audiotaped. Acceptance rates and reasons for refusal were documented. Two weeks after the consultation, patients were telephoned regarding their response to the tape and were sent a letter summarising the consultation. Two weeks later they received a further telephone call regarding the letter and their perceptions of the comparative value of the two interventions. RESULTS: Seventy-five per cent of patients were female and for 40% English was not their first language. The patients had attended a median of 14 previous oncology appointments; 52 patients were offered audiotaping, 43 accepted and 30 decided to take home a copy of the audiotape. One patient felt recording had limited the discussion. Patients refused the tape most commonly because they felt no need for this aid, and accepted it most commonly to aid recall or share with family. Twenty-six patients listened to the tape, 14 did so more than once. Twenty had shared it with another person and over 75% thought it was useful. The majority (57%) preferred to receive both the tape and letter, with three preferring the tape alone and seven the letter. Married patients and those receiving bad news were more likely to want the tape. CONCLUSIONS: Audiotaping follow-up consultations is an inexpensive procedure that is appreciated by the majority of patients. Randomised controlled trials of their impact are warranted.

Adult↗
PubMed1994

Is the potential of teenage consultations being missed?: a study of consultation times in primary care.

There is a paucity of knowledge regarding teenage health even though it features as one of the priority areas in the government's health plans. There have been few reports of adolescent contacts with primary care teams, although there are impressions of a suboptimal service. As a prelude to understanding more about communication between general practitioners and teenage patients, this study aimed to look at the time spent on teenage consultations, which can be used as one method of describing the quality of care provided to teenage patients. Nine-hundred consultations involving six doctors in one surgery were timed over a 3 month period by one observer using a validated method. One-hundred and nineteen consultations with patients aged 11-19 were compared with the 781 consultations for other age groups and showed a statistically significant mean shortfall of nearly 2 minutes (23%). This trend was confirmed for all six doctors, despite a broad range of average consulting times. The study also demonstrated some other characteristics of teenage consultations. Several implications of these results are discussed as well as possible reasons for these findings. The study emphasizes the need for further research in this area.

Adolescent↗
PubMedDate not supplied

The infectious disease consultant and the telephone consultation.

The details of 105 telephone consultations made by 62 community physicians to a subspecialist in Pediatric Infectious Disease were prospectively evaluated. Of physicians seeking consultation 95% were pediatricians. Only one inquiry did not concern the immediate management of a patient. Sixty percent of inquiring physicians were consultants to primary physicians. Of 104 patients 51% were ambulatory and 49% were hospitalized. Most questions concerned topics that were commonly encountered in practice and not newly described illnesses or therapies. The primary basis of the consultant's advice was a larger experience with similar problems rather than convenient access to the literature. The telephone consultation is an effective educational tool for the community physician; it appears to be a barometer of the types of problems confronting the practicing physician and vignettes based upon such consultations may be an effective approach for continuing medical education courses.

Communicable Diseases↗
PubMed2002

Are accident and emergency consultants as accurate as consultant radiologists in interpreting plain skeletal radiographs taken at a minor injury unit?

The objective of this study was to compare the accuracy of an accident and emergency (A&E) consultant in interpreting plain skeletal radiographs with that of a consultant radiologist (CR). It took the form of a retrospective study of 2133 radiographs taken in a Minor Injury Unit (MIU). A&E consultant reports on these films were compared with those of a CR and also with a gold standard. The A&E consultant diagnoses achieved an accuracy of 98.5% (CR 97.8%), sensitivity of 97.8% (CR 98.1%), specificity of 98.8% (CR 97.7%), positive predictive value of 97.3% (CR 95.1%) and negative predictive value of 98.97% (CR 99.07%) (gold standard of 100%). In conclusion, the A&E consultant reports of plain skeletal radiographs generated from an MIU were as accurate as those of a consultant radiologist. This could have significant implications for the wet reporting of A&E departmental radiographs.

Accidents↗
PubMed1982

Psychiatric consultations at medical and surgical wards: the role of psychiatric consultant.

A one-year survey was conducted on the psychiatric consultation work at Kyushu University Hospital. It was found that an organic brain syndrome was the most frequent psychiatric diagnosis of the referred patients. The most frequent purpose of request for psychiatric consultations was for the management of the patient. The main consultant functions were diagnoses and to advise on the management of the patient. The consultant functions agreed with the purposes of request in many cases, but discrepancies between the two were found about the patient disposition. The nature of the consultant role was compared with some American studies. It was deemed necessary that consultation-liaison psychiatry based on Japan's present conditions, medical and social, should be developed.

Humans↗
PubMed1988

Consultation among peers in general practice; from no consultation to peer review.

The present study concerned several aspects of peer consultation by general practitioners, investigated in a group of 184 doctors (response rate: 83%) who had their vocational training in the department of general practice of the University of Utrecht and practised for at least three years at the time of the study. Questionnaire responses indicated that consultation during and outside surgery hours and participation in case-discussion groups generally extended over more than two years, occurred frequently, and usually pertained to diverse problems associated with diagnosis and treatment. Participation in study and peer review groups extended usually over a shorter time (1 to 1 1/2 years) and the problems dealt with were predominantly the same as for individual consultation. One-third of the general practitioners consulted colleagues frequently and continued to do so for long periods, dealing systematically with a variety of problems; one-third did so infrequently or unsystematically, and one-third did little or not at all. A relationship was found between the setting of the practice and consulting behaviour: 20% of those who practised alone never consulted peers, whereas those in group practices and health centres were accustomed to do so regularly.

Family Practice↗
PubMed2005

[Consulting work cited in the hospital laboratory annual progress report of the laboratory information and consulting work and its role in Toyama Medical and Pharmaceutical University Hospital].

Recently, it is difficult for general patients to understand clinical inspection. Therefore we opened the laboratory information and consulting office (called Kensa Yorozu Consulting Room) from April, 2004. It is most characteristic that our office is managed by a clinical laboratory physician. A full time-specialized doctor who is belong to clinical laboratory, is stationed in the office. Duties contents of our office are consultation, publishing laboratory report and information, education and the clinical studies. We don't limit a person of consultation in particular. We accept consultations for 24 hours by coming our office, telephone, Fax or E-mail. The amount of consultations is about 5-10 per one month. The contents are suggesting inspection plan, explanation of pathophysiologic information based on clinical inspect result and so on. The examples compiled it into a database and maintains and their answers information. Because there are clinical laboratory physicians in this office, there are merits that follow. As for the medical technologist, it was not interfered with routine duties. For doctors and co-medical staffs, it is possible for detailed arguments to the diagnosis and treatment considered the condition of a patient and a characteristic of laboratory method. Doctors of outside can talk with us by telephones or emails easily. For patients, they can smoothly talk about their diseases with their physicians knowing more laboratory information. More medical stuffs need our office, because there are many repeaters although the total number is small. Therefore it is important that we let everybody know about our works and that we make good communication environment to talk easily, keeping privacy. We want to compile and share database of laboratory information. Then we can contribute to the area medical care.

Allied Health Personnel↗
PubMed1989

[Classification of reasons for consultation and results of consultation in a selected sample from specialized pulmonary outpatient care].

According to Braun's theory of applied medicine terminology 4 results of medical consultation can be defined: A) classification of symptoms, B) classification of groups of symptoms, C) classification of the clinical picture, and D) exact diagnosis. In general practice only about 10% of the results of medical consultation are exact diagnoses. We wondered if the categories A-D also pertain to the patients of a specialized pulmonary diseases outpatient department. 20 consecutive new patients were studied who had been referred by other outpatient departments, consultant specialists, or general practitioners. The group consisted of 13 men and 7 women, mean age 40 years, range 18 to 65 years. In 9 patients consultation resulted in an increase in differentiation by one or two stages in comparison with the reason for referral. The result of consultation was not an exact diagnosis, in 10 cases, even in a specialized outpatient department. Thus, Braun's terminology of applied medicine with respect to the reason for, and the result of a medical consultation is generally valid, as shown by application to a specialist outpatient department.

Adolescent↗
PubMed2007

[Consultation. Considerations on the practice of medical consultation].

On the theme of Linus Geisler's nine steps for a successful consultation between doctor and patient, the ability for self-criticism, the ability to be able to listen to oneself and the value of the doctor-patient relationship in the context of medical practice will be discussed. Subsequently, the framework of the consultation, the consulting room atmosphere and the complete setting of the consultation will be dealt with. The importance of active listening and the recognition of all messages, both verbal and from body language, will be particularly emphasized. The capability for empathy is presented as the necessary bridge to recognition of the feelings and inner world of the patient. Because one only sees what one is looking for and only recognizes what one knows, the recognition of typical complaints presented by patients in a consultation represents the "something" which must be specifically elucidated. The problems and symptoms which the patient brings to the doctor are surrounded by a ring of fears and apprehensions. For this reason it is decisive to uncover the accompanying cloud of fears and apprehensions with appropriate questions, to correctly assign the unsettling symptoms of the patient and to be able to correctly interpret them. As illustrated by the language of nature - the translation of deoxyribonucleic acid (DNA) triplets into amino acids - the translation of biological, psychological and social aspects of the complaints symptomatic into the level of diagnosis and the translation of the referential, social and affective meaning of the expressions used by the patient, into the level of the significance will be discussed. The role of the doctor here is that of a producer of context and a skilled translator. In the management of functional disorders and chronic diseases the construction of a shared reality is important. The therapeutic function of consultations is due to an introduction of metaphors as bridges - bridges to an improved understanding of the body, the self and the world. The role of the physician here is that of a moderator, motivator an accompanying person. Finally, Jaspers levels of good doctoring (natural science or causal level, nursing level, communicative-existential level) are stressed and the importance of a good patient-physician relationship for a patient-centered medicine is underlined.

Communication↗
PubMed2005

Requests from professional care providers for consultation with palliative care consultation teams.

GOALS OF WORK: Professional care providers need a substantial basis of competence and expertise to provide appropriate palliative care. Little is known about the problems professionals experience in their palliative care provision in daily practice or about the nature of the advice and support they request from experts. Our aim was to investigate the extent to which professionals requested assistance from palliative care consultation teams and the reasons behind these requests to trace any gaps they experience in the provision of palliative care. METHODS: As part of a large national palliative care development programme, we studied requests for consultation made by professional care providers over a 2-year period. The requests for consultation were recorded on a specially developed standard registration form and classified according to 11 domains relevant to palliative care. MAIN RESULTS: Professional care providers requested 4351 consultations on account of 8413 specific problems in 11 quality-of-life and quality-of-care domains. The distribution of problems over these domains was unbalanced: 42.2% of the specific problems were physical, while the percentages of psychological, pharmacological and organizational problems were 7.7, 12.5 and 12.8%, respectively. In contrast, issues of a spiritual nature or concerned with daily functioning were raised infrequently (1.1 and 0.9%). Details of the specific problems in all the domains are described in the text and tables. CONCLUSIONS: The results of our study form a valid basis on which to develop and implement improvements in palliative care. We recommend that future well-founded policies for palliative care should incorporate palliative care consultation as well as educational and organizational interventions.

Clinical Competence↗
PubMed1994

Cost comparison of psychogeriatric consultations: outpatient versus home-based consultations.

In this article a cost-comparison study of psychogeriatric outpatient and home consultations (if all outpatients are seen at home) is reported. The cost of home visits was estimated to be less than that for outpatient consultations. The results are discussed in the context of methodological difficulties and the advantages and disadvantages of home and outpatient consultations. In view of the many advantages of home-based consultations, including lower costs, it is concluded that we should be developing and evaluating services with greater emphasis on home-based consultations.

Aged↗
PubMed2006

What is "the good back-consultation"? A combined qualitative and quantitative study of chronic low back pain patients' interaction with and perceptions of consultations with specialists.

OBJECTIVE: To identify core elements of what patients with chronic low back pain perceive as good clinical communication and interaction with a specialist ("The Good Back-Consultation"). DESIGN: Qualitative study including observation of consultations and a subsequent patient interview. Quantitative data were also recorded. SUBJECTS: Thirty-five patients with chronic low back pain referred to a specialist. METHODS: Thirty-five consultations were observed with respect to history-taking, clinical examination and interaction between patient and doctor. Patients were subsequently interviewed about how they perceived the consultation. Fourteen specialists with various specialty branches and 35 patients (18 males) participated. For 3 of the specialists a positive effect (return to work) on patients with chronic low back pain had been documented in previous randomized controlled trials. Qualitative data analysis was performed using a template method. RESULTS: Most patients thought that the history-taking and clinical examination had been thorough and satisfactory. Patients emphasized the importance of being given an explanation during the examination of what was being done and found, of receiving understandable information on the causes of the pain, of receiving reassurance, discussing psychosocial issues and discussing what can be done. The most important characteristic of "The Good Back-Consultation" was that the specialist took the patient seriously. CONCLUSION: The findings may represent an important potential for enhancing clinical communication with patients.

Adult↗
PubMed2004

Do patients and expert doctors agree on the assessment of consultation skills? A comparison of two patient consultation assessment scales with the video component of the MRCGP.

OBJECTIVE: The purpose of this study was to determine whether patient ratings of general practice Registrars' consulting skills are associated with 'expert' scoring using the MRCGP video assessment protocol. METHODS: A cross-sectional observational study of general practice Registrars' consultation skills was carried out in 23 practices in South East Scotland using two types of patient assessment compared with expert assessment of video consultation. The main outcome measures were rank correlation of Registrars' overall level of attainment on the Royal College of General Practitioner (RCGP) video assessment with mean score on the Patient Enablement Instrument (PEI) and mean score on the Consultation Satisfaction Questionnaire (CSQ). RESULTS: The rank correlation of Registrars' mean PEI scores with marks on the RCGP video component was 0.01 (P = 0.97, n = 19) and mean CSQ score 0.05 (P = 0.83, n = 19). There were no adverse comments from patients, but Registrars and trainers found the process onerous. CONCLUSION: No meaningful association was identified between Registrars' score on the RCGP video examination and patient assessment via either the PEI or the CSQ. This suggests that, with regard to measuring quality in the consultation, one or more of the assessments are invalid or that they are measuring different attributes. Further research to elucidate the reasons for the lack of correlation is required.

Clinical Competence↗