Great systematic review in PLoS One [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4498685/] regarding self-management outcomes. Basically, long term chronic illnesses mean that self-management is crucial, but we don't seem to do enough research about what patients actually value. Great article. My selected highlights are as follows;
"Patients in our review identified that receiving support for self-management which is meaningful and relevant to the context of their lives is an important outcome. However, services often focus upon process driven outcomes, such as length of stay, or change in blood glucose, without necessarily considering the meaningfulness of this for the patient."
"few studies explicitly identified families’ perspectives".
We are left we the interesting problem, of how we can train physicians to better elicit the values of the their patients. Indeed, it begs interesting questions about what values health professionals bring to their work and practice.
The Psychology of Doctors
Doctors are under increasing pressure. Partly, this is due to the high expectations that people bring to medicine, and partly is due to fact that doctors collude in such expectations. The objective of this blog is review psychological research concerning doctors. The blog should be of interest to anybody interested in the role that psychology plays in the life of doctors.
Tuesday 4 August 2015
Friday 12 June 2015
Violence against health care workers - exploring why patients do it
The American Medical Association (AMA) is to
support more research to find interventions to help deal with violence against health
care workers. The statistics are quite revealing. According to the Bureau of
Labour Statistics in the US health care
workers experience the most nonfatal workplace violence compared to other
professions, with attacks at hospital and social service settings accounting
for almost 70 percent of nonfatal workplace assaults.
Research suggests that health-care
workers are hit, kicked, scratched, bitten, spat on, threatened and harassed by
patients with surprising regularity (especially nurses). The current
health care environment often requires that health care workers maintain
optimal performance even in the immediate chaotic aftermath of workplace
violence. Workplace violence prevention has not been given the priority it
rates.
The rates
of violence in both developing and developed countries strongly suggest that
the problem is a system issue, and not a small minority.
Violence
may represent an opportunity to revaluate the degree to which we involve
patients and the public in healthcare delivery, healthcare policy and
healthcare research. Health care workers must be appalled that individuals are ‘fighting’
against the people trying to help them, but answering such questions may help
to provide a more ‘patient’ view of the healthcare journey. We can’t seem to
really involve patients and the public (for a myriad of reasons), and the
violence issue is part of this.
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
- 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.
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