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PubMedDate not supplied

Consultant post prospects in medical specialties.

Consultant post prospects for Specialist Registrars (SpRs) in all the medical specialties have been analysed using the databases of the Royal College of Physicians and the Joint Committee on Higher Medical Training (JCHMT). A 'bulge' in the numbers of SpRs obtaining Certificates of Completion of Specialist Training (CCSTs) is anticipated over the next 2-3 years, but this effect will be alleviated by the increasing trend to spend extra years in research or flexible training. There are profound differences between the specialties in the ratios of SpRs holding National Training Numbers (NTNs) to consultants, and in the proportions of female SpRs, and these factors will markedly influence consultant post prospects. The outlook within most specialties is favourable, but this is critically dependent on the rate of consultant expansion over the next few years.

Female↗
PubMed2000

[Consultation course in medical education--students' evaluation].

BACKGROUND: Final-year medical students at the University of Bergen take a 16-hour consultation course. The students are trained in an educational setting focusing on structured elements of the patient-centred consultation method, self evaluation and peer evaluation. The course has a strong emphasis on learning by doing. The objective of this study was to evaluate the learning process and the subjective outcome of the course. We used a focus group technique and a self-administered free text based questionnaire. MATERIAL AND METHODS: Transcriptions from the focus groups and free text from the questionnaires were analysed using qualitative methods. RESULTS: The qualitative analysis revealed three main categories of statements about the learning process: about the process of selfchange in the consultations; about the pain of self evaluation; and about insufficiency faced with clinical uncertainty. INTERPRETATION: We conclude that the course seems to initiate changes in consultation strategies. The students' evaluation also underline the need to take care of the students during a process of change in which they are vulnerable.

Communication↗
PubMedDate not supplied

Concurrent consultations with physicians and providers of alternative care: results from a population-based study.

OBJECTIVE: We examined the factors related to consultations with both physicians and alternative practitioners, compared with visits to physicians only. METHODS: A telephone survey (random-digit dialling) collected information from 818 adults living in and around Saskatoon. Respondents reported consultations with alternative practitioners and physicians in the previous 12 months. RESULTS: Approximately one in five respondents had consulted both a physician and an alternative practitioner. Among respondents under 65 years of age, having one or more chronic medical conditions significantly increased the likelihood of concurrent use of care. Men, individuals suffering from back pain or migraines, those reporting an elevation level of distress, and those for whom spiritual values were important were also more likely to use both types of care. INTERPRETATION: Consultations with alternative care providers occur as an adjunct to, rather than a replacement of visits to physicians. Particular types of medical conditions as well as psychosocial and spiritual factors are determinants of concurrent use of physicians and alternative practitioners.

Adult↗
PubMed2001

Training programs in school consultation.

The need to train psychiatrists in school consultation is important to approach mental health and psychosocial concerns from the broad perspective of addressing barriers to learning and promoting healthy development. There is a major national impetus to improve academic achievement and literacy, which can be amplified by addressing the social, emotional, and mental health needs of children and youth. Training in school consultation allows the psychiatrist to better understand a critical institution in each child's life and also provides technical assistance and training to school personnel, which facilitates networking between programs and individuals involved in or interested in school mental health. Each of the described programs approaches consultation from a specific focus that varies in time commitment, placement options, and frequency and order of didactic presentations. There is no conclusive available evidence as to which program is most effective, since such evaluation depends on the overall goals of the consultation program itself.

Adolescent↗
PubMed2001

[Consultation (second opinion on biopsies) as an instrument of quality control in histopathologic diagnosis].

As the whole spectrum of morphological patterns encountered in surgical pathology cannot be, in its entirety, diagnosed correctly by a general pathologist alone, one has to seek consultation for difficult or unusual cases with specialised experts. In the Czech Republic, the consultation practice performed by specialists from different medical institutions is the only way to assess the quality of histopathological diagnostic performance, i.e. it represents an audit system. Audit systems functioning in other countries are described here. A proposal of a standard consultation process as well as problems concerning the financial costs and increased workload of consultants are discussed.

Biopsy↗
PubMed1992

Clinical ethics consultations: reasons for optimism, but problems exist.

[The author identifies] five problems familiar to clinical ethicists. (1) Physicians often do not recognize important ethical issues. (2) Debate exists over whether such consultations should give specific management recommendations. (3) Principles of medical ethics cannot, by themselves, resolve real ethical issues. (4) The patient's interests sometimes conflict with the interests of the family, the health professionals, and the hospital. (5) Clinical ethics consultations take a toll on the consultant....[He] discuss[es] the implications of each problem for clinical ethics consultations and offer[s] a solution to it.

Aged↗
PubMed1993

Ethics consultation: a dangerous, antidemocratic charlatanry?

Giles Scofield's argument indicates ethics consultants may need to better clarify what in fact they are and what they are not doing, claiming, and striving for. But we must not step back too far. We must neither engage in putting in envious professional claims for exclusive rights in the area of difficult and momentous decisions in healthcare nor get stuck in discussing normative ethics at the level of metaphysics, ontology, and dogmatics (as has happened in Germany for decades). We must not do so especially in view of the achievements of ethics consultation and the growing demand for it by all parties involved, conceded even by sceptics. Ethics consultation, according to Scofield, appears to be dangerous....Let us look more closely at the logic of the argument by discussing the presumed "antidemocratic" nature. The "new tyranny" of thoughts, and the "proper" role of bioethics consultation. Some considerations about the possibility of ethics expertise shall be left for the end.

Decision Making↗
PubMed1993

Why clinical ethics consultants might not want to be educators.

... Perhaps we should make explicit that clinical ethics consultants' work is to encourage and to assist others to think about the nature of their profession and reflect on their own behaviors, rather than to change behavior directly. Clinical ethics consultants' work is thus made more difficult, but it should be difficult. They should be continually challenged in their work (as teaching in that setting will do) because it will keep them from succumbing to their titles, from believing that they do know what is best, that they are ethics experts. Furthermore, clinical ethics consultants should be doing something very different from what other people in the healthcare environment are doing; they should acknowledge themselves as outsiders and should cherish that status because only then will they be able to ask the difficult questions that psychological proximity to and practical involvement in healthcare obscure. True education, of course, is the most dangerous activity, but the danger posed by such education is considerably more appealing than the danger posed by clinical ethics consultants who pursue and exert power in healthcare under cover of implicit claims and false beliefs about their expertise.

Bioethics↗
PubMed1993

A paradigm shift for ethics committees and case consultation: a modest proposal.

In conclusion, the expert-consultation model of ethics consultation is deeply imbedded in modern health care. The paradigm of consultant as expert rather than as community-enabler shapes the expectations and behaviors of healthcare personnel and institutions. This paradigm has also shaped the early stages of HEC development and ethics case consultation. It is time to shift paradigms and adopt one that derives more from the nature of ethics than from the nature of scientific medicine: the role of HECs should be to enable key professionals to carry out the ethical dimensions of patient care. When the HEC does review cases, it should be with the purpose of improving the institution, not of resolving individual cases. One consequence of this is that there will be more individual case reviews than before, but the function, emphasis, agents and locations will shift substantially. A second consequence is that the HEC will function more as an agent of social change by helping to harness the institution's resources. We judge both of these to be a welcome evolution in healthcare ethics.

Ethical Review↗
PubMed2001

Patients' attitudes towards the presence of medical students in family practice consultations.

BACKGROUND: Patients' consent to being part of medical education is often taken for granted, both in primary and secondary care. Formal consent procedures are not used routinely during teaching and patients are not always aware of teaching activities. OBJECTIVE: To investigate patients' attitudes and expectations on issues of consent regarding participation in teaching in general practice, and the influence of a student's presence on the consultation. METHODS: The study took place in 46 teaching practices during the sixth year clinical internship in family medicine. Patients completed questionnaires at the end of 10 consecutive eligible consultations. The questionnaire contained data on the willingness to participate in teaching, the preferred consent procedure and the effects of the student's presence. The doctors were asked to estimate the sociodemographic level in their clinic area. RESULTS: A total of 375 questionnaires were returned; the response rate was not affected by the clinic's sociodemographic level. Overall, 67% of the patients had come into contact with students in the past; 3.2% of the participants objected to the presence of a student during the consultation; 15% would insist on advance notification of the presence of a student, and another 13.9% would request it; 4% stated that the presence of students had a detrimental influence on the physical examination and history; and 33.6% would refuse to be examined by a student without the doctor's presence. CONCLUSION: Most patients agreed to have a student present during the consultation; some would like prior notification; a minority refused the student's presence. A large minority would refuse to be examined without the tutor's presence. Our findings need to be taken into account when planning clinical clerkships.

Attitude to Health↗
PubMedDate not supplied

Organisational culture and consultant nurse outcomes: Part 1. Organisational culture.

AIMS: The aim of this three-year study was to operationalize the role of a consultant nurse and, in so doing, facilitate the development of nurses and nursing for the purpose of providing better patient services. METHODOLOGY: Action research was used because it focuses on developing practitioners, developing practice and contributing to understanding both the phenomena being studied and the processes being used. RESULTS: The role of leadership is recognised as key to bringing about cultural change, as is the use of approaches that clarify values and highlight the contradiction between espoused culture and culture in practice. CONCLUSION: The resulting culture had a positive impact on the unit in which the consultant nurse was based, on practitioners and their practice, and also on the trust. A number of factors, including transformational leadership, other facilitative processes, expertise in the practice of nursing, and other subroles of the consultant nurse were shown to be influential. This article explores the concept of organisational culture, and a second article to be published next week, discusses the consultant nurse outcomes.

Attitude of Health Personnel↗
PubMedDate not supplied

[Survey of five years psychiatric consultations in a university general hospital].

A survey of 5 year period activity (1995-99) of a university consultation-liaison service is reported, concerning 1556 psychiatric consultations. The majority of referrals (68%) came from internal medicine units; the reason of referral was prevalently due (approx. 50%) to the presence of psychiatric symptoms; moreover, the majority of patients (approx. 51%) for which the consultation has been requested were already under psychiatric treatment and 32% of them took psychoactive drugs. In 75% of cases a psychiatric diagnosis according to ICD-10 was formulated after consultation: "Affective syndromes" were diagnosed in 25% of cases and "Neurotic, somatoformand stress-related syndromes" in 36.6% of cases. Approx. 60% of patients were prescribed psychoactive drugs; 50% received psychological support.

Adolescent↗
PubMed2002

Regulation, consultation and divergent community views: the case of access to ART by lesbian and single women.

In the many countries which have some form of regulation of ART, a public consultation of some sort is a frequent feature of either the process leading up to regulation or of the regulatory mechanism itself. Not surprisingly, widely divergent views on the moral and political acceptability of ART are expressed during such consultations. And while such diversity of opinion is to be expected, and some even argue welcomed, in pluralist liberal democratic societies, it is often unclear how these divergent community views are and ought to be fed into the opinion-forming and decision-making processes of governments or the bodies that advise them. This article discusses first why regulation of ART may be justified, even when there is radical moral disagreement in the community, and why public consultations should play a central role in the work that advisory bodies undertake in making regulatory recommendations to government. Then, it both proposes and justifies a method for dealing with the contradictory moral views expressed by interested parties during the consultation process. To illustrate this method, the example of the attempt by single and lesbian women to access donor insemination services and ART is used.

Attitude to Health↗
PubMed2002

Intraoperative consultation in gynecologic pathology.

Intraoperative consultation is widely used in gynecologic surgical practice to make intraoperative diagnosis, primarily to aid the surgeon to plan the extent of surgery. This article reviews the indications, performance and interpretation, accuracy and diagnostic pitfalls in the three major areas of gynecologic malignancies where intraoperative consultations are most frequently requested: ovarian masses, endometrial carcinoma and carcinoma of the cervix. For ovarian masses intraoperative consultation is usually requested either for histologic confirmation of malignant or borderline primary ovarian tumors before proceeding with radical surgery, or to rule out malignancy at the time of surgery for presumed benign disease. The diagnosis of endometrial carcinoma is usually made preoperatively before definitive surgical treatment. Thus, intraoperative consultation is most often used to identify the subgroup of patients with features of high risk disease who have an increased risk of metastases and who will benefit from formal surgical staging. In cases of carcinoma of the cervix frozen section is most commonly used to estimate the extent of spread of known invasive carcinoma at the time of radical surgery. Despite its restrictions, frozen section diagnosis is an important and reliable tool in the clinical management of patients with ovarian, endometrial and cervical tumors. The specificity of the method in experienced hands is high, the sensitivity is sufficient. The diagnosis of borderline ovarian tumors may be troublesome however, mainly due to their heterogeneity in appearance, especially in the case of large tumors of mucinous histologic type. It is important for pathologists to have a clear idea of the role and limitations of frozen section diagnosis in gynecological surgery in order to play a meaningful and optimal role in the management of the gynecologic oncology patient.

Female↗
PubMed2003

[The value of joint general practitioner and rheumatologist consultations in primary care patients].

OBJECTIVE: To compare the effects of regular referral by general practitioners to the Rheumatology outpatients' clinic with that of joint consultations by general practitioners (GPs) and rheumatologists, and to compare the subsequent treatment policy followed. DESIGN: Randomised. METHOD: In 1999 and 2000 all rheumatological patients who, according to the 17 participating GPs in the Maastricht region had an indication for referral, were referred to the outpatients' clinic or seen during a joint consultation where three GPs and one rheumatologist decided on a treatment policy in the presence of the patient. Agreement about diagnosis and diagnostic and therapeutic approaches between the rheumatologists and GPs was determined using questionnaires. The patient's state of health was assessed using the 'EuroQol health-related quality of life questionnaire' (EuroQol) and their satisfaction was determined by means of questionnaires. RESULTS: One hundred and sixty-six patients were included: 45 (27%) men and 121 (73%) women, with an average age of 53.7 years (SD: 14). The rheumatologists and the GPs differed in opinion on the diagnosis in 64% of the patients. Agreement on diagnosis resulted in greater agreement on the treatment policy than when there were discrepancies about the diagnosis. The rheumatologist used additional diagnostic tools and follow-up consultations at the outpatient clinic (78% and 65%) more frequently than during the joint consultation (44% and 15%). Patient satisfaction and general state of health were comparable in both groups.

Family Practice↗
PubMedDate not supplied

A model for clinical practice within the consultant nurse role.

This article discusses how the clinical, or practice element, of the consultant nurse role can best be delivered and how consultant nurses can enable others to develop their practice. The model for the clinical practice of a consultant nurse outlined in this paper is continually being reviewed. However, it is clear that consultant nurses should not work in isolation to provide care or services and must work alongside others to both inform their role and enable others to apply research evidence to nursing care.

Consultants↗
PubMed2002

[Medical consultation: a practice in the 18th century].

This paper outlines a typology of medical consultation in the 18th century, with emphasis on those carried out with the physicians present. This practice did not differ from that of previous centuries. Medical consultation, as a specifically structured procedure, served as an instrument to define the hierarchy of those present. This reflected the professional instability of the medical practice in 18th century Spain. The sources for this study include chronicles by physicians of the period that describe teh consultation sessions among doctors, gathered in what they called "Juntas", as well as written consultations.

History, 18th Century↗
PubMedDate not supplied

[Detection of bulimia nervosa in primary health care consultations].

INTRODUCTION: To estimate the prevalence of bulimia nervosa and bulimic behavior in women who come to Primary Health Care consultations, using the DSM-IV criteria. DESIGN: Descriptive, observational study Setting. Primary Health Care. PARTICIPANTS: Women over 14 years who come to general medicine consultations. Selection by systematic sampling of 175 women (proportion expected: 4%; confidence index: 95%; accuracy: 3%). MAIN MEASURES: Examination, by semi-structured interview, of diagnostic criteria of bulimia (recurrent binge eating, compensatory behaviors and excessive concern about weight or body image), socio-demographic variables and variables on morbidity (health problems according to CIPSAP-2-defined). RESULTS: Prevalence of bulimia was 5.3% (95% CI: 2.4-9.7), there being recurrent binge-eating in 23.4%. Among the compensatory behaviors, fasting (13.5%), intense exercise (8.2%) and self-induced vomiting (4.7%) were the most frequent. In women with bulimia, a background of anorexia and establishment of goals to lose weight appeared more frequently (p <0.05). Their average age was significantly lower (p <0.05) (31.2 14.7 SD). By logistic regression, the associated variables with the presence of bulimia were age (OR: 0.94), existence of previous psychiatric morbidity (OR: 9.0) and having previously set goals to lose weight (OR:7.3). CONCLUSIONS: In the women who came to the Primary Health Care consultations, prevalence of bulimia is greater than that described in the general female population. This disorder is more frequent in younger women and in those who present a background of psychiatric morbidity. Examination of the diagnostic criteria makes its detection easy in Primary Health Care consultations.

Bulimia↗