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PubMed1996

Characteristics of practices, general practitioners and patients related to levels of patients' satisfaction with consultations.

BACKGROUND: Despite interest in the relationship between patient satisfaction and consultation performance, there is little information about how other characteristics of general practitioners, practices and patients influence satisfaction with consultations. AIM: To identify characteristics of patients, practices and general practitioners that influence satisfaction with consultations. METHOD: In 1991-92, a consultation satisfaction questionnaire (CSQ) was administered to 75 patients attending each of the 126 general practitioners in 39 practices. Further questionnaires were used to collect information about the practice (such as total list size, training status, fundholding status and presence of a personal list system) and about the general practitioners (age, sex, whether vocationally trained, a trainer or a trainee, and the number of patients booked in the appointment system per hour). Stepwise multiple regression was undertaken to identify characteristics of patients, practices or general practitioners that influenced satisfaction. RESULTS: The mean of the response rates to the patient questionnaire for each general practitioner was 76.6%, with a standard deviation (SD) of 17.8. Practice characteristics associated with falls in satisfaction were an increasing total list size, the absence of a personal list system and its being a training practice. If more patients were booked in the appointment system per hour, satisfaction with the perceived length of consultations fell. Patient characteristics associated with falls in satisfaction were increased age and an increased proportion of male patients. The only characteristic of general practitioners associated with lower levels of satisfaction was increasing age. The sex of general practitioners did not influence satisfaction. CONCLUSIONS: The findings of this study give further support to the importance of a personal service in determining patient satisfaction in general practice. General Practitioners need to review the organization of practices to ensure an acceptable balance between the requirements of modern clinical care and the wishes of patients. Future studies should take account of the many variables that can influence patient satisfaction.

Adult↗
PubMed1997

Consulting in occupational health nursing. An overview.

1. The term consultant is defined as anyone who provides professional advice or services, which may include internal and external consultants. Consulting is a challenging way to practice occupational health nursing. 2. The consulting process involves problem solving and the creation of change. This process may be illustrated by using the nursing process and the steps of assessment, analysis, planning, implementation, and evaluation. 3. Successful occupational health nursing consultants are excellent communicators, are willing to market themselves, love problem solving, and are self starters.

Consultants↗
PubMed1997

[Establishment of a laboratory information office in response to the expanding need for consultation--actual situation of the laboratory information room, Clinical Laboratory Department, Kitasato University Hospital].

Due to the advancement, segmentation and specialization of the medical care, laboratory examinations covered by the National Health Insurance (NHI) tariff have exceeded several hundred, and it is not possible for medical staff to be familiar with all of these and to utilize them appropriately. There is an urgent need for laboratory information for physicians, nurses, and other health professionals. Accordingly, our Clinical Laboratory Department, Kitasato University Hospital, established a "Laboratory Information (Consultation) Office" in July 1995 to provide consultations on clinical laboratory tests to those engaged in daily clinical practice and in medical research. The office is situated on the second floor of the Laboratory Building of the Kitasato University Hospital. One laboratory technician and one laboratory physician (clinical pathologist) are stationed there. They are available for telephone consultations from 9:00 to 17:00 on weekdays, except for holidays, and from 9:00 to 13:00 on the first, third and fifth Saturdays. In addition, since January 1997, this office also has been open to members of medical associations in various cities in our area. To cope with requests for laboratory information, including whether an examination is covered the NHI tariff, selection of appropriate screening examinations and availability of new laboratory tests, consultations by fax are accepted at any time, even after regular working hours. As a post-graduate education program, the clinical laboratory physicians study specimen handling analytical methods and interpretation of results. At medical staff meeting, personnel from the Laboratory Information Office provide clarification on the types of consultations offered, address complex questions and find resolutions for rarely encountered and difficult laboratory issues. At these meetings, a summary of new laboratory examinations also is presented. This system of an information office where full-time laboratory physicians and laboratory technicians are stationed is the first such attempt in Japan. It may be considered a pilot project to determine if such a system may be applied to other laboratory departments in the future.

Clinical Laboratory Information Systems↗
PubMed1997

Guidelines for managing domestic abuse when male and female partners are patients of the same physician. The Delphi Panel and the Consulting Group.

OBJECTIVE: To provide clinical guidelines for primary care physicians who are dealing with domestic abuse and who have both the abused woman and her partner as patients. PARTICIPANTS: A 15-member expert panel with members having experience in family practice, gynecology, emergency medicine, medical ethics, nursing, psychology, law, and social work; an 11-member consulting group with members representing medicine, consumers, police, psychology, social work, and nursing; and participants from focus groups including 48 previously abused women and 10 previously abusive men. Members of the expert panel and the consulting group were recruited by the research team. Focus group members were recruited through the agencies from which they were receiving services. EVIDENCE: Available research information, and opinions of the expert panel, the consulting group, and the focus group participants. CONSENSUS PROCESS: Scoring of 144 clinical scenarios was performed by the expert panel using a modified Delphi technique involving 4 iterations. Scenarios were rated in terms of best practice for primary care physicians dealing with suspected and confirmed cases of physical abuse. Consulting group members and focus group participants then commented on the panel's results. Final guidelines were approved by the panel and the consulting group, with comments reserved in the guidelines for information from focus group participants. CONCLUSIONS: It is not a conflict of interest for the physician to deal with abuse of the female partner when both partners are patients. Both patients have a right to autonomy, confidentiality, honesty, and quality care. Patients should be dealt with independently, thereby facilitating assessment of the magnitude and severity of the victim's injuries. Physicians should not discuss the possibility of domestic abuse with the male partner without the prior consent of the abused female partner. Joint counseling is generally inadvisable and should be attempted only when the violence has ended, provided both partners give independent consent and the physician has adequate training and skills to deal with the situation without escalating the violence. If the physician feels unable to deal effectively with either patient because of the dual relationship, referral to another qualified physician is preferred.

Confidentiality↗
PubMed1997

Changes in diagnostic decision-making after a computerized decision support consultation based on perceptions of need and helpfulness: a preliminary report.

We examined the degree to which attending physicians, residents, and medical students' stated desire for a consultation on difficult-to-diagnose patient cases is related to changes in their diagnostic judgments after a computer consultation, and whether, in fact, their perceptions of the usefulness of these consultations are related to these changes. The decision support system (DSS) used in this study was ILIAD (v4.2). Preliminary findings based on 16 subjects' (6 general internists, 4 second-year residents in internal medicine, and 6 fourth-year medical students) workup of 136 patient cases indicated no significant main effects for 1) level of experience, 2) whether or not subjects indicated they would seek a diagnostic consultation before using the DSS, or 3) whether or not they found the DSS consultation in fact to be helpful in arriving at a diagnosis (p > .49 in all instances). Nor were there any significant interactions. Findings were similar using subjects or cases as the unit of analysis. It is possible that what may appear to be counter-intuitive, and perhaps irrational, may not necessarily be so. We are currently examining potential explanatory hypotheses in our ongoing current, larger study.

Attitude to Computers↗
PubMed1997

The nature and extent of training activities in clinical pathology required for effective consultation on laboratory test selection and interpretation.

OBJECTIVE: The goal of this study was to identify the activities in clinical pathology training and the length of time required in each to effectively train residents as consultants on laboratory test selection and interpretation. METHODS: The information needed to address these questions was obtained from a study of 20 residents in clinical pathology at our institution between 1990 and 1996. In the survey participants were asked to assess the value of specific training activities in developing their confidence when addressing consultative questions on laboratory test use and interpretation. Participants were also asked to assess the length of time required to gain confidence in performing this role. RESULTS: The results of the study demonstrate that confidence in providing advice on clinical laboratory test selection and interpretation is acquired to a significant but not absolute degree after an intense 8-week experience in a single clinical laboratory subspecialty, during which time no other responsibilities are assigned. The data also indicate that interactions with clinical pathologists and formal lectures provided to the trainees during their rotations are critical components of the consultation service. There was a significant decrease in the length of time required to provide effective information on test selection and interpretation as the residents progressed through their training. CONCLUSIONS: For all of the major subspecialties in clinical pathology, the residents gained significant confidence by 4 weeks of intense training, and by 8 weeks participants were very confident in answering consultation questions. Even after 8 weeks, however, fewer than 10% of the residents felt absolutely confident in their own decisions regarding laboratory test use and interpretation prior to discussion with senior residents and faculty. Thus, acquisition of expertise to effectively provide advice on laboratory test selection and interpretation required up to 8 weeks of focused training in each clinical laboratory subspecialty. Gaining confidence in multiple areas requires a significant commitment of full-time training. This study provides an understanding of the type and extent of training required to attain the skills necessary to effectively provide consultation in clinical pathology.

Clinical Competence↗
PubMed1998

Consultation skills in radiology: a qualitative study.

OBJECTIVE: Consultation is an important part of radiologic practice. Recently, many concerns have been expressed about the lack of emphasis on consultation skills as part of the training requirements for radiologists. In order to improve the teaching and assessment of trainees, we designed a qualitative study to specify the consultation skills expected from a trainee by the end of residency. METHODS: Three successive focus groups were held with professors of radiology, residents in radiology, and referring physicians. Participants were asked to identify the various competencies required from radiologic consultants (1) spontaneously, (2) by reacting to a previously generated list, and (3) by reacting to common clinical problems encountered in radiology. RESULTS: Consultation skills thus identified were organized in a framework consisting of 2 groups: observable skills and standards of practice. Observable skills were subdivided into 5 "problem-setting" skills and 6 "results-management" skills. Seven qualities and attitudes identified were combined under the rubric "standards of practice." CONCLUSION: The specification of these abilities and competencies through a consensus process should permit the teaching of these skills and their evaluation through objective, structured clinical examinations.

Internship and Residency↗
PubMed1998

[A successful attempt with a consulting service for boys].

As adolescence is a critical period of development, and as boys are less inclined than girls to approach the school facility for adolescent counselling, segregated consulting hours were introduced for boys to attract those with problems. The frequency of consultations by boys increased by 25 per cent, and 70 per cent of the boys reported a preference for the segregated consulting hours; 75 per cent appreciated the absence of girls from the waiting room; and of the 42 per cent with special preferences regarding the gender of the staff encountered, half reported preferring a man. Most of the boys presented with defined problems, though many revealed other problems, often relating to sexuality, in the course of consultation. The availability of segregated consulting hours for boys with adolescent problems is important, and often the only way to reach young boys who need help.

Adolescent↗
PubMedDate not supplied

Ethics and insurance consultants.

Health care professionals who serve as consultants for insurance companies provide an essential service in reducing health care costs and ensuring access to care for increased numbers of people. The role and function of these consultants is not always appreciated or welcomed by providers, who may view them as intruders to the doctor-patient relationship and feel that treatment plans are being second-guessed. Consultants, on the other hand, may be placed in uncomfortable positions when radiographically visible pathological conditions are not addressed on a treatment plan. Overlooking such conditions in hopes of not embarrassing the treating dentist is not an ethical option. When an isolated omission or error is encountered, it is best for consultants to contact the treating dentist and advise him or her of the disparity between planned treatment and observed pathology. Patients, providers, and the profession will benefit through this collegial exchange of information. When consultants observe continual omissions or errors, the stakes are much greater and the public's health must be protected through implementation of the peer-review system.

Consultants↗
PubMed1998

[Value of multidisciplinary consultation in diagnosis and survival of Marfan syndrome].

OBJECTIVES: To facilitate diagnosis, define a strategy for prevention and treatment and obtain further insight concerning Marfan's disease, we conducted a series of multidisciplinary consultations in French clinics. PATIENTS AND METHODS: Five specialists (a genetics specialist, a pediatrician or a rheumatologist, an ophthalmologist, and a psychologist) saw all the patients successively in the same clinic. A synthesis of the clinical files was prepared for analysis. Since the first consultation on 1 January 1995 and the study end on 30 June 1997, 494 patients (67% adults) participated in primary consultations, 143 were seen at follow-up consultations. RESULTS: The diagnosis of Marfan's disease was affirmed in 41% of the patients, disaffirmed in 48% and uncertain in 11%. Among the Marfan's patients, 75% were seen again within the framework of a multidisciplinary follow-up consultations. Annual work-up included cardiology (echocardiography with measurement of the proximal aorta diameter in search for indication for beta-blocker therapy or preventive valve replacement), ophthalmology (lens, retina) and rheumatology examinations (skeletal involvement). CONCLUSION: Early diagnosis and rigorous follow-up can help prevent ocular and cardiac complications in Marfan's disease. The multidisciplinary approach provides more precise data for diagnosis and possible phenotype-genotype correlations.

Adult↗
PubMed1996

The Health Care Ethics Consultant, edited by Françoise Baylis.

The Health Care Ethics Consultant marks a stage in the development of ethics consultancy. Ethics consultancy is a manifestation of a newly secularized society in which a new discipline has developed to fill a gap created by the combination of the diminishing influence of traditional moral authorities and the growth of new problems associated with the development of new technology and changes in society and culture. The stated primary objective of the book is to focus attention on an immediate practical problem: the role and responsibilities, the education and training, and the certification and accreditation of health ethics consultants. An edited collection of articles, the book originated as a research project financed by the Social Sciences and Humanities Research Council of Canada, undertaken by a Strategic Research Network which included faculty members from Dalhousie University, McGill University, the University of Toronto, McMaster University and the University of Calgary.

Canada↗
PubMed2006

A model of teaching-learning transactions in generalist-specialist consultations.

INTRODUCTION: A new paradigm in continuing medical education is characterized by emphasis on physicians' learning in practice. Consistent with this paradigm, our study examined a subset of clinical practice--generalist-specialist consultations--from an educational perspective. METHODS: We applied the grounded-theory method with semistructured interviews. Ten primary care physicians and 9 internal medicine subspecialists were interviewed regarding their approaches to learning and teaching during generalist-specialist consultations. RESULTS: Based on 48 formal and informal consultations reported by physicians, we developed a theory of teaching-learning transactions in generalist-specialist consultations. DISCUSSION: As a teaching-learning transaction, the mutual learning process in generalist-specialist consultations involves 3 components: needs assessment, dialogue, and sufficiency. Providers of continuing medical education may use the proposed theoretical framework to help clinicians and health care organizations analyze and enhance educationally valuable interactions at the interface of primary and secondary care.

Education, Medical, Continuing↗
PubMed1997

General principles in child liaison consultation service: a literature review.

Consultation-liaison psychiatry emerged in the late thirties as a bridge between body and mind splitting of medical care. Setting-up of consultation-liaison services in general hospitals began some years later and is still developing in many countries. Paediatric consultation-liaison services share some general characteristics with those for adults, but others are more specific. Different models of child consultation-liaison services have been described, such as their organization in relation to the specific characteristics of the ward (surgical, intensive care units, etc.) and to the resources provided. This paper describes the general basis of the organization of a child consultation-liaison service. The specific characteristics needed for working with children are emphasized.

Adolescent↗
PubMed2006

Perception of nocturia and medical consulting behavior among community-dwelling women.

We investigated the perception of nocturia and possible explanatory factors for medical consultation among community-dwelling women. Between October 2004 and February 2005, women aged > or =40 years living in Matsu, Taiwan, who were identified as having nocturia in a previous epidemiological survey, were interviewed with a questionnaire eliciting information about nocturia-specific quality of life impact (N-QOL), perceptions of nocturia, and medical-consultation behavior. A total of 328 women completed this study. Of these, 187 (57%), 99 (30.2%), 30 (9.1%), and 12 (3.7%) reported one, two, three, and four or more nocturia episodes, respectively, per night during the past 4 weeks. Most women attributed nocturia to aging or excessive fluid intake and had a lack of medical information. Overall, only 13.1% had visited a doctor for this condition. Nocturia episodes [> or = three vs <three, odds ratio (OR) 3.8], N-QOL score (OR 2.0, per 10-point decrement), linking nocturia to a disease (OR 2.9), and medical information (OR 2.2) were independent factors associated with medical-consultation, whereas the lack of knowledge that nocturia was treatable appeared to be an important barrier to medical-consultation. Only 62.8% of the women were offered treatment upon consultation, even though nearly half of those treated reported significant improvement. A few women with nocturia have sought medical help, which appears to be affected by a compendium of factors. This study suggests that more information about nocturia should be provided to health providers and patients to identify and meet their most essential needs.

Adult↗
PubMed2006

A survey of consultant practice: intravenous salbutamol or aminophylline for acute severe childhood asthma and awareness of potential hypokalaemia.

British Thoracic Society guidelines recommend intravenous salbutamol or aminophylline for acute severe asthma in children. In the survey reported here, 133 consultant paediatricians completed a questionnaire aimed at evaluating their choice of intravenous bronchodilator for acute severe asthma and their awareness of subsequent hypokalaemia. Of the non-Paediatric Intensive Care Unit (PICU) consultants who responded, 82%, including respiratory paediatricians, reported using aminophylline; in contrast, PICU consultants were significantly more likely to use salbutamol (p=<0.001). There was a lack of awareness that hypokalaemia occurs with aminophylline: 50% of the consultants suggested that hypokalaemia was rare or did not occur. Consultants using intravenous aminophylline were significantly less likely to recheck serum potassium levels than those using intravenous salbutamol (p=0.03). Based on the completed questionnaires, salbutamol infusions are rarely used outside the PICU, and the awareness of potential hypokalaemia following intravenous bronchodilator treatment is variable. It would appear, therefore, that standardised clinical practice is required in order to recognise and treat potential hypokalaemia.

Albuterol↗
PubMed1992

Symptoms of irritable bowel syndrome in a British urban community: consulters and nonconsulters.

Because the prevalence of the irritable bowel syndrome (IBS) in the general population is unknown, a questionnaire of intestinal symptoms was administered to a stratified random sample of 1058 women and 838 men. Subjects were asked if they had consulted a physician about such symptoms. One or more symptoms occurred frequently in 47% of women and 27% of men. Diagnosable IBS, defined as three or more symptoms, was present in 13% of women and 5% of men. Abdominal pain was the most common symptom, and recurrent intestinal pain was reported by 20% of women and 10% of men. All symptoms were more common in women except runny or watery stools. Most symptoms including pain were unrelated to age. Only half the people with diagnosable IBS had consulted a physician about it. The likelihood of consulting a physician was directly proportional to the number of symptoms and was similar in men and women after controlling for the number of symptoms. Of individual symptoms, the one most strongly associated with consulting was abdominal pain, especially in men. It is concluded that IBS is prevalent at all ages, especially in women, that it is nearly always painful, and that people with multiple symptoms are more likely to consult a physician.

Adult↗
PubMed1995

The influence of audiotapes on patient participation in the cancer consultation.

This study examined the effect of providing patients with an audiotape of a previous consultation on their level of participation during a subsequent consultation. 117 newly referred medical oncology patients randomised to receive a tape (n = 63) or not (n = 54) had two linked consultations which were both audiotaped. A content analysis revealed no significant differences between tape and control group in the mean number of questions asked during the second consultation. However, significantly more tape group patients (77%) asked for clarification of at least one piece of information compared to the control group (57%) (P = 0.04). A larger number of control group patients (61%) made at least one request for facts already provided in their first consultation compared to tape group patients (39%) (P = 0.05). Audiotapes appear to facilitate patients' requests for the clarification of previously given information and permit the re-absorption of complex information given when patients may have been too distressed for it to be assimilated.

Adult↗
PubMed2005

Perceptions and practice of concordance in nurses' prescribing consultations: findings from a national questionnaire survey and case studies of practice in England.

BACKGROUND: The number of nurses able to independently prescribe medicines in England is increasing. Patient adherence to prescribed medicines remains a significant problem [Department of Health, 2000. Pharmacy in the Future: Implementing the NHS Plan. A Programme for Pharmacy in the NHS. Stationary Office, London]. Concordance-a partnership approach to medicine consultations-is advocated as an effective solution [Medicines Partnership, 2003. Project Evaluation Toolkit. Medicines Partnership, London]. OBJECTIVES: To investigate whether nurses were practising the principles of concordance within their prescribing interactions. DESIGN: Phase (i) postal questionnaire survey. Phase (ii): case studies of practice. SETTINGS: Phase (i) primary and secondary care trusts throughout England in which nurse prescribers were practicing. Phase (ii) six general practice settings; one community midwifery service; one specialist community palliative care service; one secondary care ophthalmology unit; one NHS walk-in centre. PARTICIPANTS: Phase (i) a random sample of 246 nurses registered as independent nurse prescribers with the Nursing and Midwifery Council in 2002/2003. Phase (ii) purposively selected sample of 14 nurse prescribers who participated in Phase (i) of the study; a total of 208 purposively selected patients completed self-administered questionnaires. METHODS: Phase (i) postal questionnaires. Phase (ii) structured non-participant observation of 118 nurse prescribing consultations; 115 post-consultation patient questionnaires; 93-patient postal questionnaires. RESULTS: 99% of the nurses in the national survey stated they were practising the principles of concordance. The majority of patients surveyed also reported experiencing concordance in practice. Observation of practice revealed that although some principles of concordance were regularly integrated into nurses' practice, other principles were less often in evidence. Some evidence from both observation of practice and patient questionnaires suggested that a professionally determined 'compliance' agenda may still be partially operating in practice. CONCLUSIONS: Most nurses believe they are practicing concordance in their prescribing consultations. The majority of patients also reported that they had experienced some of the principles of concordance in practice. Observation of practice highlighted that the shift from a professionally determined compliance agenda to the integration of concordance into nurses' prescribing consultations had not yet taken place.

Attitude of Health Personnel↗