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At least 1,423 records · Page 79Linked to original sources
PubMed2002

How physicians experience patient consultations at an orthopaedic out-patient clinic: a qualitative study.

The aim of this study is to describe physicians' experiences in their encounters with patients by allowing the physicians to observe and comment on their own video-recorded medical consultations. Eighteen orthopaedic surgeons took part in the study; they were informed that we were interested in studying what actually takes place during a consultation, the quality of communication between doctor and patient, and how the physicians themselves experience the consultation. Each time the physician wished to make a comment, the video film was stopped and the comments were taped on audiocassette. The results showed that when the physicians watched the video-recorded consultations they commented spontaneously on issues regarding, among others: (1) how they try to adapt their communication to the patient's situation; (2) the need to explain things to the patient; (3) perceptions of working under unfavourable conditions; (4) difficulties in helping certain patients.

Adult↗
PubMed2003

Physician communication in different phases of a consultation at an oncology outpatient clinic related to patient satisfaction.

The aim of this study was to identify the relationship between content during the different phases of the consultation and overall patient satisfaction with regular follow-up consultations at a cancer outpatient clinic. Thirty-six consultations were analysed with Roter Interaction Analysis System (RIAS). In the statistical analysis, timed events of the RIAS categories were used. The regular follow-up consultations were rather short aiming at discussing medical and therapeutic aspects of the illness. There was a positive correlation between physician informal talk (IT) and patient satisfaction in the history-taking phase. Patients were found to be dissatisfied if the physician had focused on a great deal of psychosocial exchange (PE) during physical examination. Our study suggests that the physician should not initiate discussion of psychosocial topics during physical exam. This result should be studied further in other samples and designs.

Adult↗
PubMed2004

A qualitative study of patient's views on the consultation at the Glasgow Homoeopathic Hospital, an NHS integrative complementary and orthodox medical care unit.

We investigated consultations at the Glasgow Homoeopathic Hospital (GHH), by the use of in-depth, semi-structured interviews with a purposive sample of 14 patients. Interviews (lasting 1-2 h) were taped and transcribed verbatim. Analysis was based on a grounded theory approach. Two main categories of themes emerged: (1) those "outside" the consultation, related to expectations, initially formed from experiences of family and friends, but then strengthened by ongoing attendance at GHH; and (2) themes "inside" the consultation including length of consultations, the whole-person approach, being treated as an individual, and telling and having their "story" listened to in depth. Equality of relationship, mutual respect, and sharing decisions were also prominent themes. In conclusion, patients attending the GHH highly value the holistic approach, and view time, empathy, and the therapeutic relationship as being of key importance.

Adult↗
PubMed2000

Demographic, symptom, and medication profiles of cancer patients seen by a palliative care consult team in a tertiary referral hospital.

In this retrospective study, the charts of 100 consecutive cancer patients who had been referred to a palliative care consult team within a tertiary acute care hospital were reviewed. Demographic characteristics, including reason for admission and disease status upon admission, length of stay, and discharge and admission location, were recorded. Symptom acuity, cognitive status, and risk for substance abuse were evaluated. Medications before and after the consult were tabulated and compared to recommended medications; compliance with the recommendations was assessed. Five patients were not palliative at the time of the consult. Only 46/95 (48%) were known to have untreatable cancer at the time of their admission. The CAGE questionnaire for alcoholism and the Mini-Mental State Questionnaire (MMSQ) were abnormal in 19/78 (24%) and 40/91 (44%), respectively. The most intense symptoms, as measured by the 100-mm scales of the Edmonton Symptom Assessment Scale (ESAS) were fatigue (72 +/- 24), appetite (60 +/- 32), and well-being (50 +/- 29). Eighty-nine of the 95 patients were living at home prior to admission and 34/95 were able to return home. Twenty died during hospitalization, 23 were transferred to a palliative care unit, and the remaining 18 were discharged to another hospital or long-term care. The patient's physician complied with the palliative care consult team's recommendation in 122/137 cases (89%).

Adult↗
PubMed2004

Emergency department mental health triage consultancy service: an evaluation of the first year of the service.

This article presents the findings of a review of the first year of a night emergency department (ED) mental health triage and consultancy service. During the first 12 months of operation of the service, data on key performance indicators were entered into an emergency mental health triage and consultancy database. Data were also obtained from pre- and post-satisfaction surveys completed by ED staff and from self-appraisal statements generated by the five mental health nurses who undertook the position during the review period. The findings show the ED mental health triage and consultancy service positively impacted on the functioning of the emergency department. This was evidenced by staff' perceptions regarding the value of the service and through shorter "seen by times", a reduction in the number of patients with psychiatric/psychosocial problems who left the department without being seen, and the effective management of patients presenting with psychiatric/psychosocial problems, particularly those presenting with deliberate self-harm. The review provided evidence regarding the value of the emergency mental health triage and consultancy service and highlighted the advanced practice role undertaken by mental health nurses in this position.

Adolescent↗
PubMed1996

Internal medicine consultation via the information superhighway.

On-line computer consultation provides an excellent medium by which specialists and general practitioners can communicate to share information. Networks of veterinarians are available on the internet as well as through several on-line service companies. Some of the advantages of on-line consultation include access to the collective wisdom of thousands of veterinarians, better communication through discontinuous interchange on a flexible schedule, rapid response time to requests for information, and better client service through continuing education and improved patient care. Disadvantages include the cost of computer equipment and on-line charges, user computer phobia, and drawbacks common to all types of long distance consultation such as the inability of consultants to physically examine the patient. Overall, the advantages far outweight the disadvantages. On-line veterinary information exchange will continue to expand and will play an even more important role in knowledge transfer in the 21st century.

Humans↗
PubMed1990

Mental health and medical consultation in primary care settings.

This paper examines the effect of psychiatric morbidity, as measured by the GHQ-60, on the probability of being in contact with a primary care physician, and the socio-demographic factors which influenced this effect. We found that the presence of psychiatric morbidity emerged as a major determinant of primary care utilization in both sexes, and about one-sixth of consultations in men and one-fifth of consultations in women could be attributed to it. Logistic modelling was used to investigate the joint effect on general practitioner consultation of psychiatric morbidity and seven socio-demographic variables. Sex, age, and psychiatric morbidity exerted independent, but not interactive, effects on consultation.

Adolescent↗
PubMed2002

Consultants' opinion on a new practice-based assessment programme for first-year residents in anaesthesiology.

BACKGROUND: Assessment in postgraduate education is moving towards using a broad spectrum of practice-based assessment methods. This approach was recently introduced in first-year residency in anaesthesiology in Denmark. The new assessment programme covers: clinical skills, communication skills, organizational skills and collaborative skills, scholarly proficiencies and professionalism. Eighteen out of a total of 21 assessment instruments were used for pass/fail decisions. The aim of this study was to survey consultants' opinions of the programme in terms of the representativeness of competencies tested, the suitability of the programme as a basis for pass/fail decisions and the relevance and sufficiency of the content of the different assessment instruments. METHODS: A description of the assessment programme and a questionnaire were sent to all consultants of anaesthesiology in Denmark. The questionnaire consisted of items, to be answered on a five-point scale, asking the consultants' opinions about representativeness, suitability and content of the programme. RESULTS: The response rate was 251/382 (66%). More than 75% of the respondents agreed that the assessment programme offered adequate coverage of the competencies of a first-year resident and was appropriate for making pass/fail decisions. There was strong agreement that the content of the 18 tests used for pass/fail decisions was relevant and sufficient for pass/fail decisions. CONCLUSION: Judging from the consultants' opinions, the assessment programme for first-year residency in anaesthesiology appears to be appropriate regarding the range of competencies assessed, the appropriateness as a basis for pass/fail decisions, and regarding the content of the tests used for pass/fail decisions. Further studies are needed to assess the feasibility and acceptability of the programme in practice.

Anesthesiology↗
PubMed2006

Patients' understanding of disease status and treatment plan at initial hematopoietic stem cell transplantation consultation.

Patients referred for hematopoietic stem cell transplantation (HSCT) often have knowledge deficits about their disease and overestimate their prognosis making it difficult initially to discuss potentially life-threatening transplant options. To determine patients' understanding of their disease and the adequacy of a 3-h consultation at our center, we developed a survey that measured perceived knowledge deficits of disease, prognosis, and emotional status before and after their initial consultation. Ninety nine consecutive eligible patients completed the survey. Although 76.7% claimed adequate information about their disease pre-HCST visit, 51.5 and 41.4% respectively lacked knowledge about their 1-year prognosis with and without any therapy. After the visit, 66.7% of the patients had obtained enough information to make an informed decision regarding HSCT versus 23.2% pre-visit, and a significant reduction in the need for further information was reported by 53.5% of patients (P<0.001). Patients were not overwhelmed or confused by the visit and there was a small but significant decrease in negative affect. Measures to increase patients understanding of their disease and its prognosis pre-HSCT consultation visit are warranted; however, a 3-h consultation visit provides the majority of patients with sufficient information to make an informed decision about the risk/benefit ratio of HSCT.

Data Collection↗
PubMed2000

Promoting effective teaching and learning: hospital consultants identify their needs.

OBJECTIVES: The aim of this study was to help hospital consultants identify their needs in relation to teaching skills, leading to the development of a teacher training programme. DESIGN: The study was directed at all 869 consultants in the region and initially involved a postal questionnaire which had a 60.5% response rate. SETTING: Hospitals throughout Northern Ireland. SUBJECTS: Hospital consultants. RESULTS: Results from this questionnaire indicated that while the majority of respondents were interested teachers, only 34% had received any teacher training. The questionnaire was followed by a focus group study involving three groups of consultants drawn randomly from those who had responded to the questionnaire. Participants in these groups identified the following key areas of hospital education: qualities of hospital teachers; selection procedures; problems of teaching in hospitals; the need for teacher training and how it should be provided. CONCLUSION: The study highlighted that hospital teachers need to acquire and update their teaching skills through attending courses that should include basic teaching and assessment/appraisal skills. These courses should last 1 or 2 days and be provided at a regional or subregional level. As a result of this study, teacher training courses have been developed in this region.

Consultants↗
PubMed1997

The proportion of medical consultations motivated by skin diseases in the health centers of Bamako (Republic of Mali).

BACKGROUND: Skin diseases have recently been identified as a public health problem in developing countries. However, most studies on skin diseases in developing countries, have been conducted in specialized dermatologic centers. Data on the proportion of consultations motivated by skin diseases in nonspecialized health centers in developing countries are scarce. In order to appreciate the request for dermatologic care of the population of a developing African country, we attempted to measure this proportion in health centers of Bamako, the capital of Mali. METHODS: Eight out-patient health centers were randomly selected in Bamako, and the medical registers for the first 6 months of 1993 were consulted. RESULTS: Out of a total of 14,058 consultations given, 1639 (11.7%) were motivated by skin diseases. The main diagnoses registered were pyoderma (42.2% of all the dermatologic diagnoses), eczema (15.5%), scabies (8.5%), and fungal infections (7.9%). CONCLUSIONS: The high proportion of ambulatory consultations in health centers in Bamako motivated by skin diseases suggests that they are an important health problem for the population of this city. Public health policies should be implemented in order to manage this problem.

Ambulatory Care Facilities↗
PubMed2001

Giving tape recordings or written summaries of consultations to people with cancer: a systematic review.

OBJECTIVE: To examine the effects of providing recordings or summaries of consultations to people with cancer and their families. DESIGN: Systematic review. DATA SOURCES: MEDLINE, CINAHL, Cancerlit, EMBASE and other electronic bibliographic databases. Bibliographies of relevant papers. SELECTION CRITERIA: Randomized and non-randomized controlled trials of the provision of taped recordings or written summaries of consultations to people with cancer and/or their families. MAIN RESULTS: Eight randomized controlled trials were found, all involving adult participants. No non-randomized controlled trials were found. The quality of the studies was generally poor. Between 83% and 96% of people who received recordings or summaries found them useful to remind them of what was said and/or to inform family members and friends about their illness and treatment. Of seven studies that assessed recall of information given during the consultation, four reported better recall among the groups that received recordings or summaries than among control groups. Receiving a recording or summary had no significant effect on anxiety or depression between the groups. None of the included studies assessed survival or health outcomes other than psychological outcomes. CONCLUSIONS: Wider use of consultation tapes and summary letters could benefit many adults with cancer, without causing additional anxiety or depression, but consideration should be given to individuals' circumstances and preferences.

Humans↗
PubMed1998

Positive influence of a liaison program on the rate of psychiatric consultation referrals for cancer patients.

To improve access to psychiatric consultation for cancer patients as well as non-cancer patients with psychiatric disorders, a psychiatric liaison programme to communicate closely with physicians and ward staff regarding anticipated psychiatric morbidity in patients, was introduced in each ward of a general hospital. The rate of psychiatric consultation referrals for cancer patients was significantly higher after the psychiatric liaison programme was established. The programme had a greater impact on the rate of psychiatric consultation in a unit with cancer patients who were informed of their diagnoses. The greater consultation rates in cancer patients after the liaison programme might be, in part, associated with the physicians' attitude toward the more open disclosure of the cancer diagnosis.

Aged↗
PubMedDate not supplied

Automatic special case consultations in transfusion medicine.

In the past, consultations in immunohematology were usually delivered only when there was a blood or component shortage, or when the time required for compatibility testing was prolonged due to the presence of a difficult recipient antibody problem. More recently, transfusion medicine physicians have increased their role as clinical consultants concerned about the appropriate indications for blood transfusion. This communication presents a way to begin a sound program of clinical transfusion medicine consultation. The program can fit with community-wide teaching efforts, community or hospital transfusion audits, and specific physician education programs. Automatic or unsolicited consultations appear to have been both accepted well and beneficial in large hospitals and in communities where they have been provided for more than 7 years.

Antibodies, Viral↗
PubMed1986

Psychiatric consultation in somatization disorder. A randomized controlled study.

The per capita expenditure for health care of patients with multiple physical symptoms but no apparent physical disease (somatization disorder) is up to nine times the average per capita amount. We conducted a randomized controlled trial to determine whether psychiatric consultation would reduce the medical costs of these patients, without effecting a substantial change in patient outcome. Thirty-eight patients were randomly assigned to treatment or control groups and studied prospectively for 18 months. Treatment consisted of a psychiatric consultation and suggestions on management given to primary physicians. After nine months, the control group was crossed over to receive treatment with the same intervention. After the psychiatric consultation, the quarterly health care charges in the treatment group declined by 53 percent (P less than 0.05). In contrast, the charges in the control group showed wide variations but no overall change. The quarterly charges in the control group were significantly higher than those in the treatment group (P less than 0.05). After the control group was crossed over to receive treatment, their quarterly charges declined by 49 percent (P less than 0.05). The reductions in expenditures in both groups were due largely to decreases in hospitalization. We conclude that psychiatric consultation in the care of patients with somatization disorder reduced subsequent health care expenditures without inducing changes in health status or patients' satisfaction with their health care.

Adult↗
PubMed2004

Consultation with non-English speaking communities: rapid bilingual appraisal.

Government services, including health departments, are insisting that consumers or users of health services be consulted. Linguistic diversity in communities can pose challenges to planners and policymakers in this communication and consultation agenda. This article presents rapid bilingual appraisal as a useful technique for health services to meet the requirements set by equity and access guidelines and legislation. This method was used in an area health service as part of an independent feasibility study. Health services should recognise the need for such consultation and allocate appropriate resources and time to conduct such consultations, and for skilled bilingual facilitators and qualified interpreters to be employed and developed as part of the team.

Communication Barriers↗
PubMed1995

The case for not interpreting unconscious mental life in consulting to organizations.

DESPITE differing theoretical orientations in psychoanalysis, there is general agreement that its distinctive feature among all therapies is its attempt to bring to consciousness mental conflict that is unconscious. Does this distinctive feature of psychoanalysis apply in organizational consultation? I argue that unlike clinical psychoanalysis, more harm than good occurs when consultants attempt to interpret unconscious material to clients in organizations. The main use of psychoanalytic psychology in consulting work is for observation and understanding on the part of the consultant, who as an advisor presents recommendations aimed at enhancing rationality.

Consultants↗
PubMedDate not supplied

Treating erectile dysfunction through electronic consultation: a pilot study.

We investigated a group of men suffering from electric dysfunction (ED) who visited the website www.erectie.info and who had received consultation through the Internet (n = 219). We measured the treatment's effectiveness using the 5-item version of the International Index of Erectile Function (IIEF-5; Rosen et al., 1996; Rosen, Cappelleri, Smith, Lipsky, & Pena, 1999) and a global assessment question (GAQ). We investigated the motives and characteristics of the users of electronics consultation using a questionnaire. After a few months, the consultation group showed a considerably higher IIEF-5 score compared with their baseline score. Eighty-one percent replied in the affirmative to the GAQ. E-consultation is likely to be effective when treating ED, especially among men who find the medium convenient and for men who experience much embarrassment.

Adult↗