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?