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At least 19 recordsLinked to original sources
PubMed1990

Is the Friday afternoon consult frequent? Timing of consultation requests on a psychiatric consultation service.

Two hundred psychiatric consultations were reviewed to determine if there was a pattern regarding the time of day and day of the week that consultations were requested. Consultations were found to be requested on a random basis although a survey of consultation psychiatrists perceived that consultations were more often requested late in the day. The implications of such misperceptions are discussed as they relate to negative attitudes towards consultative psychiatry by psychiatric physicians.

Child Psychiatry↗
PubMed1992

Non-consulters and high consulters in general practice: cardio-respiratory health and risk factors.

The 1990 General Practitioner contract requires that health promotion and illness prevention services should be provided to all patients aged 16-74 years. Consultation rates over a period of three years were examined in 7010 middle-aged men in Great Britain to compare the cardio-respiratory health and risk factor status of non-consulters (men who did not consult in three years) with those of average consulters (men who consulted 3-5 times in three years) and high consulters (men who consulted 24 or more times in three years) to assess their relative need for health promotion and illness prevention services. The non-consulters (n = 1025) were remarkably similar to the average consulters (n = 1585) in health and lifestyle characteristics. The high consulters (n = 306) had a greater burden of ill-health and a less healthy lifestyle. Chest pain on exertion, chronic bronchitis, breathlessness or wheeze were present in 23 per cent of non-consulters, 27 per cent of average consulters and over 50 per cent of high consulters. Similarly, 48 per cent of the non-consulters smoked, drank heavily or were obese compared with 47 per cent of the average consulters and 61 per cent of the high consulters. The prevalence of recall of high blood pressure which had been diagnosed by a doctor rose from 6 per cent in non-consulters and 10 per cent in average consulters to 29 per cent in high consulters.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

How well do nurse-run telephone consultations and consultations in the surgery agree? Experience in Swedish primary health care.

The telephone consultation service is an important part of Swedish primary health care. However, few studies have compared telephone consultations managed by nurses with surgery consultations managed by both doctors and nurses in terms of information obtained from the patient regarding his or her symptoms, and the management decisions made. In this study, the information obtained from a patient during a telephone consultation with a health centre nurse and the management decisions made, were compared with those obtained at a subsequent surgery consultation with the same nurse, and then with a doctor. Of 200 telephone consultations at a health centre (50 in each of the following four categories as defined by the management decision of the nurse: acute case, semi-acute case, referral case and self-care case), 193 patients were included in the study. The information given to the nurse during the telephone consultation was recorded. The patient was then asked to come for a surgery consultation on the same day, first with the same nurse and then with a general practitioner. A comparison was made between the information obtained and the decisions taken in these three situations. In 185 of the 193 cases (96%) the information led to the same management decision by the nurse, in both the telephone consultation and later in the surgery consultation. In all cases the same history was recorded by the nurse during the telephone and surgery consultations as by the general practitioner. This indicates that in most cases little or no information is missed in a telephone consultation with a nurse as compared with a surgery consultation with a nurse or doctor.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1978

The consultation readiness scale: an attempt to improve consultation practice.

The Consultation Readiness Scale is designed to facilitate mental health and other forms of human services consultation. The scale is based on the assumption that consultee-consultant relationships vary in their "readiness" for consultation. A basic task for consultants is to assess the current readiness level and help move the relationship to a higher level. The Consultation Readiness Scale facilitates this process by specifying six levels of readiness and indicating the general intervention strategies appropriate for each. Initial, descriptive data based on five consultants and 366 consulteees are presented. Most consultation relationships were not as high levels of readiness; readiness varied with the amount of time consultants had worked in the consultees' setting and did not vary by more than one level over a 6-month period.

Community Mental Health Services↗
PubMed1990

The Psychiatric Consultation Checklist: a structured form to improve the clarity of psychiatric consultation requests.

Medical specialty consultation is requested to obtain expert review of a patient's condition. The specialist usually receives a case synopsis with pertinent positives and negatives and a specific request for assistance. In contrast, the psychiatrist often gets a statement of diagnostic speculation (e.g., "depressed") with a request to "please evaluate." Classically, the psychiatric consultant begins with open-ended empathic questioning in an attempt to redefine the written consultation question. However, given the difficulty consultees have in forming questions, and increasing time limitations, a more structured approach to obtaining data might assist both the consultee (M.D. requesting assistance) and the consultant (psychiatrist). The Psychiatric Consultation Checklist (PCC) was devised to function as a paper "expert" questioning system to provide such assistance. In a pilot study, 10 administrations of the PCC took an average of 3.6 minutes. In comparison to consultations using standard forms, more data were supplied in several categories when the PCC was used, particularly regarding patient stressors, patient behaviors of concern, and consultee speculation on psychiatric diagnostic formulation. The PCC may be used in consultation research, for assessment and education of physicians in training (regarding psychiatric issues in the medical/surgical setting), and for general clinical consultation purposes.

Humans↗
PubMed1992

What can doctors do to achieve a successful consultation? Videotaped interviews analysed by the 'consultation map' method.

Positive consultations, where both the GP and the patient had a positive impression, were compared with negative consultations, where both the GP and the patient had a negative impression. The consultations were compared with respect to tasks listed by Pendelton et al. in their 'consultation map', constituting satisfying and efficient consultation. The determining points in the positive consultations were that the GP and the patient were in agreement about the reason for the consultation and that the GP asked about the patients' ideas and concerns or health beliefs. In consequence, the GP used more time to achieve a share understanding with the patient and involved the patient in the management. This last point seemed to be the most discriminating between the positive and the negative consultations.

Adult↗
PubMed1992

Follow-up appointments at consultation clinics: consultants fail in knowing their own practice.

In National Health Care Systems excessive reappointments at consultative clinics can result in over utilization of those services and/or too much retention of patients which frustrates family physicians in their interest for continuity of care for chronic patients. In order better to understand many consultants' complaints about overwork, we examined the proportion of patients who were given follow-up appointments by type of specialty in 2840 consecutive services requested in a multispecialist centre of a prepaid system in Israel, analysing as well the suspected disparity between this proportion and the consultants' perceptions on this subject. The results of this study show that 44.7% of patients at consultant clinics were given follow-up appointments, and that there was a marked disparity between the real and the subjectively estimated rates of follow-up in surgical specialties (rate-ratio 2.4). This suggests that a problem exists in the knowledge that consultants have of the structure of their own practices.

Ambulatory Care Facilities↗
PubMedDate not supplied

Psychiatric consultation with MICU nurses: the consultation conference as a working group.

A group of MICU nurses responded to a series of acute and chronic clinical and administrative stresses by establishing a consultation conference with a psychoanalyst. The evolution of the consultation conference into an ongoing working group is described. Its value as a modality to help deal with the special stresses of MICU nursing personnel is discussed. The problems of introducing a research focus into the conference are examined.

Adult↗
PubMed1976

[Peculiarities of a consultative service and a psychosomatic consultation-hour at a dermatological university clinic (author's transl)].

When organizing a consultative service and a psychosomatic consultation-hour at a dermatological clinic the following (specific?) peculiarities resulted: 1) the fellow doctors at the clinic at first only sent somatically untreatable cases and 2) were afraid of a correction of their diagnosis. 3) By way of identification they were faced with their own proper problems. The patients understood themselves to be physically ill and at first could not be approached regarding to their subconscious conflicts. The actual conduct of the patients in the wards and their attitude to the physicians was used in a psychodiagnostical way (whereas analytical interpretations were dispensed with) and was used therapeutically to elucidate the psycho-genesis of their affliction. Only with some singular patients suffering from skin-diseases a proper analysis could be performed for research purposes; most of them had to be treated simultaneously dermatologically as well as psychoanalytically (in a modified way). Merely with patients suffering from andrological troubles group-therapy along analytical lines was feasible and proved to be successful.

Adult↗
PubMed1991

Consultation-liaison psychiatry. Does it help to get organized? The European Consultation-Liaison Workgroup.

Since 1987 consultation-liaison (C-L) psychiatrists in Europe have decided to develop a closer collaboration to stimulate the development of the C-L field. A first result of this collaboration is a companion paper on the history and current state of C-L psychiatry in Europe. This paper describes the arguments for the development of the European Consultation-Liaison Workgroup for General Hospital Psychiatry and Psychosomatics (ECLW), and the results of the first 3 years of collaboration.

Europe↗
PubMed1991

Diagnostic consultations: a speech-act theoretical reconstruction for the design of consultation systems.

In this paper the theory of speech acts is applied for a structural reconstruction of medical diagnostic consultations. The reconstruction provides the conceptual model for a research prototype of a consultation tool which is expected to play a mediating role between the participants in the professional diagnostic discourse. Preliminary results of the design will be outlined.

Diagnosis, Computer-Assisted↗
PubMed1991

Interinstitutional comparison of frozen-section consultation. A College of American Pathologists Q-Probe study of 79,647 consultations in 297 North American institutions.

In 1989, the College of American Pathologists Q-Probes Quality Assurance Program studied intraoperative frozen-section consultations performed in 297 institutions with mean bed size of 316 (range, 0 to 1351 beds) in North America during 5 consecutive months. The aggregate database was composed of 933,751 surgical cases (mean, 3144 per institution); 52,464 frozen-section cases (mean, 177); and 79,647 individual frozen sections performed (mean, 268). The rate of frozen sections per all surgical case accessions was 5.6% (cases with frozen section) and 7.3% (individual frozen sections performed), with an average of 1.5 frozen sections per case. Frozen-section rate increased proportional to bed size, from less than 5% in institutions with bed size below 150 to 15% in institutions with bed size above 600. Of all frozen sections performed, 4.2% were deferred. Deferrals to paraffin sections in pathologists' opinions were 92.6% appropriate, 1.2% inappropriate, and 6.2% not stated. When frozen-section diagnoses were compared with permanent section diagnoses, there was a 98.3% diagnostic concordance, adjusted for deferred diagnoses, but including the performance of frozen sections on mammographically directed biopsy specimens with no gross abnormalities in 80% of institutions. This practice accounted for 11.8% of the discordant frozen-section diagnoses. The reasons for diagnostic discordances were gross tissue sampling (44.8%); misinterpretation (40%); sectioning (12.7%); inadequate history (5.6%); staining (1.5%); labeling (0.5%); and other (3%). Assessment of diagnostic discordance on patient outcomes by the reviewing pathologist showed that patient management was unaffected in 74%, minimally affected in 20%, and greatly affected in 2.5%.

Biopsy↗
PubMed1991

Consultation-liaison psychiatry in western Europe. The European Consultation-Liaison Workgroup.

Consultation-liaison psychiatry (C-L) services have developed throughout Europe, largely as a result of individual local initiative. Reviews by contributors from 14 countries reveal similarities in national approaches and in the problems caused by inadequate resources, lack of recognition from psychiatric colleagues, and difficulties in integrating C-L with comprehensive systems of psychiatric care, which are mainly oriented toward community care. National C-L organizations and a recently established European Workgroup have focused attention on the clinical importance of C-L and the need to define national and local policies for its clinical role, staffing, and other resources. There is considerable and increasing interest in European C-L research.

Cross-Cultural Comparison↗