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PubMed1994

Computers in the consultation: the patient's view.

BACKGROUND: The use of computers in general practice consultations is becoming widespread. AIM: A qualitative study was undertaken to determine how patients in one practice responded to the use of computers, and the issues which particularly concerned them when doctors used computers in the consultation. METHOD: Thirty patients whose age-sex characteristics were proportional to the age-sex distribution of one practice were selected to be interviewed within two weeks of a consultation. The interviews were taped, transcribed and analysed. RESULTS: Patients had seen or used computers in many other places and accepted their role in data management. Patients with more experience of computers were more aware of their limitations, particularly with regard to the possibility of loss of confidentiality. Patients did not think the use of a computer led to a loss of the personal touch in the consultation as long as verbal skills and eye contact were maintained. However, they did expect doctors using computers to have acquired computer skills. All but one patient said they wanted to see what was on the screen, although 11 did not know they had the right to read their notes on the screen. CONCLUSION: Patients regarded the use of computers by their doctors as normal and indicative of the doctors being up to date. Most respondents were concerned about possible loss of confidentiality. This concern, and their expressed preference for computer details to be visible and shared, pose challenges to doctors' technical and communication skills.

Adolescent↗

PubMed1993

[Trends in consultations and prescriptions for children with COPD].

National data were provided on consultations (first, repeat) and prescriptions in patients having ambulatory care for asthma and COPD combined, by age group (0-4, 5-11, and 12-19 yr) and doctor's category (GP, specialist) over the period 1981-1990. Prescriptions were subdivided into (1) beta 2-agonists, anticholinergics, ketotifen, methylxanthines, cromoglycate, inhaled steroids, oral steroids, (2) antibiotics, (3) other drugs. Age specific rates/1000 persons/year were calculated. Rates for first consultations remained steady, pointing to a stable incidence. Rates for repeat consultations increased in the 0-4 yr age group (GP and specialist) and the 5-11 yr age group (specialist). Prescription rates for the pulmonary medication group also rose in particular in these two age groups. For the GP, however, they were counterbalanced by decreasing trends in prescriptions of the 'other drugs', pointing to a shift towards more rational treatment. The increased ratios of prescription rate to consultation rate, not only for the anti-inflammatory drugs but for the bronchodilators as well, especially in the specialist category, suggest an increased morbidity (severity) from obstructive airways disease in childhood.

Adolescent↗

PubMed1993

What to expect from a psychiatric consultation.

The authors present guidelines for psychiatric consultations. The authors emphasize the need for specifics in presenting reasons for psychiatric consultation and/or referral to consultants, and the need for responsive consultation and communication.

Humans↗

PubMed1993

[Primary care consultation rates among the middle aged and elderly].

The consultation rate among family physicians has been widely discussed in the literature, but very few studies have been done in Israel. We analyzed the pattern of visits to the family physician of 1,860 patients aged 40 years and older in 3 urban clinics, 2 kibbutzim and 1 rural clinic with a total population of 6,700. The consultation rate rose steadily with age. It was 3.4 per year at age 40-49, and 5.6 at ages 70 and over, with a mean annual rate of 4.6. 77% of the screened population consulted the physician in 1 year and 91.4% in 3 years. Only 9.6% did not visit their physicians in the 3 years. About two-thirds visited the physician 1-4 times a year, and only 2% visited more than 15 times. In urban practices women attended more often than men but there was no significant sex difference in the rural practices. As a result of the greater visit rates of the elderly, they consumed a larger share of medical services. The mean consultation rate in this survey is similar to that in England and in other Western countries. However, it is relatively low in comparison to other studies in Israel. This may be due to the different practice setting and the use of a different sampling frame.

Adult↗

PubMedDate not supplied

Psychiatric consultations in pediatric inpatients.

Emotional problems are not uncommon in hospitalized children. The authors reviewed psychiatric consultations on a pediatric ward in a medical center and compared the findings with a non-pediatric group and the Western reports. Forty consultations were requested in a three-year period which represented 0.35% of all admissions to pediatric ward and 1.0% of all psychiatric consultations in that period. The consultation rate of the pediatric ward is significantly lower than that of the non-pediatric wards. The most common reason for the referrals was for the evaluation of possible psychopathogeneses from unexplained physical symptoms. A wide range of psychiatric diagnoses were found. Among them, adjustment disorders, anxiety or somatoform disorders, diagnosis deferred and no psychiatric diagnosis were the most commonly made. Pediatric patients had a similar percentage diagnosis of adjustment disorders compared with the non-pediatric group but far less organic mental disorders. Besides medication, psychological and family intervention were frequently recommended by the psychiatrists. These findings suggest that there were unique psychological characteristics in the hospitalized children which required specialists and further studies. It is hoped that increasing the collaboration between pediatricians and psychiatrists can improve the medical care of these sick children.

Adolescent↗

PubMedDate not supplied

Personal computer teleradiology interhospital image transmission of neonatal radiographs to facilitate tertiary neonatology telephone consultation and patient transfer.

OBJECTIVE: Our purpose was to study the ability of personal computer teleradiology (PCT) to improve the quality of communication between physicians during newborn infant transfers and consultations. STUDY DESIGN: In the first part of the study 36 radiographs of neonatal intensive care unit patients were transmitted by PCT. The pediatrician reviewed the original films and three neonatologists reviewed the PCT images. Their interpretations were scored by use of criteria established by a neutral reader. In the second part chest x-ray films (CXR) of 31 newborns weighing > 2000 gm with respiratory distress were transmitted by PCT. A pediatrician and three neonatologists participated in an exercise to simulate a telephone neonatology consultation. Patient severity assessments as measured by assignments to receive intermediate or intensive care were compared before and after neonatologists viewed the PCT image of the CXR. RESULTS: In part 1 of the study neonatologists correctly identified 98%, 91%, and 98% of the x-ray interpretation scoring items, whereas at best the pediatrician identified 82% of the scoring items (p = 0.002). In part 2 neonatologists correctly assigned patient care levels an average of 73% after reviewing a standard clinical profile and a written description of the infant's CXR. After reviewing a PCT image of the infant's CXR, patient care level assignments were correctly assigned an average of 67%. The interpretation of the PCT CXR image was consistent with the radiologic report of record in 90 of 93 interpretations (31 cases read by three neonatologists). CONCLUSIONS: PCT represents an inexpensive means to accurately send a radiographic image over the phone as part of a telephone consultation. Neonatologists were able to interpret teleradiology images more accurately than a pediatrician reviewing the original film. Although this did not result in an improvement in the neonatologists' ability to determine patient severity on the basis of the model used in part 2, their identification of serious radiographic findings missed by the pediatrician can only suggest that teleradiology may be beneficial in certain instances. Although verbal communication can often suffice in a telephone consultation or transfer, there may be specific instances when visualizing a radiographic image such as an x-ray film or computed tomographic scan can provide important information that cannot be optimally described verbally. Rural hospitals can form interhospital image transmission links with tertiary center resources.

Humans↗

PubMed1995

The impact of an electroconvulsive therapy consultation service on ECT use at a university teaching hospital.

In order to test the hypothesis that the establishment of a centralized electroconvulsive therapy (ECT) consultation service would affect ECT use at a university teaching hospital, we retrospectively reviewed medical records of patients who received ECT during two 12-month periods preceding and following the institution of a comprehensive ECT consultation service. Data regarding ECT usage, including utilization, types of patients treated, and lengths of stay, were obtained. Patients treated after the institution of a comprehensive ECT consultation service received ECT with less delay, were discharged more quickly after the conclusion of ECT treatment, and had shorter lengths of stay compared with patients who received treatment before the initiation of the service. Following the establishment of the ECT service, the absolute number of patients who received ECT increased, although the rate of ECT use did not change. These findings suggest that the establishment of a comprehensive ECT consultation service may lead to more efficient use of this important treatment in university hospitals and to more cost-effective treatment of some patients with major depression. Additional research is necessary to explore the generalizability of these findings to other treatment settings.

Aged↗

PubMed1997

Telepathologic review: utility, diagnostic accuracy, and interobserver variability on a difficult case consultation service.

The diagnostic accuracy of telepathologic analysis has not been compared to that of conventional light microscopic review on a difficult case consultation service. The anatomic pathology consultation files of the University of Iowa were retrospectively examined, and 105 difficult cases from a variety of organs were chosen for real-time telepathologic and light microscopic review. The telepathologic and light microscopic crude agreement of five pathologists were compared, with use of the original consultation diagnosis as the "gold standard." Cases were scored as correct, partially correct, or incorrect. After making a video diagnosis, the pathologists reported whether they wanted to review the case with use of a light microscope. The pathologists performed significantly better with the light microscope, even after excluding cases in areas of inexpertise (P = .005). The mean percentage of cases that the pathologists wanted to review with the light microscope was 64%, and the major reason for review was diagnostic uncertainty. Cases incorrectly diagnosed with use of the video monitor were almost always requested for review. We conclude that, on a difficult case consultation service, pathologists perform significantly better with use of light microscopic than with telepathologic analysis; rarely make an incorrect diagnosis and do not request that case for light microscopic review; and exhibit high telepathologic diagnostic accuracy in areas of expertise.

Adolescent↗

PubMed1997

[Clinical laboratory consultation in the general hospital].

The future of laboratory medicine depends not only on quality assurance but also on appropriate use of laboratory tests. The clinical laboratory consultation system is effective tool for clarifying purpose. As an active laboratory-initiated consultation, we report patient-oriented "Laboratory Comment" on important or abnormal test results of each patient. About one thousand laboratory comments have been accumulated over the past eight years. From these comments, we discussed the requirements of laboratory consultation skills, establish standards for laboratory data check, and a database of reported and accumulated consultations or comments.

Clinical Laboratory Information Systems↗

PubMedDate not supplied

Community nurses and their collaboration with clinical nurse consultants.

A survey was undertaken of 129 community nurses who had chosen to utilise a clinical nurse consultant for education and/or patient care at home. Accessibility, efficiency, usefulness of the consultation and the educative role of the clinical nurse consultant were examined. The responses indicated that the community nurses had positive perceptions regarding their collaboration with the clinical nurse consultants. It is recommended that an objective tool be developed to demonstrate the effectiveness of the collaboration, for data collection purposes, when measuring patient outcomes and evaluating specialist resources.

Australia↗

PubMed1996

Listening or telling? Thoughts on responsibility in clinical ethics consultation.

This article reviews the historical and current controversies about the nature of clinical ethics consultation, as a way to focus on the place and responsibility of ethics consultants within the context of clinical conversation--interpreted as a form of dialogue. These matters are approached through a particularly compelling instance of the controversy that involves several major figures in the field. The analysis serves to highlight very significant questions of the nature and constraints of clinical situations, and the moral responsibility and legal accountability that are especially important for clinical ethics consultants.

Casuistry↗

PubMed2006

Exploring the perceived role and impact of the nurse consultant.

BACKGROUND: Nurse consultant roles were introduced in 1999 with defined role criteria including expert practice, research, education and leadership. The primary objective of the role is to develop nurses and nursing to provide effective patient outcomes. In 2000 the first nurse consultant in rheumatology was appointed to establish a co-ordinated service for the management of patients with chronic musculoskeletal pain. There are now ten nurse consultants within rheumatology yet little is known of their role or impact. AIM: The aim of the study was to identify the perceived role and impact of one nurse consultant (NC) in rheumatology within the context of being a practitioner-researcher. METHOD: Seven peers of the NC and five patients cared for by the NC participated in a semi-structured interview to identify their perceptions regarding the role of the NC within the rheumatology service. RESULTS: The following themes were identified from the interviews: (1) development of a new model of care for patients with chronic musculoskeletal pain; (2) holistic person-centred care experienced and valued by the patient; (3) leadership and education; and (4) feeling cared for. CONCLUSION: The NC role had impacted on service development and culture in the instigation of a chronic musculoskeletal pain service and leadership and education activities. Patients experienced the holistic nature of the role.

Humans↗

PubMed2003

Factors affecting patient and clinician satisfaction with the clinical consultation: can communication skills training for clinicians improve satisfaction?

The provision of adequate information in a clear and sensitive manner can improve cancer patients' experience of care. Satisfaction with the cancer consultation may impact on satisfaction with care in general and adjustment to the disease. This study aims to identify factors that influence patient and clinician satisfaction with the cancer consultation and whether satisfaction can be improved with communication skills training. 160 doctors from 34 UK cancer centres participated. Half were randomized to attend a communication skills training course. Patient satisfaction data are presented at baseline and following a communication skills course or in the case of the control doctors, three months after baseline. Clinicians also rated their satisfaction with the consultations. Overall patient satisfaction was not related to the speciality, seniority or sex of the clinician or patient, site of primary cancer or type of treatment. Satisfaction was related to patients' age, psychological morbidity and, most significantly, satisfaction with the length of wait in clinic. Clinician satisfaction was not related to age, sex or cancer site but clinicians were less satisfied following consultations with patients being treated palliatively. Communication skills training had a non-significant positive effect on patient satisfaction. The subtle benefits of improved communication may be overshadowed by practical problems such as waiting too long to see the doctor, which have an adverse effect on satisfaction.

Adult↗

PubMed1990

Nonpsychiatric consultations within a general hospital psychiatric unit: characteristics and concordance.

Nonpsychiatric consultations to a general hospital psychiatric unit were investigated for concordance with diagnostic testing advice, drug recommendations, and representation of the medical diagnoses in the discharge summary. Those patients who received consultations were older and had less social support but did not have more severe medical illnesses. The level of concordance with medical consultants' recommendations was far greater than previous reports of psychiatric consultants' advice to nonpsychiatric colleagues.

Adult↗

PubMed1988

[Physician consultation and use of drugs for rheumatic symptoms].

Between May 1986 and November 1987 we asked 4037 randomly sampled 25-74 year old german residents at Hannover (FRG) by a mailed questionnaire for back, neck and joint pain, for joint swelling and morning stiffness. Further we asked for the consultation of a physician during the past 12 months and for the use of drugs during the past 7 days because of rheumatoid complaints. 3426 members of the sample (85%) returned the questionnaire. 1828 (53%) reported at least one symptom "today" (= "the day you fill out this questionnaire"). The highest rate of persons suffering from complaints of the locomotor system was found among middle-aged women, with the maximum of 74% in the age group 50-54 years. For the illness behavior-physician consultation, use of drugs-the extent of complaints was of decisive importance. Sex was without, age of very low influence. The rate of those who reported the consultation of a physician and/or the use of drugs was increasing with the amount of positive answers to the questions on rheumatoid complaints. Nevertheless, of those who had answered in the affirmative all questions on complaints, 10% had denied the question on physician consultation. 41% had denied the question on the use of analgetic/antirheumatic drugs.

Adult↗

PubMed2004

Public consultation in ethics: an experiment in representative ethics.

Genome Canada has funded a research project to evaluate the usefulness of different forms of ethical analysis for assessing the moral weight of public opinion in the governance of genomics. This paper will describe a role of public consultation for ethical analysis and a contribution of ethical analysis to public consultation and the governance of genomics/biotechnology. Public consultation increases the robustness of ethical analysis with a more diverse set of moral experiences. Consultation must be carefully and respectfully designed to generate sufficiently diverse and rich accounts of moral experiences. Since dominant groups tend to define ethical or policy issues in a manner that excludes some interests or perspectives, it is important to identify the range of interests that diverse publics hold before defining the issue and scope of the discussion and the premature foreclosure of ethical dialogue. Consequently, a significant contribution of ethical dialogue strengthened by social analysis is to consider the context and non-policy use of power to govern genomics and to sustain social debate on enduring ethical issues.

Bioethical Issues↗

PubMed2001

[How are beginning students in surgery selected? Results of a survey of German consultant surgeons].

AIM: After finishing medical school it is getting more and more difficult for medical students to get one of the rare positions in a surgical training program. Only a good career plan and an intelligent strategy for the first steps in surgical life seem to be an advantage for that competition. On the other hand the selection of basic surgical trainees only based on the curriculum vitae and brief interviews may not be satisfying. The aim of this investigation was to answer the following questions: 1. How do consultant surgeons select their basic trainees? 2. How important is the applicant's record and the interview? 3. Which educational and personal criteria are important for the selection? 4. How can medical students improve their chance of getting a position in a surgical training program. METHODS: Using an anonymous and standardized questionnaire 39 chiefs of university departments of surgery and 44 consultant surgeons each from general and local hospitals were interviewed concerning their selection process and criteria required for application in their training program. The candidates were chosen from an official address list (Deutsche Chirurgie 98, Berufsverband der Deutschen Chirurgen). The questionnaire was sent to the candidates by official postal service together with a prepaid return envelope. RESULTS: Twenty-eight chiefs of university departments of surgery (71.8%) and 29 (65.9%) and 20 (45.5%) of the interviewed consultant surgeons in general and local hospitals responded to the 89-item questionnaire. It turned out that the majority of applications were send to the clinics at the applicant's initiation. Personal relationships or networks are important. Position advertisements are not important. 85.1% of the responders are satisfied with their procedure of selection, nevertheless, 43.4% are interested in recruiting markets. In detail, chiefs of surgical departments in university clinics get a mean of 12.3 (5-50) applications for basic surgical training per month, consultant surgeons in general hospitals 6.5 (4-20), those in local hospitals 5.6 (2-10). The completion and the contents of the doctor's thesis, former research efforts, foreign languages, computer knowledge and other qualifications are the most important criteria in the selection process. Reliability, loyalty, physical and psychological stability, organising and planning ability, stamina, sociability and independence are the most valued personal skills. CONCLUSIONS: Despite the satisfaction with the established common selection process, the high rate of participation in our study shows how important this subject is ranked by leading surgeons. It turned out that besides professional qualification, personal skills are a major criterion in the selection of basic surgical trainees.

Clinical Competence↗

PubMed2004

Personality disorders in the community: results from the Australian National Survey of Mental Health and Well-being Part III. Relationships between specific type of personality disorder, Axis 1 mental disorders and physical conditions with disability and health consultations.

BACKGROUND: The aim of the present study was to examine in a national survey sample the risks of having a specific personality disorder (PD) and associations with gender, of having one or more physical conditions, of having one or more Axis 1 conditions, and of the severity (or degree) of disability. We also examined the association of specific PDs with having sought a consultation for health or mental health problems with a general practitioner (GP), a psychologist, or psychiatrist over the past 12 months. METHOD: Data were derived from the Australian National Mental Health and Well-Being Survey, conducted between May and August 1997. A stratified random sample of households was generated, from which all persons aged 18 or over were considered potential interviewees. There were 10,641 survey respondents, this representing a response rate of 78%. Each interviewee was asked 59 questions indexing specific ICD-10 PD criteria. RESULTS: Logistic regressions identified that some specific PDs, especially borderline PD, were more strongly associated with having one or more Axis I conditions, greater mental disability and lost days of total and partial role functioning than having No PD, and that others, notably anankastic PD, were less likely to be associated with the same variables. Some specific PDs, again most notably borderline PD, were more associated than others, again most notably anankastic PD, with having sought mental health consultations from GPs, psychiatrists, and psychologists. By contrast, PD associations with gender, physical conditions, physical disability and health consultations with the three professional groups were weaker as reflected in the comparatively smaller odds ratios and were also less consistent than the pattern with the previously mentioned variables. CONCLUSION: The study reports findings from a nationwide survey and, as such, the data are less influenced by the selection and setting bias found in most other studies investigating these variables. The findings of the study do point to some specific PDs, such as borderline PD, being associated with greater Axis 1 psychopathology, disability and mental health consultations than others, such as anankastic PD. It appears that although anankastic PD in itself is associated with more disability than having No PD, it becomes significantly more disabling when it is associated with other comorbid PDs.

Adult↗