Medical professionalism--who cares?

What is important, what needs treating? How GPs perceive older patients' multiple health problems: a mixed method research study

BACKGROUND

GPs increasingly deal with multiple health problems of their older patients. They have to apply a hierarchical management approach that considers priorities to balance competing needs for treatment. Yet, the practice of setting individual priorities in older patients is largely unexplored. This paper analyses the GPs' perceptions on important and unimportant health problems and how these affect their treatment.

METHODS

GPs appraised the importance of health problems for a purposive sample of their older patients in semi-structured interviews. Prior to the interviews, the GPs had received a list of their patients' health problems resulting from a geriatric assessment and were asked to rate the importance of each identified problem. In the interviews the GPs subsequently explained why they considered certain health problems important or not and how this affected treatment. Data was analysed using qualitative content analysis and quantitative methods.

RESULTS

The problems GPs perceive as important are those that are medical and require active treatment or monitoring, or that induce empathy or awareness but cannot be assisted further. Unimportant problems are those that are well managed problems and need no further attention as well as age-related conditions or functional disabilities that provoke fatalism, or those considered outside the GPs' responsibility. Statements of professional actions are closely linked to explanations of important problems and relate to physical problems rather than functional and social patient issues.

CONCLUSIONS

GPs tend to prioritise treatable clinical conditions. Treatment approaches are, however, vague or missing for complex chronic illnesses and disabilities. Here, patient empowerment strategies are of value and need to be developed and implemented. The professional concepts of ageing and disability should not impede but rather foster treatment and care. To this end, GPs need to be able to delegate care to a functioning primary care team.

TRIAL REGISTRATION

German Trial Register (DRKS): 00000792.

Is it time to define veterinary professionalism?

The medical profession has spent much time and many resources engaging in a discourse of medical professionalism and debating the appropriate attitudes and behavior of physicians, but little has been published concerning the concept of veterinary professionalism. Physicians are commonly examined by social scientists and educationalists to establish definitions of medical professionalism in order to teach and assess these values within curricula. This challenging process has not been without criticism, however, with some calling the numerous definitions unhelpful, especially when these behaviors are not demonstrated in practice or the wider sociological implications of medical professionalism are ignored. Veterinary curricula often include professional skills, and there has been some discussion about their inclusion as well as the scope of veterinary surgeons and their role in society. Despite this, no true definition of veterinary professionalism exists, and the teaching of the values and behaviors expected of veterinary professionals may not be explicit. Regardless of the difficulties of engaging in such a discourse, perhaps it is time that this occurred and a realistic and usable definition of veterinary professionalism is established. This is a period of change for the veterinary profession, and a teachable and assessable definition can provide some clarity and assist educators within ever evolving veterinary curricula.