Ward Consultations Research Articles

Politeness and dignity on paediatric ward rounds

Introduction The principle of politeness is considered universal and cross cultural, and is deemed by the General Medical Council (GMC) to be a fundamental quality required by all doctors. The audit focused on ward rounds, as they have been identified as a major problem area where there is a lack of respect for patients9 dignity. This audit was conducted to assess any differences between consultants9 and registrars9 levels of politeness and to ensure patients and carers are treated politely and considerately. Methods Sixty eight ward round consultations were observed over a four week period, led by a number of different consultants and registrars. Consultations were assessed prospectively using a pro forma focusing on standards set by the GMC. Results of the consultations were recorded and analysed using Microsoft Excel. Results Comparisons between the consultants and registrars focused on three aspects of politeness: talking at eye level: 84% and 50% (consultants and registrars respectively); introduction by name and grade: 80% and 60%; engaging with child when appropriate: 100% and 89%. Other factors of politeness and dignity monitored included: appropriate greeting (average 99%); knocking door before entering (16%); asking if convenient to enter (24%); using curtain when examining (83%), and taking leave of patient/parent (98%). Conclusion This audit has demonstrated a difference in standards between consultants and registrars, highlighting a training need at registrar level. Not all doctors may consider “knocking before entering”, for example, as a necessary form of politeness, and thus it did not occur regularly. Therefore, there is a need for discussion and clear guidance on what is expected from all doctors, and further research into what constitutes “politeness” within the hospital setting is required.

Transient global amnesia in the district general hospital

Cases of transient global amnesia (TGA) seen by one consultant neurologist over a 4-year period (2002-2005 inclusive) were identified. Of 10 possible cases, eight fulfilled suggested diagnostic criteria. Five cases were seen as ward consultations, three in outpatient clinics; seven were seen in district general hospitals. Six of the eight cases had already been seen by hospital physicians, whose working diagnoses included stroke/TIA and epilepsy. In some cases, this had resulted in inappropriate investigation, treatment and advice. Although rare, TGA is a diagnosis both hospital physicians and general practitioners need to be aware of in order to avoid potential pitfalls. The critical importance of collateral history in reaching the diagnosis is emphasised.

Genetic conditions among patients receiving genetic services in middle Tennessee.

We reviewed genetics charts of 2235 patients seen from 1985 to 1990 at Vanderbilt University Medical Center, Nashville, Tennessee, and summarized the 20 most common reasons for referral (occurring in 1138 of the patients) and the diagnoses or conditions among patients receiving genetic services in one of four clinical settings (prenatal counseling clinics, general genetics clinics, outreach genetics clinics, and ward consultations). The five most common reasons for referral were advanced maternal age (> or = 35 years) (203/1138, or 18% of patients), followed by dysmorphic features/multiple congenital anomalies (MCA) (185/1138; 16%), developmental delay/mental retardation (MR) (168/1138; 15%), Down's syndrome (103/1138; 9%), and abnormal maternal serum alpha-fetoprotein (MSAFP) (74/1138; 7%). The five most common diagnoses or conditions identified for all genetics patients were advanced maternal age (> or = 35 years) (195/906; 22%), developmental delay/MR (111/906; 12%), dysmorphic features/MCA (107/906; 12%), Down's syndrome (88/906; 10%), and multiple fetal losses (57/906; 6%). Of the 20 most common diagnoses or conditions categorized in 602 of the 906 patients, a multifactorial cause was observed in 25% of those patients; a chromosomal cause was observed in 26% of cases of Down's syndrome, accounting for 55% of the chromosomal disorders; a single gene disorder was observed in 17% of patients; an environmental cause was seen in 4%; and an unknown cause was noted in 28%. We hope this study will help physicians in middle Tennessee and surrounding areas by increasing their awareness of the types and frequencies of genetic diseases so that misdiagnoses and delayed referrals can be avoided.

The secondary prevention of stroke in patients with atrial fibrillation.

During ward consultations we are often asked whether a patient with stroke and atrial fibrillation (AF) should receive anticoagulants to prevent recurrence. Of late this question has been less often asked, perhaps because our colleagues prefer a more definitive answer than the one we are able to give to a question that they quite rightly believe ought to have a definite answer. Our reply is usually that we do not know, because the data needed to make a decision are either nonexistent or inadequate. Anticoagulant therapy should, in theory, be helpful. The rationale is reasonably logical and based on the notion that AF (from any cause) leads in some way to the formation of a thrombus in the left atrium. The thrombus then can be carried away— in whole or in part—to the brain, causing cerebral infarction and stroke; subsequent, long-term anticoagulant therapy interferes with this process of thromboembolism and

The Psychiatric Interview in Clinical Practice

The authors have used a refreshing approach to the teaching of interview technique by serially presenting the primary categories of psychiatric patients, and outlining for each the psychopathology, thepsychodynamics, and the specific problems arising during the interview of that type of patient. The orientation is psychoanalytic, but the authors are sufficiently flexible to be comfortably eclectic in situations which require other modes. The student of psychotherapy will find real assistance in the sections on the management of the interview and the specific techniques of establishing the therapeutic alliance. Special situations are dealt with in a second section on the psychosomatic patient, the ward consultation, the psychologically unsophisticated patient, and the psychiatric emergency. The concluding section gives advice on the problems of the telephone in psychiatric practice, the interview via an interpreter, and note-taking. Very few questions are begged, and the majority of the queries a beginning therapist might have are answered; exceptions