How to learn skilled communication in primary care MUS consultations: a focus group study

Experiences of hospital rotation from family medicine residents' points of view an empirical holistic study

OBJECTIVE

Trainees or medical residents' experiences of hospital rotations and training have not been sufficiently studied. More empirical holistic studies of experiences of General Practice/Family Medicine (GP/FM) residents in Sweden are needed. The purpose of this study was to describe experiences of hospital rotation during residency.

DESIGN

Empirical-holistic study.

SETTING

GP/FM residents were invited by email to participate in the study. They could describe their experiences anonymously by answering two questions via an esMaker internet survey. Analyses of the responses were carried out with content analysis as the analytical methodology. Both manifest and latent responses were analyzed.

SUBJECTS

Fifty-nine GP/FM residents participated in the study.

MAIN OUTCOME MEASURE

The results identified four main topics: structure, resources, effects, and constructive supervision.

RESULTS

GP/FM residents experienced hospital rotations as effective when there was a structured schedule and adequate time allotted for introduction and meeting patients. Hospital rotations that lacked, or had unstructured, supervision caused uncertainty and insecurity, which led to rotations being experienced as less beneficial, which was, from a GP/FM perspective, not constructive.

CONCLUSION

The study suggests that family medicine residents required a structured and planned schedule during hospital rotations. This study may contribute to increased quality of hospital rotations during residency as a family physician.

The Effect of Characteristics of Patient Communication on Physician Feedback in Online Health Communities: An Observational Cross-Sectional Study

With the rapid development of e-health and telemedicine, previous studies have explored the relationship between physician-patient communication and patient satisfaction; however, there is a paucity of research on the influence of the characteristics of patient communication on the characteristics of physician feedback. Based on the communication accommodation theory, as well as the computer-mediated communication theory and media richness theory, this study aimed to explore how characteristics of patient communication influence characteristics of physician feedback in online health communities. We employed a crawler software to download the communication data between 1652 physicians and 105,325 patients from the Good Doctor platform, the biggest online health community in China. We built an empirical model using this data and employed a multilevel model to test our hypotheses using Stata and Python software. The results indicate that the amount of patients' rendered information positively influences the physicians' text (α = 0.123, t = 33.147, P < .001) and voice feedback (β = 0.201, t = 40.011, P < .001). Patients' hope for help signals and the provision of their electronic health records weaken the effect of the amount of patients' rendered information on physicians' text feedback (α = -0.040, t = -24.857, P < .001; α = -0.048, t = -15.784, P < .001), whereas, it strengthened the effect of the amount of patients' rendered information on physicians' voice feedback (β = 0.033, t = 14.789, P < .001; β = 0.017, t = 4.208, P < .001). Moreover, the occurrence of high-privacy diseases strengthened the effect of the amount of patients' presented information on physicians' text and voice feedback (α = 0.023, t = 4.870, P < .001; β = 0.028, t = 4.282, P < .001). This research contributes to the development of computer-mediated communication theories and sheds light on service delivery in the online health community.

Communication interventions for medically unexplained symptom conditions in general practice: A systematic review and meta-analysis of randomised controlled trials

Background

Medically unexplained symptoms (MUS) account for 3–50% of all General Practitioner (GP) consultations and are difficult to diagnose due to their unknown aetiology, symptom overlap between conditions, and lack of effective treatment options. MUS patients’ and primary care clinicians frequently face challenges during consultations, with GPs reporting difficulty identifying and classifying MUS, whilst patients report stigma and feeling illegitimised by clinicians. Communication interventions have been proposed as a method to facilitate the doctor-patient relationship and aid the management of MUS.

Aim

This systematic review aims to evaluate the effectiveness of primary care based communication interventions at improving MUS patients’ and/or clinician outcomes.

Method

Four electronic databases were searched from inception to November 2021. Two researchers independently undertook screening, data extraction and quality appraisal. Given the heterogeneous nature of the studies identified, narrative syntheses were conducted, along with meta-analyses where possible to pool data.

Results

9 papers from 10 Randomised Controlled Trials were included. The included studies displayed considerable risk of bias and poor reporting. Some limited evidence suggests that communication interventions tailored to MUS and not following a pre-specified model (such as reattribution) could improve pain, mental and physical functioning whilst reattribution training may improve clinician confidence treating MUS. However, methodological limitations mean that these findings should be interpreted with caution.

Conclusion

A range of interventions for improving communication with MUS patients in primary care have been evaluated. However, the heterogeneous nature of existing evidence and poor study quality mean we cannot conclude whether these interventions are effective. Before considering further randomised controlled trials researchers should focus on developing a new or modified communication intervention for MUS patients and their clinicians.

Trail registration

The systematic review was prospectively registered with PROSPERO (registration record CRD42020206437).

Strategies for achieving efficiency in the general practitioner's everyday life

OBJECTIVE

To describe concrete, effective strategies used by experienced GPs to achieve time efficiency, increase patient satisfaction and maintain high medical quality during patient meetings.

DESIGN

Qualitative observation yielded field notes for qualitative content analysis according to Graneheim and Lundman. Follow-up telephone interviews were conducted to get feedback from patients.

SETTING

A normal working day with patient meetings in a primary health care center in Sweden.

SUBJECTS

Five GPs known for being experienced and well-functioning clinicians were strategically chosen to participate in an observational study during patient meetings. Afterwards a random selection of 25 patients (five from each GP) were asked to rate their experience of their meeting.

RESULTS

Observation and analysis of GPs' work before, during, and after patient meetings revealed several concrete strategies, which we classified into two main categories: Behavioral and Communicative, comprising nine and seven subcategories, respectively.

CONCLUSION

Most important behavioral skills for time efficiency were a GP's ability to handle interruptions, and effective administration. Medical quality during patient meetings was most supported by GP continuity and relationship, an exploratory patient-centered approach, a focus on one task at a time, and the ability to acknowledge and learn from medical uncertainty. Patients were most satisfied with GPs who had good communicative skills, good GP continuity and relationship.Key pointsThe changing field of general medicine requires general practitioners (GPs), to work efficiently, but studies on effective work strategies for GPs are scarce.GPs used several concrete strategies falling into two broad categories (behavioral and communicative) that may also be important for other practitioners wishing to improve their methods in clinical patient work.The most important strategies for time efficiency were mainly behavioral; for medical quality during patient meetings, a mix of behavioral and communicative; and for patient satisfaction, communicative.