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PubMed1984

Consultation use of a computer by general practitioners.

Reporting on an experimental field study of computer use by general practitioners during consultations, this paper focuses particularly on the experiences of the doctors in their efforts to communicate concurrently with a patient and a computer. Through the analysis of logs of computer use, video recordings of consultations and interviews with doctors, the authors report on the uptake of the computer facilities, the impact of such use on information handling during the consultation, the doctors' views about using the system, and finally the relationship between doctors' ;natural' consulting styles and their uptake and views of the system.

Computers↗
PubMed1995

[For which health problems in children is the family physician consulted and how often?].

OBJECTIVE: To determine how often and for what health problems in children general practitioners (GPs) are consulted, and whether this is affected by age, gender, season, socioeconomic status and degree of urbanisation. DESIGN: Descriptive. SETTING: 103 general practices (161 GPs) in the Netherlands. METHOD: Data from 63,753 children (0-14 years of age) collected in the framework of the Dutch National Survey were used. A random sample of 161 GPs registered all contacts between patient and practice during 3 months. Sociodemographic characteristics of all practice populations were gathered. Health problems were coded according to the International Classification of Primary Care (ICPC). Consultation frequency, morbidity presented, age and gender specific incidence rates were determined, as well as relative risks of presented morbidity relative to sociodemographic characteristics and season. RESULTS: Children consulted a GP on average 2.8 times per year. Problems from the respiratory tract (upper respiratory tract infection, acute bronchitis, coughing and acute tonsillitis) and acute otitis media were presented most. The morbidity varied strongly with age. Children from low socioeconomic strata and children living in larger cities presented more problems (in particular respiratory and ear problems). CONCLUSION: The GP is confronted with a great diversity of health problems in children. The variation in consultation frequency and morbidity according to selected sociodemographic characteristics showed that presentation of information in more detail by age is necessary in order to obtain optimal insight.

Adolescent↗
PubMed1994

[The supplementary effect of consulting vaccination in expanded program on immunization (EPI)].

This study was carried out in 420 of children aged 12-24 months in two counties of Gansu Province, China. The result showed that general consulting rate was 30.24% in county or township hospital. The average consulting time was 2.14. A formula was designed K = R x C (1-V) for detecting the effect of consulting vaccination in EPI. The maximum supplementary coefficients of initial immunization of outpatient children for the vaccines were as follows: BCG 0.3024, TOPV-3 0.0953, DPT-3 0.0929, MV 0.0643. And once immunization were BCG 0.3024, TOPV 0.2643, DPT 0.2381, MV 0.0643. The study also explores the supplementary effect of consulting vaccination in different vaccination times and immunization coverages.

Child, Preschool↗
PubMed1993

[Indications for psychiatric consultation: a case-specific parallel survey of psychiatrists and treating physicians].

In a prospective study about the consultation triad (doctor-doctor-patient) 334 of 388 consecutive psychiatric consultations at two large hospitals of Lübeck within 5 months have been analyzed. The psychiatric consultant and the doctor on duty answered questions with regard to diagnosis, treatment indication and after care. 162 physicians (22 psychiatric consultants and 140 physicians working in 14 different departments) took part in the study. On one hand it turned out that there were specific indications for different diagnosis groups. On the other hand the two samples of physicians presented surprising differences with regard to their (case related) treatment indications and after care options. Psychiatrists found it less important to carry out reconsultations and the somatic orientated doctors emphasized more often psychodynamical orientated interventions for patients in contrast to the psychiatrists. Psychiatrists in contrast have been more sensitive for atmospheric tensions at the ward. These differences even grew following the amount of practice. Gerontopsychiatric patients turned out to be a special problem group. Doctors of both groups rarely share their opinion with regard to after care options.

Adult↗
PubMed1993

Consultation and the suicidal patient.

This paper presents an argument for a paradigm shift in the way that mental health professionals approach their work with psychiatric patients in the midst of a suicidal crisis and suggests that the time has come to discuss a standard of care based on integration of detected risk factors, effective education and training in suicidology, and most importantly, the routine use of consultation and teamwork. Also proposed is a workable model for the use of consultation that has a number of major components: quality education in suicidology, the training and availability of appropriate consultants, clinical teamwork, and the recognition by training programs and clinical institutions that it is necessary to routinely consider a consultative risk management approach for work with suicidal patients.

Curriculum↗
PubMed1993

[Evolution of the emergency consultations in patients with human immunodeficiency virus infection in various levels of medical care in an urban area of Barcelona].

Medical emergencies involving patients with Human Immunodeficiency Virus (HIV) infection comprise an increasing number of the total hospitalary consults and contribute to their overflow. In order to evaluate possible alternative solutions to this problem, we performed a retrospective study of urgent medical consults by HIV patients at three different levels of medical care (primary assistance, extrahospitalary and hospitalary emergencies centers) all included in the same urban area of Barcelona. We demonstrated a growing excess in hospitalary emergencies, with high requirements of complementary explorations and hospitalary admittances. In the extrahospitalary emergency center, we can observe a progressive increasing of emergency consults, but still reasonable in number and adequate to the real possibilities of the center. At primary care level, HIV patients consulted because of less severe reasons. We conclude that a possible solution in order to decrease the assistance requirements in the hospitalary emergencies level could be to try to attend these patients in emergency extrahospitalary centers. These centers should be technically provided and with a close relationship both with the primary assistance care level and with the reference hospital.

Adult↗
PubMed1993

What's new for the medical consultant.

The role of the medical consultant caring for the surgical patient has evolved over the last 20 years as numerous books and articles have contributed to the knowledge base of this field. Consultants used to merely "clear" patients for surgery. Now, guidelines based on data are available to direct many perioperative management decisions. The consultant is responsible for knowing the ever-growing body of literature and for conducting himself or herself according to accepted guidelines for consultation.

Diagnostic Tests, Routine↗
PubMedDate not supplied

Acute stroke treatment in UK hospitals: the Stroke Association survey of consultant opinion.

The aim of the Stroke Association survey was to document United Kingdom consultant opinion of the immediate treatment for patients with acute stroke. A national postal survey of all UK hospital consultant general physicians, geriatricians and neurologist was carried out in 1992/3. We identified 1,953 consultants who routinely cared for patients with acute stroke; 39% of them regularly used aspirin for patients with acute stroke and 10% used low-dose subcutaneous heparin. Other treatments were rarely used. There was much uncertainty about the effectiveness of all currently available acute stroke treatments; 73% of physicians were prepared to start aspirin before a CT scan, but a much smaller proportion would start heparin therapy without one. Twenty-seven percent of consultants would actively treat hypertension in the initial 24 hours after stroke. Routine aspirin for secondary prevention after ischaemic stroke was widely accepted, but blood cholesterol lowering by drugs was not. In conclusion, aspirin and heparin alone are the only routinely used treatments for the immediate treatment of acute stroke; other treatments are used sparingly or not at all. The great uncertainty about the value of all available acute stroke treatments should encourage participation in randomised controlled trials.

Aspirin↗
PubMed1997

Evaluation of consulting skills of trainee general practitioners.

OBJECTIVE: This pilot survey was performed primarily to confirm the identity of areas of observed weakness in the consulting styles of young graduates, thus enabling educational models to be set up to correct any deficiencies. A secondary objective was to trial the design of a research instrument and detect and rectify any design flaws for subsequent and improved surveys. The consulting skills of 98 GP registrars, enrolled in the various stages of the RACGP Training Program in Western Australia were surveyed. METHOD: A pilot survey was conducted using a recording form with a Likert rating format, designed to analyse certain defined areas of the consultation. This was conducted by skilled observers who explored five hypothesised areas of weakness. RESULTS: Seven areas of concern were identified in the consulting skills of GP Registrars, with consistency across the observers. Modest improvements of skills in some but not all of these parameters occurred in the later stages of the RACGP Training Program. CONCLUSION: One task of the pilot study was to assess the quality of the statements used with reference to the 14 aspects identified (items 9 to 22); the aim being to produce an improved instrument, with less chance of misinterpretation, in a further survey. Areas of concern were defined with some constancy across the raters and largely coincided with the hypothesised concerns. Suggestions for remedial educational input and for additional research into the same area are made.

Clinical Competence↗
PubMed1996

[Study of medical-legal consultations outside the health system in primary care].

OBJECTIVE: To evaluate how consultations in order to obtain a medical/legal document, whose destination is other than the health service. DESIGN: A descriptive, crossover study, using a questionnaire filled in by the doctor at the time of the medical-legal consultation. PATIENTS AND OTHER PARTICIPANTS: All those users who attended in one year the clinics of the doctors taking part in the study, in order to seek a medical-legal document (MLD) whose destination was other than the health service. MEASUREMENTS AND MAIN RESULTS: Between 1-9-93 and 31-8-94 there were 287 consultations for a MLD. Of the variables studied, most attendances were by the age group between 15 and 44, masculine, with schooling up to EGB level (basic) or lower and unemployed or pensioner. Average length of the consultation was 6.6 minutes. 42.5% had a clinical interview. 4.6% were referred to a specialist. In 77.7% of cases, a document belonging to the health service was issued. The reason for the procedure was: health certificate (40%), and a sick note (39%). CONCLUSIONS: The PC doctor normally receives a considerable number of visits to obtain this kind of document, which are required by official bodies to determine the health status of users or concede social benefits to them. There are gaps in the rules on what kind of document.

Adolescent↗
PubMed1977

Consultation frequencies in general practice.

Some models of the process by which individuals seek medical care suggest the negative binomial as the underlying distribution of the frequencies of consultations in a given practice. Data from the 1970-71 National Morbidity Survey of General Practice are used to test these competing models. It is shown that the negative binomial distribution successfully fits consultation frequencies in aggregate and in subdivisions according to age, sex, and duration of registration. In this article is is assumed that the consultation process has two components: the patient's decision to visit his doctor for a new illness and the follow-up visits that results from this new problem. Supplementing previous evidence that the distribution of episodes of new illnesses follows a negative binomial distribution, this article shows that consultation frequencies among individuals presenting with one new illness also follow a negative binomial distribution. A unifying model is required to synthesize these findings.

Adolescent↗
PubMed1997

Teenagers' views on the general practice consultation and provision of contraception. The Adolescent Working Group.

BACKGROUND: The rate of unwanted pregnancies in adolescents in the United Kingdom (UK) is one of the highest in Europe and is a major reason for the RCGP's concern at the under-use of general practitioners' (GPs') contraceptive services by young people. AIM: To discover the attitudes of 15- to 16-year-olds to the GP consultation and contraceptive services. METHOD: Questionnaires were completed as part of an evaluation of a novel sex education programme in 30 schools in 1994, and provided the data for this study. A total of 4481 teenagers (51.6% male and 48.4% female completed the questionnaires in their classrooms under conditions of complete confidentiality. RESULTS: The median consulting rate per year was two for males and three for females. Over 60% of adolescents attended the consultation with a parent. Of the males, 27.5% 'felt that the discussion with their GP could be relayed to their parents against their wishes', as did 25.1% of the females. Other difficulties with GP appointments were identified as embarrassment (63% of females and 46% of males), difficulty getting a quick appointment (44% of both males and females), and an unsympathetic GP (32% of females and 20.5% of males). CONCLUSIONS: Adolescents identify significant factors blocking them from easy access to consultation with their GP. These included lack of trust in confidentiality, lack of staff friendliness, and delay in appointment. Consideration of how these blocks can be removed will assist in providing improved contraceptive services in primary care. General practices need to consider the above factors when providing contraceptive and other services to their teenage patients.

Adolescent↗
PubMed1998

Everyday symptoms in childhood: occurrence and general practitioner consultation rates.

BACKGROUND: Fewer than 20% of all illnesses that occur in the home require the attention of a general practitioner (GP). Whether specific illnesses in children are more likely to need the attention of a GP is poorly understood, as is the influence of various other factors. Health diaries are the most suitable method of collecting comprehensive information about children's health problems at home and in general practice simultaneously. AIM: To investigate the occurrence of, and consultation rates for, specific symptoms in childhood in relation to age, sex, birth order, and place of residence of the child, and season of the year. METHOD: The parents of 1805 children kept a health diary over three weeks and recorded symptoms and consultation behaviour. The symptoms were later combined into illness episodes. RESULTS: Over three weeks, colds/flu (157/1000 children) and respiratory symptoms (114/1000 children) occurred most frequently. More young children (0-4 years) suffered from illness generally. Eleven per cent of all illness episodes required the attention of a GP. Consultation rates differed greatly according to symptoms. A GP was consulted most often for ear (36%) and skin (28%) problems, and least often for headaches (2%) and tiredness (1%). Regardless of symptoms, young children (0-4 years) were taken to a GP twice as often as older children (10-14 years). CONCLUSIONS: This study emphasizes the enormous amount of illness that occurs in children and the fact that more than 80% of all illnesses are dealt with by parents without reference to the professional health care system.

Adolescent↗
PubMed1998

Chinese herbal medicine and acupuncture. How do patients who consult family physicians use these therapies?

OBJECTIVE: To determine how a population of Chinese patients consulting family physicians in Vancouver use traditional Chinese medicine (TCM), specifically Chinese herbal medicine and acupuncture. DESIGN: Bilingual survey (English and Chinese). SETTING: Four family practices with predominantly Chinese patients in metropolitan Vancouver. PARTICIPANTS: The 932 patients or family members who visited one of the practices. MAIN OUTCOME MEASURES: Demographic characteristics; frequency and reason for visiting a family physician, Chinese herbalist, or acupuncturist; choice of practitioner if affected by one of 16 common conditions. RESULTS: The study population was mostly Chinese and immigrant to Canada. Chinese herbal medicine was currently used by 28% (262/930) of respondents (more than one visit in the last year), and another 18% (172/930) were past users. Acupuncture was currently used by 7% (64/927) and had been used in the past by another 8% (71/927). Use of Chinese herbal medicine varied significantly (P < .01) according to age, sex, immigrant status, and ethnicity. Acupuncture use varied significantly only by age. The main reasons for consulting Chinese herbalists were infection (41%, 157/382), respiratory problems (11%, 42/382), and rheumatologic problems (10%, 38/382), whereas acupuncturists were consulted almost exclusively for rheumatologic problems (80%, 45/56). CONCLUSIONS: Using TCM in conjunction with visiting family physicians was very popular among this predominantly Chinese study population. Patients with acute conditions, such as influenza, consulted both their family physicians and Chinese herbalists in quick succession. On the other hand, those suffering from more chronic conditions, such as rheumatologic diseases, were more likely to start using TCM after repeated visits to their family physicians.

Acupuncture Therapy↗
PubMed1998

[A survey of "heavy consumers" of emergency care services in Stockholm. Six per cent of the patients accounted for a quarter of emergency consultations].

A small subgroup of patients accounts for a substantial proportion of emergency room (ER) consultations. Of the 479,956 consultations at ER facilities at Stockholm hospitals in 1996, a quarter were accounted for by six per cent of the patients, a subgroup characterised by at least four ER consultations during the year. Some 1,500 patients consulted 12-233 times. Analysis of the care-seeking habits of five extremely heavy ER-facility consumers showed them also to be heavy consumers of other health care services such as primary and tertiary facilities. Since previous studies have shown heavy ER-facility consumers to be a vulnerable subgroup both medically and socially, co-ordination and planning of their care might well be beneficial.

Adolescent↗
PubMed1989

An analysis of ethics consultation in the clinical setting.

Only recently have ethicists been invited into the clinical setting to offer recommendations about patient care decisions. This paper discusses this new role for ethicists from the perspective of content and process issues. Among content issues are the usual ethical dilemmas such as the aggressiveness of treatment, questions about consent, and alternative treatment options. Among process issues are those that relate to communication with the patient. The formal ethics consult is discussed, the steps taken in such a consult, and whether there should be a fee charged. We conclude with an examination of the risks and benefits of formal ethics consults.

Ethicists↗
PubMed2006

Ethicians, ethicists and the goals of clinical ethics consultation.

We believe that clinical ethics consultation (CEC) has as its goal the delivery of healthcare in a manner consistent with the moral rules and the moral ideals. Towards this end, CEC pursues the instrumental ends of clarifying the limits of acceptable ethical disagreement and facilitating a choice among ethically acceptable alternatives. In pursuing these ends, healthcare ethics consultation (HEC) and CEC services confront three broad categories of questions: (1) questions of professional duty; (2) questions of law; and (3) questions of general morality. Professional duty questions concern what has been referred to as the "internal morality of medicine", and include questions such as the medical legitimacy of the goal(s) being pursued, or the acceptability of the means being employed. Questions of law concern themselves with what the law requires, permits or prohibits. Questions of general morality include all those not falling within the scope of the above categories. We submit that this has implications for the organization and structure of consultation services and HEC and for the methodology and processes employed in CEC. Thus: (1) questions of professional duty should be addressed only by physician members (whom we would distinguish by employing the term "ethicians") of the HEC or CEC service. The only role for non-ethicians under these circumstances would be in helping to resolve disagreements between/among professionals; (2) questions of law, in contrast, should be addressed only by the attorney member(s) of the HEC or CEC service; (3) questions of general morality may be addressed by the entire membership of the HEC or CEC service.

Consultants↗
PubMed2004

Internet consultations from a remote Pacific island: impact of digitized radiologic images on referral decisions.

A study was carried out to determine whether digitized radiologic images added valuable information to Internet consultations from a remote Pacific Island. Chuuk State Hospital (Federated States of Micronesia) has limited film screen radiology, minimal ultrasound capability, and no radiologist. Providers initiate Web-based referrals for consultation or patient transfer. Digitized images (via low-cost digital camera or flatbed scanner) were uploaded to a Web site. Images were assessed for impact on referral decisions. A radiologist scored image quality and confidence (scale: 1-7). Of 97 referrals with images that were reviewed, 74 (76%) image sets were abnormal, 20 (20%) were normal, and 3 (4%) were indeterminate. Median scores were 4 for image quality and 5 for diagnostic confidence. In most cases with abnormal radiology (52/74, 70%), images were considered valuable. Radiologic images digitized with a low-cost camera or flatbed scanner provided valuable information for decision making in an Internet-based consultation and referral process from a remote, impoverished Pacific Island jurisdiction, despite relatively low image quality.

Humans↗