Doctor Feels Research Articles

Anliegen und Wünsche gesunder Patienten - wie gehen Hausärzte damit um?

It is hardly known how physicians feel and act if patients complain about social damage, familial tragedies or problems at work instead of illnesses or diseases. Seven general practitioners discussed this subject in a focus-group setting. Within two hours, the three female and four male practitioners described some typical needs and wishes of their healthy patients. They were also encouraged to relate their feelings, reactions and behaviour as doctors. We interpreted the transcript of the recorded discussion according to the rules of a content-analysis. Certificates, (non-medical) advice and information, general care and reducing expenses are the main reasons for healthy patients to see them, the doctors quoted. The doctor's feelings depend on the personality of the patient and the reported problems. As a result, the physician's acceptance of needs and wishes of healthy patients varies over a broad spectrum and the decisions differ and seem arbitrary, although reporting on similar situations. Her/his personal attributes and mood mainly determine their decision about the patient's wishes. The question of whether to refuse or to respect healthy patients' wishes was arbitrary in this focus-group setting. Because no specific medical curriculum exists, rules for doctors' reactions and decisions on social, familial or working problems of their patients could be helpful. In particular, specific problems should be dealt with by social workers and related professions.

HAS ANYONE MET A PATIENT? BALINT GROUPS WITH YOUNG DOCTORS IN THEIR FOUNDATION YEARS AT A COUNTY HOSPITAL IN SWEDEN

Doctors in their foundation years attend a Balint group during their work in different departments at a County Hospital in Sweden. This programme has been a compulsory activity influenced by their Director of Studies. They work at this hospital for 15 months and they meet in the group once a month. In this paper there is a description of how the groups started and a closer perspective on the topics that tend to come back, frequently, in the different groups. This programme has been going on for 7 years and is still running. Frequent topics include how the doctor feels subordinate or insecure, the topic of death, treating friends and family, and reports to the National Swedish Board of Health and Welfare. Some differences in the occurrence of frequent topics between groups for foundation doctors and Balint groups for GPs are also discussed.

Radiología innecesaria en Atención Primaria

The request for diagnostic tests proceeding from primary care shows a progressive increase over time and a great interpersonal variety in the requests, which suggests that ineffective services are being applied. The aim is to determine the characteristics of the those making requests for radiological tests (general radiology and echography) and to quantify the unnecessary tests in primary care. Cross-sectional study of a cluster sample of 23 health centres of Navarre in the month of March 2004. A specific questionnaire was designed to be completed by the doctor requesting the diagnostic test. Logistic regression to study the association between unnecessary tests and the other variables of the study was used. Tests were asked for on 9 per thousand of the population studied. The inter-professional variability in the request for tests oscillated between 0 and 33.3 per 1,000 health cards of children's age. The radiological studies requested with greatest frequency were osseous (48.9%, IC: 42.4-55.5). In 63.2% of the requests no modifications were made to the treatment prior to the request for a test and 57% (IC: 52.4-61.7) of the tests carried out were requested to rule out pathologies. Twenty-four point seven percent (IC: 17.1-29.2) were unnecessary tests and in 15.2% (IC: 10.7-18.2) there was pressure from the patient in the request. In the multivariant analysis significant differences were observed for thorax Rx, changes in the treatment and pressure from the patient. After adjustment for the other variables, the request for an unnecessary test is 12.55 times greater if the doctor feels under pressure from the patient. The correct indication for radiology must be analysed, especially in osseous radiology, and the role of the radiologist in the final decision on carrying out the test must be strengthened.

Medical ethics manual

Medical ethics manual Author: John R Williams Publisher: World Medical Association, Ferney-Voltaire, France; 2005 ISBN: 92-990028-1-9; softcover; 134 pages; English, French and Spanish full-text versions can be downloaded free from the World Medical Association's web site: http://www.wma.net/(copies of the English print version can be obtained by contacting the publisher) In 1999 the Fifty-first Annual General Assembly of the World Medical Association (WMA) passed a resolution that medical ethics and human rights be included as obligatory courses in all medical school curricula. Subsequently, the WMA went through an extensive global consultation process, resulting in publication of its Medical ethics manual. The stated goal of this manual is fill the void of a basic, universally used curriculum for the teaching of medical This is an ambitious but worthy goal. In view of the complexity of today's multicultural and legal bounds to medical practice, burgeoning information overload, and rapid technological advances in medicine, the challenges to producing this manual were enormous. WMA has risen to these challenges well and published a book that has an attractive pocket-size format, is easy to read, and is appealing to a wide audience. The first chapter outlines the principles of medical ethics. The next three chapters deal separately with the principal ethical issues of concern to a physician--those related to the patient, society at large, and colleagues --and in this way the book elegantly simplifies a very complex topic. The penultimate chapter, on the ethics of medical research, is followed by one on the responsibilities and privileges of a physician. These six chapters cover the entire range of issues relevant to medical ethics. Strengthening the teaching of medical ethics; Internet resources; WMA resources; a glossary, and several case studies are subsequently dealt with in five appendixes. One can easily visualize a young doctor in a remote setting having to deal with a patient with a terminal illness but who refuses treatment. The doctor feels morally bound to insist on some treatment--any treatment--for this patient who has entrusted himself to his care. What is this young doctor to do? Does he accept the patient's request to stop treating him, or does he continue prescribing medicines knowing that they may be futile? He has no senior colleague or bioethicist with whom to discuss his dilemma. The Medical ethics manual, particularly the section on the right of self-determination, may provide him with some guidance. There will be many other such instances, in many countries, in many remote settings, where physicians will use this manual to understand better the issues of patient rights, their own responsibilities, and the role of families and others in the care of patients. It deals very comprehensively not only with traditional concepts such as confidentiality, communication, and consent but also with more topical issues: the care of HIV-positive patients; beginning-of-life issues such as assisted reproductive technologies, prenatal genetic screening and abortion; and end-of-life issues such as euthanasia and assisted suicide--topics that are relevant to practising physicians worldwide. Moral and ethical actions are often underpinned by philosophical discourses that can be quite daunting; their presence in a practical book such as this could have been a diversion. The author has deftly skirted this difficult issue by highlighting issues through the use of case studies. These case studies--one per chapter--have been chosen with great care, in that they could apply to a wide variety of settings and are almost universal in their relevance. However, they merely illustrate what is right or wrong. The really interesting and challenging case studies appear in Appendix E. These are examples of what today's doctors commonly and increasingly have to face in their practice but which are moral dilemmas with no clear solutions. …

3310 脈診解析のための基礎的研究(OS15 人工現実感援用教育訓練(I),未来社会を支えるものづくりとひとづくり(設計・システムから))

In Orient medicine, pulse diagnosis is one of the most important diagnosis methods. Because pulse diagnosis is very sensitive, and it requires high level of skill and long experience, it is mostly difficult for a trainee to master. It is also a problem that pulse diagnosis is a technique depending on feelings of separate doctors without a clear standard. In this study, the volume change of the surface of the skin caused by pulsation of the artery was measured as a method of settlement of the above issue point, and the development of the device to analyze pulse diagnosis quantitatively was tried.

The listening loop: a model of choice about cues within primary care consultations

As well as hearing a story at the start of an interaction, listening in medicine involves picking up and checking out patients' cues. Despite this, cues are frequently missed or ignored by doctors. To explore the perceptions of general practitioners (GPs) about initiating listening and choosing not to listen during interactions. Qualitative study constant comparison. Methods General practitioners with over 5 years' experience in practice in a semi-rural area of England took part in a single, semistructured, audiotaped interview which was piloted initially. Interviews were transcribed and analysed according to the precepts of constant comparison. In total, 23 of 24 eligible doctors participated. The data emphasise the importance of spotting cues during interactions. Factors influencing judgements on whether or not to attend to cues included pressure of work, the doctor's mood or feelings about the patient, and the context of the interaction. Methods of limiting, blocking or resisting listening included reassuring, changing the subject, interrupting, being directive or making a plan, reducing sympathy and using body language. A tramline metaphor of choice in listening emerged (the listening loop: a definite period of listening by the GP within the interaction, generally separate to hearing the patient's initial story). The listening loop offers a simple model of listening that emphasises choice and judgement in response to patients' cues within interactions. Emphasising this choice highlights both picking up cues and pragmatic limits and resistance to attending to them, with implications for teaching.

Estructura cognitiva de los médicos de familia en formación sobre la relación médico-paciente

To find and compare thought structures of family doctors in training concerning the doctor-patient relationship. Qualitative and descriptive. Primary care. 10 first-year residents selected through intentional sampling. Piaget interview modified by Pinies evaluated with the propositional analysis technique of concepts and conceptual maps. Five thematic areas concerning doctor-patient relationship were defined: importance and repercussions, characteristics and requisites, model of relationship, patient behaviour and doctor's behaviour. The concepts were not sufficiently elaborated. The importance of the doctor-patient relationship was recognised, but not all its repercussions. Its most oft cited desirable requisite was patient confidence. Those interviewed opted for a relationship in which the patient is passive, although they were aware of the danger of leading questions. The personality of the patient was the most commonly cited determinant of his/her behaviour, but other determinants were mentioned, such as beliefs and expectations. The decision to go for a consultation was not seen just as a product of the symptoms. Denial was the most widely recognised defence mechanism. The role of the doctor's feelings was indicated, but not about how to neutralise them. Training was not emphasised, either. There was insufficient appreciation of the practical importance of the doctor-patient relationship. A directive model of relationship was most common, lacking any biopsychosocial orientation. Training in this area, even though its need is not perceived, should be prioritised. The kind of knowledge underlying doctors' cognitive structure and its role in their behaviour should be investigated.

Clinical trials.

The randomized clinical trial is a scientific method for solving clinical problems. The method is typically employed before a new type of treatment is offered on a major scale in order to safeguard patients against a less curative therapy. Especially with regard to cancer treatment, randomized studies are conducted in increasing numbers. However, there remains a considerable discrepancy between the actual number of patients entered in randomized trials and the eligible number available. The demand of obtaining informed consent is a major reason for not entering patients into randomized studies. The critical item is whether information about randomization as a method for allocation should be disclosed to the patient. The doctor feels embarrassed not to be able to advise and support the patient in decision making about treatment and finds his or her role as the caring doctor replaced by the roulette. The requirement to seek informed consent has increased the rate of denial to participate in randomized trials from a few percent, up to about 50% or even higher.

Encouraging patient participation in general practice consultations: Effect on consultation length and content, patient satisfaction and health

Abstract Following the evidence from earlier research that one-to-one interventions can increase the patient's contribution to the consultation, this paper reports the results from a randomised control trial which assessed the effects of a leaflet designed to enhance patient participation in consultations. A random sample of patients (aged 16 to 74) waiting to see a general practitioner were given either an intervention leaflet, which encouraged the patient to take an active role in the consultation, or a control leaflet which gave dietary advice. The effects of the intervention were assessed by measuring length of consultation, number of questions asked by the patient, patient satisfaction score, doctor's feelings about the consultation, the change in patients' health in the 4 weeks following the consultation (measured by the SF-36 Health Survey) and the number of patient visits to a GP in the following year. The results showed that patients in the intervention group had significantly longer consultation...

The doctor and his feelings: a course for residents in family medicine.

A course on the doctor and his feelings was presented as part of a programme for family medicine residents. The course was led by family physicians and behavioural science professionals who taught as an integrated team. Various teaching techniques were utilized to highlight emotional aspects of the doctor-patient relationship to inexperienced residents. Pre- and post-course assessments suggested there were benefits in a short intensive course of this nature. Possible explanations for the findings are discussed.

A complicating factor: Doctor's feelings as a factor in medical care

A complicating factor: Doctor's feelings as a factor in medical care

Doctors and their spouses speak: stress in medical practice.

Abstract Many sociological articles assume that the patient‐doctor relationship is satisfactory for the doctor and unsatisfactory for the patient. This paper describes a research project on stress among doctors and their families. It seems that the stress the doctor feels may significantly contribute to the problems of the patient‐doctor relationship. For example, doctors who cannot cope with their own stress may find it difficult to help their patients cope with stress. The implications of these findings are discussed in the context of the social structure of medical practice and medical education.

The impact of ward dynamics on psychiatric consultation and liaison

This article has examined the particular characteristics of several medical and surgical services as they affect interaction with psychiatric services. Two central themes have emerged. The first is that physicians in various specialties have different types of commitments to their patients. All are committed to the healing process and request psychiatric consultation when the patient's mental status endangers the healing process. When the danger is less serious, the overall responsibility the doctor feels for his patient, which depends to a large extent on the length and intensity of the doctor-patient relationship, influences the level of his interest in the patient's psychosocial status. Responsibility for management of psychiatric problems often falls on nonphysician staff members. The second theme is that each service has an individual combination of staff personalities, distribution of responsibility amount disciplines, and adminstrative structure. These influence the nature of the C-L work that can be done. A particular liaison intervention cannot be effective in all ward climates and will continue to be disappointing to the C-L staff which provides it. Liaison activities must be designed for the milieu of the specific ward. Teaching should be directed toward the individuals who need and appreciate it most, be they nurses on one ward, social workers on another or physicians on the third.

Referral of patients for psychotherapy.

It is generally agreed that some 15% of the family practitioner's list of patients has an obvious psychiatric disorder,1 and another 10% a hidden one.2 But only a small proportion, varying from one in 10 to one in 20, of these are referred to psychiatrists. Those who are admitted to psychiatric units tend to be acutely and severely disturbed, even psychotic, unlike the bulk who are referred to the psychiatric services as outpatients and those who remain under the care of their general practitioner. These are suffering from either acute or chronic stress, and varying degrees of neurotic disability, personality problems, or psycho? somatic disorder. They are the patients for whom the temporary provision of a holding hospital environment and the suppression of acute symptoms with medication may be unnecessary or insufficient, perhaps even contraindicated as long-term solutions to the underlying problems. Psychotherapy at some level is often indicated. Range of psychotherapeutic techniques The range of psychotherapeutic techniques is now very great ?indeed, even bewildering: individual, group, family and marital, social therapy, behavioural psychotherapy, and a host of new fringe therapies.3 We here attempt to offer some conceptual guidelines to both general practitioners and psychia? trists in considering what established forms of psychotherapy would be appropriate for particular patients. We first considered presenting our ideas historically, beginning with the development of psychoanalysis at the turn of the century, the emergence of individual analytically based psycho? therapy after the first world war, and then of group psycho? therapy and of therapeutic community ideas (social therapy), particularly after the second world war, and, finally, family and marital therapy in the past two or three decades, during which time behavioural psychotherapy has also developed. Finally we chose to turn history on its head in presenting the concept of a series of sieves, or screens, ranging from coarse to fine. This entails examining the patient's problem as part of the disturbance in his living context, firstly, in his marriage or family, then in his general pattern of relationships with others, and, finally, within his internal world. Psychotherapy in the general sense is part of all medicine (or any well-conducted profession). This requires respectful interest in the patient, and recognition of his need for support by a helper who is concerned yet sufficiently detached to be objective. Cawley,4 in describing four different levels of psychotherapy, has called this general approach psychotherapy 1. It is synonymous with the art of medicine?what a good doctor does?and includes the ability to communicate with people with all sorts of back? ground and problems. It is the level too of support and counselling (see below). Psychotherapy 2?what a good psychiatrist does? goes further and includes an ability to communicate with people in all sorts of mental distress and disturbance. It draws on under? standing the role in the patient's problems of his development and patterns of personal relationships, and how these influence his presentation and way of seeking help. A repetition of past, often problematic, relationships within the doctor-patient relation? ship becomes a source of information, particularly in a more ill and disturbed patient, when it tends to reflect child-parent relationships (transference). Such transference is not deliberately fostered and explored as it is in psychotherapy 3, but rather monitored to keep it mildly and appropriately positive. A doctor's feelings (counter-transference) may be used at this level also as a source of important information in general practice, as the Balint group has shown so well.5-7 Psychotherapy 3 is the level of formal, dynamic psychotherapy stemming from the work of Freud, and deliberately explores unconscious conflicts and processes, such as transference, within a regular relationship of increasing intimacy and trust. This may be relatively short term, as in brief or focal psychotherapy, weekly for 10 to 40 sessions,8-10

Keeping up to date.

Despair and consternation almost crush a doctor's curiosity as he watches the pile of medical information grow and grow. The doctor feels that it is his duty to keep up with it, but it all seems too much, whatever his specialty, and all the more so if he has no specialty. Some doctors give up altogether. There was once a general practitioner, the story goes, who every summer lent his house to a faithful locum with generous instruc tions to use the tennis court, the swimming pool, the billiard table?anything. Do what you like, except on no account are you to open the cupboard under the stairs. That and that alone is private. The locum obeyed these instructions year after year, but one summer, overcome by curiosity, he opened the for bidden cupboard and there, neatly arranged on shelves, were 30 years' worth of Lancets?all unopened. The variation on this old chestnut is that the journals were BMJs. His was an extreme case : most of us try a little harder to placate our consciences by at least reading the obituaries before discarding the journal we pay for or get free as part of our membership privileges. This then, is the first lesson : a sense of duty on its own will not take a doctor very far. Keeping up to date must be fun, exciting, and productive. For self-help in keeping up to date Samuel Smiles has provided us with the following dictum: System, economy, and efficiency.

The Outsiders

Throughout the country there has been a recent surge of interest in the correlation between the quality of hospital care and patient satisfaction. Elisabeth Kubler-Ross has called the hospital experience gruesome because it is lonely, mechanical, and dehumanizing.1 In an extensive study of patient adjustment to hospitalization, Hans Mauksch observed that in addition to getting well, most patients must also strive for psychological survival in a power system where the rules for behavior are often ambiguous.2 During a newspaper interview in Charlottesville, Va., Trisha Krupas, a 25 year old secretary suffering from leukemia, said of hospital staff, “the doctor feels all right as long as he can help you, but when confronted with the terminally ill, he feels hopeless. When doctors feel there is nothing more they can do for you, they go out of their way not to see you in the hall. Personal contact is often dropped completely.”3

MANAGEMENT OF THE INDIVIDUAL HYPERTENSIVE PATIENT 1

Our knowledge of hypertension is at present at an awkward stage. The disease process is well enough known to make detailed investigation of the individual patient desirable, but not well enough understood to make the investigation easy Drug therapy is also at a complicated stage; autonomic control of the cardiovascular system has always been a happy hunting-ground for the pharmacologist, and we now have access to what must be the largest range of drugs that is available to any one particular condition. Yet these drugs are largely non-specific; most of them do not, as far as we know, correct any basic abnormality. Added to this is the fact that in treatment of hypertension we are dealing with a sensitive end-point, a fairly narrow range of blood pressure levels at which the patient feels comfortable and the doctor feels satisfied.

Scared to Death

ABSTRACT To the Editor:— The recent commentary in The Journal on premonitions of death (197:516, 1966) brings to mind a similar episode, in which several of my colleagues have laughingly accused me of scaring a patient to death.Dr. Goodwin's comment that Dr. John M. T. Finney said a patient says, 'Doctor, if you operate on me, I am going to die'... don't operate on should be heeded very carefully, but I can go one step further. If the doctor feels he should not operate because of a patient's appearance, then let him postpone the operation. I was all set for a Caldwell-Luc procedure at the Veterans Hospital in Hines, Ill, when they wheeled the patient in. He was white as a sheet, with big globs of perspiration all over his face. He even said he was scared, but we knew that all he needed was reassurance. I

The Uses of Psychology in Geriatric Ophthalmology.

This small volume, although written from the psychiatric point of view, is essentially a discussion of the art of dealing with older patients in the practice of ophthalmology. As such, it will appeal to the younger, inexperienced practitioner, and it will give him a hint of some of the problems he will face. These include the difficulty of evaluating psychologic changes in the elderly, the tendency of some patients not to tell the truth, a discussion of the doctor's role when the patient asks, Will I go blind? and the problem of the elderly driving a car. Emphasis is placed on the importance of individualizing the doctor's response to the specific situation, and on the whole the advice is solid. For instance, it is pointed out that such statements as, If you had only come earlier simply transfer the doctor's feeling of inadequacy to that of the patient. The book