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Use of rules of thumb in the consultation in general practice: an act of balance between the individual and the general perspective
Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Hälsouniversitetet.
Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Hälsouniversitetet.
2003 (engelsk)Inngår i: Family Practice, ISSN 0263-2136, Vol. 20, nr 5, s. 514-519Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Background. Rules of thumb used by GPs could be considered as empirical evidence of intuition and a link between science and practice in general practice.

Objective. The purpose of the present study was to analyse the description of the application of rules of thumb with regard to different situations in general practice.

Methods. An explorative and descriptive study was started with focus group interviews. Four groups with 23 GPs were interviewed. The interviews were transcribed and analysed, and the rules and their application were classified by an editing analysis.

Results. A specific set of rules of thumb was used for rapid assessment, when emergency and psychosocial problems were identified. When the main focus of the problems was identified as somatic or psychosocial, the GPs did not disregard the other aspects but described the use of rules in a simultaneous individualizing and generalizing process. The rules contained probability reasoning and risk assessment.

Conclusion. Rules of thumb seemed to serve as a link between theoretical knowledge and practical experience and were used by the GPs in an act of balance between the individual and the general perspective.

sted, utgiver, år, opplag, sider
2003. Vol. 20, nr 5, s. 514-519
Emneord [en]
Consultation, focus groups, general practice, heuristics
HSV kategori
Identifikatorer
URN: urn:nbn:se:liu:diva-13635DOI: 10.1093/fampra/cmg503OAI: oai:DiVA.org:liu-13635DiVA, id: diva2:21089
Tilgjengelig fra: 2003-03-29 Laget: 2003-03-29 Sist oppdatert: 2018-09-01
Inngår i avhandling
1. Rules of Thumb and Management of Common Infections in General Practice
Åpne denne publikasjonen i ny fane eller vindu >>Rules of Thumb and Management of Common Infections in General Practice
2004 (engelsk)Doktoravhandling, med artikler (Annet vitenskapelig)
Abstract [en]

This thesis deals with problem solving of general practitioners (GPs), which is explored with different methods and from different perspectives. The general aim was to explore and describe rules of thumb and to analyse the management of respiratory and urinary tract infections (RTI and UTI) in general practice in Sweden. The results are based upon focus group interviews concerning rules of thumb and a prospective diagnosis-prescription study concerning the management of patients allocated a diagnosis of RTI or UTI. In addition unpublished data are given from structured telephone interviews concerning specific rules of thumb in acute sinusitis and prevailing cough.

GPs were able to verbalize their rules of thumb, which could be called tacit knowledge. A specific set of rules of thumb was used for rapid assessment when emergency and psychosocial problems were identified. Somatic problems seemed to be the expected, normal state. In the further consultation the rules of thumb seemed to be used in an act of balance between the individual and the general perspective. There was considerable variation between the rules of thumb of different GPs for patients with acute sinusitis and prevailing cough. In their rules of thumb the GPs seemed to integrate their medical knowledge and practical experience of the consultation. A high number of near-patient antigen tests to probe Streptococcus pyogenes (Strep A tests) and C-reactive protein (CRP) tests were performed in patients, where testing was not recommended. There was only a slight decrease in antibiotic prescribing in patients allocated a diagnosis of RTI examined with CRP in comparison with patients not tested. In general, the GPs in Sweden adhered to current guidelines for antibiotic prescribing. Phenoxymethylpenicillin (PcV) was the preferred antibiotic for most patients allocated a diagnosis of respiratory tract infection.

In conclusion, the use of rules of thumb might explain why current practices prevail in spite of educational efforts. One way to change practice could be to identify and evaluate rules of thumb used by GPs and disseminate well adapted rules. The use of diagnostic tests in patients with infectious illnesses in general practice needs critical appraisal before introduction as well as continuing surveillance. The use of rules of thumb by GPs might be one explanation for variation in practice and irrational prescribing of antibiotics in patients with infectious conditions.

sted, utgiver, år, opplag, sider
Institutionen för hälsa och samhälle, 2004
Serie
Linköping University Medical Dissertations, ISSN 0345-0082 ; 840
Emneord
General practice, rules of thumb, decision making, respiratory tract infections, urinary tract infections, diagnostic tests, C-reactive protein test, antibiotic prescribing
HSV kategori
Identifikatorer
urn:nbn:se:liu:diva-5183 (URN)91-7373-812-3 (ISBN)
Disputas
2004-03-12, Aulan, Hälsans hus, Campus US, Linköpings universitet, Linköping, 13:00 (engelsk)
Opponent
Merknad
On the day of the public defence the status of the articles IV and V was: Accepted.Tilgjengelig fra: 2003-03-29 Laget: 2003-03-29

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Totalt: 146 treff
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