Is there a crisis in clinical consultations?

Launer, John

doi:10.1136/postgradmedj-2016-134691

Cited by 5 publications

(3 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Patients not only often want less medical intervention than their doctors think, but they also want continuity and access to a GP who knows about them as an individual 6. There are many factors preventing good communication in modern general practice,7 , 8 and remaining genuinely patient centred while exploring and negotiating patient priorities, options, and goals requires a high level of communicative competence 9…”

Section: Introductionmentioning

confidence: 99%

Setting goals with patients living with multimorbidity: qualitative analysis of general practice consultations

et al. 2019

View full text Add to dashboard Cite

BackgroundEstablishing patient goals is widely recommended as a way to deliver care that matters to the individual patient with multimorbidity, who may not be well served by single-disease guidelines. Though multimorbidity is now normal in general practice, little is known about how doctors and patients should set goals together.AimTo determine the key components of the goal-setting process in general practice.Design and settingIn-depth qualitative analysis of goal-setting consultations in three UK general practices, as part of a larger feasibility trial. Focus groups with participating GPs and patients. The study took place between November 2016 and July 2018.MethodActivity analysis was applied to 10 hours of video-recorded doctor–patient interactions to explore key themes relating to how goal setting was attempted and achieved. Core challenges were identified and focus groups were analysed using thematic analysis.ResultsA total of 22 patients and five GPs participated. Four main themes emerged around the goal-setting process: patient preparedness and engagement; eliciting and legitimising goals; collaborative action planning; and GP engagement. GPs were unanimously positive about their experience of goal setting and viewed it as a collaborative process. Patients liked having time to talk about what was most important to them. Challenges included eliciting goals from unprepared patients, and GPs taking control of the goal rather than working through it with the patient.ConclusionGoal setting required time and energy from both parties. GPs had an important role in listening and bearing witness to their patients’ goals. Goal setting worked best when both GP and patient were prepared in advance.

show abstract

Section: Introductionmentioning

confidence: 99%

Setting goals with patients living with multimorbidity: qualitative analysis of general practice consultations

et al. 2019

View full text Add to dashboard Cite

show abstract

“…18 Clinicians in higher-performing teams are typically open to rapid and meaningful feedback to guide their actions, and feel empowered to deviate from guidelines using judgement to escape a tyranny of algorithms, rather as Launer and Greenhalgh have called for in general practice. 19,20 The combination of professional empowerment with an open approach to learning, challenge, and dynamic feedback is characteristic of these provider organisations.…”

Section: Unshackling Professionalism Safelymentioning

confidence: 99%

Lifting the dead hand on general practice

Sanfey¹,

Ahluwalia²

2017

Br J Gen Pract

View full text Add to dashboard Cite

According to the Professional Standards Authority (PSA) 'it is primarily the professionalism of individuals that keeps the public safe …'. 1 But GPs find it increasingly difficult to exercise professionalism with the current workload pressures. 2 Part of the problem is over-regulation and bureaucracy, and recently NHS England, the Care Quality Commission (CQC), and the General Medical Council (GMC) called for action to lessen the burden. 3 Any reduction will help, but it may prove more important to understand the culture that drives over-regulation. We seem to be locked in a vicious cycle that undermines professionalism. With every stepwise increase in workload comes further micro-management and control, which make matters worse. Only by understanding the mechanics of this damaging cycle, can we change the culture of control to one that makes better use of the most valuable resource in the NHS: the professionalism of its workforce. WHEN CONTROL SYSTEMS BACKFIRE Sanfey and Ahluwalia have described a fearavoidance cycle that emerges whenever a prevailing regulatory culture is seen as oppressive or punitive. 4 Doctors become reluctant to openly investigate and correct flaws in the care they deliver. Without selfcorrection by professionals, regulators feel compelled to impose external controls, which generate yet more fear, and so on. A similar vicious cycle may also be driving up costs. In advanced economies, up to 30% of total healthcare spending can be medically unnecessary. 5 In the UK, defensive practice is rising inexorably, driven largely by fear, 6 and increasing the proportion of unnecessary referrals, investigations, and prescriptions. 7 Economic models however, are very poor at distinguishing necessary from unnecessary healthcare. 5 They interpret the rise in medical interventions as increased patient demand, which means a vicious cycle can develop when methods for controlling expenditure also increase medically unnecessary interventions. Staff and tariff costs were targeted to improve productivity in the first Quality, Innovation, Productivity, and Prevention programme (QIPP) from 2010-2015. Cutting pay causes stress, which together with excessive workload, burnout, and riskaversion is known to generate unnecessary referrals, prescriptions, and investigations. 8,9

show abstract

“…Clinical consultation skills are a core component of medical student training and postgraduate practice, and essential in the delivery of high-quality healthcare [ 1 , 2 ]. Some clinicians, however, feel the standard of modern-day clinical consultations is poor and have been advocating for improvement [ 3 ]. Dr Gordon Caldwell has proposed 10 indicators to improve the quality of clinical consultations, and thereby improve patient outcomes, patient experience, patient safety, and staff satisfaction (see Figure 1 ) [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Quality in Clinical Consultations: A Cross-Sectional Study

Graf

Koh

Caldwell³

et al. 2022

Clinics and Practice

View full text Add to dashboard Cite

The coronavirus disease 2019 pandemic may have affected the quality of clinical consultations. The objective was to use 10 proposed quality indicator questions to assess outpatient consultation quality; to assess whether the recent shift to telemedicine during the pandemic has affected consultation quality; and to determine whether consultation quality is associated with satisfaction and consultation outcome. A cross-sectional study was used to survey clinicians and patients after outpatient consultations (1 February to 31 March 2021). The consultation quality score (CQS) was the sum of ‘yes’ responses to the survey questions. In total, 78% (538/690) of consultations conducted were assessed by a patient, clinician, or both. Patient survey response rate was 60% (415/690) and clinician 42% (291/690). Face-to-face consultations had a greater CQS than telephone (patients and clinicians < 0.001). A greater CQS was associated with higher overall satisfaction (clinicians log-odds: 0.77 ± 0.52, p = 0.004; patients log-odds: 1.35 ± 0.57, p < 0.001) and with definitive consultation outcomes (clinician log-odds: 0.44 ± 0.36, p = 0.03). In conclusion, consultation quality is assessable; the shift to telemedicine has negatively impacted consultation quality; and high-quality consultations are associated with greater satisfaction and definitive consultation outcome decisions.

show abstract

Is there a crisis in clinical consultations?

Cited by 5 publications

References 4 publications

Setting goals with patients living with multimorbidity: qualitative analysis of general practice consultations

Setting goals with patients living with multimorbidity: qualitative analysis of general practice consultations

Lifting the dead hand on general practice

Quality in Clinical Consultations: A Cross-Sectional Study

Contact Info

Product

Resources

About