Wednesday, 28 January 2015

How Physicians react to complaints

Using a large data set of 7926 doctors, a paper in BMJ Open* sheds some interesting light on how complaints affect doctors. The response rate was low (8.3%), so conclusions have to be interpreted with caution. That said, some of the highlights of study were:
- Of doctors who had a recent complaint (of any kind) 77%  were more likely to suffer from moderate to severe depression than those who have never had a complaint. They also have double the risk of having thoughts of self-harm and double the risk of anxiety.
-  80% of doctors answering the survey reported changing the way they practiced as a result of either complaints against themselves, or after observing a colleague go through a complaints process.

It's a cross sectional paper, so its difficult to establish any casual link. For example, it is possible that doc's suffering from mental health problems may be more likely to have complaints made against them.
Anyway, interesting paper, limitations aside.

* Bourne T, Wynants L, Peters M, et al. The impact of complaints procedures on the welfare, health and clinical practise of 7926 doctors in the UK: a cross-sectional survey. BMJ Open 2015;4:e006687. doi:10.1136/bmjopen-2014- 006687

Wednesday, 21 January 2015

Should physicians wear white coats?

Does physician attire influence patient trust and satisfaction? A 2015 systematic review in BMJ Open [BMJ Open 2015;5:e006578. doi:10.1136/bmjopen-2014-006578] suggests wide variability in preferences, and difficulty in reaching robust conclusions. However, a fine grained reading of the paper highlights some interesting findings:
1.    Patients who received clinical care were less likely to voice preference for any type attire than patients that did not
2.    Studies that included physician encounters were less likely to find specific preferences (3/12 studies) compared to studies conducted outside of a physician–patient meeting (18/18 studies).
3.    Studies originating from the UK, Asia, Ireland and Europe most often expected formal attire with or without white coats (especially among older people.


So, conclusions 1 and 2 seem to suggest that issues concerning physician attire become less important as the patient experience becomes more real.

Tuesday, 20 January 2015

Is technology the enemy of patient history taking?

No one doubts the potential for technology to aid medical decision making and the organization of health systems. However, there is a thought provoking viewpoint in JAMA [http://jama.jamanetwork.com/article.aspx?articleid=2020379] on the potential downside to Electronic Health Records (EHR). The authors use the idea of the 'flipped' patient to argue that EHRs may degrade history taking. To quote the authors; "For a generation for whom texting can be more intimate than face-to-face conversation, there might be an assumption that the EHR is the dialogue with the patient, not a representation of one." Food for thought for any teaching medical students.

Friday, 9 January 2015

HPs perceptions of clinical governance

Great paper in the latest issue of BMJ Open [Gauld R, et al. BMJ Open 2015;5:e006157. doi:10.1136/bmjopen-2014-006157] on HP perceptions of clinical governance in New Zealand. The response rate was 25%, but the results are instructive.  Five key themes illustrating barriers to clinical governance implementation were found, representing problems with: developing management–clinical relations; clinicians stepping up into clinical governance and leadership activities; interprofessional relations; training needs for governance and leadership; and having insufficient time to get involved.

Interestingly, only 47% respondents said they were ‘familiar’ or ‘very familiar’ with the concept of clinical governance. 

Healthcare organizations are populated by educated and motivated people, so the results of the paper seem to suggest that there is a problem with a common/shared vision?

Friday, 7 November 2014

Medical students’ view about deceiving patients with dementia

Dementia is set to become one of the major challenges of the next 50 years, in both the developed and developing world. In a 2014 paper in Aging and Mental health [Aging & Mental Health, 2014 http://dx.doi.org/10.1080/13607863.2014.967173] students expressed uncertainty as to their ability to make judgments about honest communication with patients with dementia and their families. In this very interesting qualitative study, the researchers found that whilst students recognised the importance of the autonomy of each individual with dementia, they expressed difficulties with determining an individual’s‘best interests’ in isolation. Students commented on the apparent mismatch between rule based ethical ideals, as promoted in formal documents about professionalism, and the complexities that they had seen in practice. They expressed anxiety about their own ability to interpret professional guidelines and act in the best interests of individual patients at all times. This is a great paper for both researchers and as a teaching tool. 

Monday, 27 October 2014

Solving global health problems and healthcare

Do the solutions for global health lie in healthcare? A recent analysis article in the BMJ [BMJ 2014;349:g5457 doi: 10.1136/bmj.g5457] should be sobering reading for all of us. The author Jocalyn Clark reminds us to why putting all our money on healthcare to solve global health problems is doomed to failure. The article does a fine job in arguing why we need to find creative solutions that integrate healthcare into the equation. My own take on the piece is that is has interesting implications for how we train and educate doctors. I will be distributing copies of it to the clinicians that I teach, and exploring their reactions to its implications. 

Tuesday, 7 October 2014

Safety and quality are not necessarily the same thing!

An excellent article in BMJ Open [Mumford V, et al. BMJ Open 2014;4:e005284. doi:10.1136/bmjopen-2014-005284] reveals how safety and accreditation processes can travel in different directions. The study involved a longitudinal comparative study of hand hygiene compliance and accreditation outcomes in 96 Australian hospitals. The most interesting aspect of the study was that higher accreditation scores as reflected in hand hygiene rates appears to be confounded by an accreditation programme that makes it more difficult for smaller hospitals to achieve high infection control scores. Basically, smaller hospitals (with good hand hygiene scores) failed to score well on the accreditation programme due to organizational size. As the authors conclude themselves; “In this study, a focus on the accreditation results would underestimate the successful implementation of the hand hygiene policy by smaller hospitals. Conversely, just using hand hygiene results would underestimate the research and leadership investment in infection control by larger hospitals.”