Umgang mit Unbestimmtheit – zur Hypermodernität des Hausarztes

Barth, Niklas; Nassehi, Armin; Schneider, Antonius

doi:10.1016/j.zefq.2013.11.004

Cited by 6 publications

(5 citation statements)

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“…Our decision to restrict ourselves to therapeutically indeterminate situations was arbitrary and followed from our specific study question. A lot of indeterminateness is clearly strongly related to diagnostic uncertainty [15, 32]. Furthermore, we expect that therapeutically indeterminate situations occur in many medical areas, but probably less frequently than in general practice and with somewhat different features.…”

Section: Discussionmentioning

confidence: 99%

“…Such situations occur frequently in encounters with patients suffering from minor illnesses, non-specific complaints, medically unexplained symptoms, or long-lasting complaints associated with chronic diseases. Our assumption was based on three strands of evidence: 1) the limited number of qualitative studies addressing the issue of “non-scientific prescribing” in a broader manner [8–12], 2) the quantitative work on the widespread use of CAM and non-specific treatments partly cited above, and 3) sociological work on indeterminateness [13–15]. Among the studies on “non-scientific prescribing” Comaroff’s seminal study among 51 Welsh GPs from 1976 [8] had a great influence on our thinking, and caused us to wonder whether her findings still apply today.…”

Section: Introductionmentioning

confidence: 99%

“…Compared to uncertainty, indeterminateness is not only a problem but also a basis for productive and creative strategies. Given the level of uncertainty in day-to-day practice, GPs should be almost specialists in dealing with therapeutic indeterminateness [15].…”

Section: Introductionmentioning

confidence: 99%

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On the edges of medicine – a qualitative study on the function of complementary, alternative, and non-specific therapies in handling therapeutically indeterminate situations

et al. 2019

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Background In routine practice, general practitioners (GPs) see many patients for whom treatment might not be necessary, or evidence-based treatments are not available, yet often a treatment is prescribed. We denote such situations as therapeutically indeterminate. We aimed to investigate 1) whether therapeutically indeterminate situations play a role in the accounts of GPs in their practical work; 2) the role of complementary and alternative medicine (CAM) modalities or non-specific therapies, and of other strategies used in handling therapeutically indeterminate situations; and 3) factors associated with preferences for specific strategies. Methods We performed semi-structured, individual face-to-face interviews with 20 purposively sampled, experienced GPs from Bavaria, Germany. A grounded theory approach was used for data analysis. Results Participants reported that therapeutically indeterminate situations recur often in their daily practice. Professionally legitimate strategies such as empathetic consultations without providing a treatment intervention did not seem to suffice for coping with all of these situations. CAM treatments were used frequently, but motives varied. While some participants were convinced that these treatments were active and effective, others were uncertain or had doubts and used them as a relational tool, as a non-specific treatment or as a beneficial placebo. Conventional drugs were also used in a non-specific manner or despite doubts regarding the risk-benefit ratio. The extent to which GPs felt responsible for offering solutions in therapeutically indeterminate situations seemed to influence their preference for specific strategies. Conclusion Our results demonstrate the important role of CAM and the somewhat smaller role of non-specific therapies for German general practitioners in dealing with therapeutically indeterminate situations. The concept of therapeutically indeterminate situations may be helpful in better understanding why many general practitioners treat patients in situations where treatment does not appear to be clearly indicated. Electronic supplementary material The online version of this article (10.1186/s12875-019-0945-4) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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On the edges of medicine – a qualitative study on the function of complementary, alternative, and non-specific therapies in handling therapeutically indeterminate situations

et al. 2019

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“…[16,17] [24]. In der Allgemeinmedizin spielt sie jedoch eine besonders wichtige Rolle [9,[25][26][27]. Dies spiegelt sich auch darin wieder, dass empirische Forschungsarbeiten zu diesem Themenbereich vergleichsweise häufig aus der Allgemeinmedizin kommen (siehe [16,28,29] Bei der Interpretation unserer Ergebnisse ist zu beachten, dass die von den Teilnehmer*innen berichteten Unterschiede zwar zu einem erheblichen Teil auf die Unterschiede zwischen der Arbeit im Krankenhaus und in der hausärztlichen Praxis zurückzuführen sein dürften, zum Teil aber auch auf Unterschiede zwischen Theorie (im Medizinstudium) und Praxis sowie zwischen der Arbeit als Spezialist und Generalist [27].…”

Section: Diskussionunclassified

“…Aufgrund der häufig langfristigen Beziehung sind AÄ ihren Patient*innen in besonderem Maße individuell verpflichtet, gleichzeitig kommt ihnen im Sinne eines Gatekeepers oder eines Koordinators eine Schlüsselrolle bei der Vermeidung unnötiger Maßnahmen zu [4]. Aus diesen Gründen unterscheiden sich die praktischen Heuristiken, Prozesse und Vorgehensweisen von AÄ zum Teil erheblich von denen von Fachärzten anderer Disziplinen [2,3,[5][6][7][8][9].…”

Section: Introductionunclassified

Wie erleben junge Allgemeinärzt*innen den Übergang in die hausärztliche Praxis? Eine qualitative Studie

Linde

Huber

Barth

et al. 2020

Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheit

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Schlüsselwörter: Primärversorgung Allgemeinmedizin Unsicherheit Krankenhaus Weiterbildung Qualitative Studien z u s a m m e n f a s s u n g Hintergrund: Obwohl die Bedeutung der Allgemeinmedizin in den letzten Jahren gestärkt wurde, bleiben Medizinstudium und die klinische Phase der Weiterbildung von der spezialisierten Versorgung schwerkranker Menschen in Krankenhäusern dominiert. Es erscheint plausibel anzunehmen, dass junge Ärzt*innen durch diesen klinischen Fokus geprägt sind. Ziel: Zu untersuchen, wie junge Allgemeinärzt*innen den Übergang aus Studium und klinischer Weiterbildung in die hausärztliche Praxis wahrnehmen. Methoden: In einer qualitativen Studie wurden insgesamt 13 Ärzt*innen in Weiterbildung zum Facharzt für Allgemeinmedizin bzw. Fachärzt*innen für Allgemeinmedizin, die ihre Facharztprüfung vor maximal zwei Jahren abgeschlossen hatten, in problemorientierten Interviews befragt. Die Interviews wurden mittels einer zusammenfassenden Inhaltsanalyse ausgewertet. Ergebnisse: Für die Studienteilnehmer*innen waren die großen Unterschiede des ärztlichen Arbeitens in Klinik und hausärztlicher Praxis zu Beginn eine einschneidende Erfahrung. Zentrale Unterschiede bzw. Herausforderungen im Vergleich zur Arbeit in einem Krankenhaus waren 1) die völlig anderen Patienten bzw. Beschwerden, mit denen sie konfrontiert waren; 2) zu lernen, dass man in vielen Situationen auf Zeit spielen kann und sollte (,,abwartendes Offenlassen''); 3) abwendbar gefährliche Verläufe effizient ausschließen und das entsprechende Restrisiko aushalten zu können; 4) dass es manchmal nicht sinnvoll bzw. unmöglich ist, eine Diagnose zu stellen; 5) dass das Verhältnis zum Patienten in der Praxis partnerschaftlicher sein muss; und 6) dass häufig ein Handlungsdruck besteht oder empfunden wird, obwohl aus medizinisch-wissenschaftlicher Sicht keine eindeutige Handlungsnotwendigkeit bzw. -option besteht. Schlussfolgerungen: Die Ergebnisse bestätigen die deutliche Prägung der Studienteilnehmer*innen durch Studium und die klinische Phase der Weiterbildung. Die ärztliche Arbeit in Krankenhaus und hausärztlicher Praxis wird als sehr unterschiedlich empfunden.a b s t r a c t Background: Although the role of general practice has been strengthened in recent years, undergraduate teaching at medical schools and the clinical phase of specialist training remain dominated by specialized care of seriously ill people in hospitals. It is to be assumed that young doctors' views on medical care are strongly shaped by this clinical focus. Objective: To investigate how young general practitioners (GPs) perceive transition from medical school and hospital work to general practice. Methods: In a qualitative study, a total of 13 physicians in specialist training for general practice as well as general practitioners who had completed their specialist examination up to two years ago participated in problem-oriented interviews. The interviews were analyzed using content analysis. Results: The significant differences between hospital-based and primary care practice ini...

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The conceptualization of acute bronchitis in general practice – a fuzzy problem with consequences? A qualitative study in primary care

2023

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Background Acute bronchitis is one of the most frequent diagnoses in primary care. Scientifically, it is conceptualized as a viral infection. Still, general practitioners (GPs) often prescribe antibiotics for acute bronchitis. The explanation for this discrepancy may lie in a different conceptualization of acute bronchitis. Therefore, we wanted to know, how GPs conceptualize acute bronchitis, and how they differentiate it from common cold and pneumonia. Furthermore, we tried to find out the GPs’ reasons for prescribing antibiotics in those cases. Methods To answer our study questions, we conducted a qualitative study with GPs in Bavaria, Germany, by using semi-structured guided interviews. The analysis of the data was conducted using the documentary method according to Ralf Bohnsack. The transcripts were subdivided into categories. Analyzing each part by reflective interpretation, first manually, secondly with the help of RQDA, we extracted the most representative citations and main messages from the interviews. Results The term acute bronchitis seems to be applied when there is neither certainty of the diagnosis common cold, nor of pneumonia. It seems it bridges the gap of uncertainty between supposedly harmless clinical pictures (common cold/viral), to the more serious ones (pneumonia/bacterial). The conceptual transitions between common cold and acute bronchitis on the one side, and acute bronchitis and pneumonia on the other are fluid. The diagnosis acute bronchitis cannot solve the problem of uncertainty but seems to be a label to overcome it by offering a way to include different factors such as severity of symptoms, presumed signs of bacterial secondary infection, comorbidities, and presumed expectations of patients. It seems to solve the pathophysiologic riddle of bacterial or viral and of decision making in prescribing antibiotics. Conclusion Acute bronchitis as an "intermediate category" proved difficult to define for the GPs. Applying this diagnosis leaves GPs in abeyance of prescribing an antibiotic or not. As a consequence of this uncertainty in pathophysiologic reasoning (viral or bacterial) other clinical and social factors tip the balance towards antibiotic prescribing. Teaching physicians to better think in probabilities of outcomes instead of pathophysiologic reasoning and to deal with uncertainty might help reducing antibiotic overprescribing.

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Umgang mit Unbestimmtheit – zur Hypermodernität des Hausarztes

Cited by 6 publications

References 9 publications

On the edges of medicine – a qualitative study on the function of complementary, alternative, and non-specific therapies in handling therapeutically indeterminate situations

On the edges of medicine – a qualitative study on the function of complementary, alternative, and non-specific therapies in handling therapeutically indeterminate situations

Wie erleben junge Allgemeinärzt*innen den Übergang in die hausärztliche Praxis? Eine qualitative Studie

The conceptualization of acute bronchitis in general practice – a fuzzy problem with consequences? A qualitative study in primary care

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