liu.seSearch for publications in DiVA
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Use of rules of thumb in the consultation in general practice: an act of balance between the individual and the general perspective
Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences.
2003 (English)In: Family Practice, ISSN 0263-2136, Vol. 20, no 5, 514-519 p.Article in journal (Refereed) 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.

Place, publisher, year, edition, pages
2003. Vol. 20, no 5, 514-519 p.
Keyword [en]
Consultation, focus groups, general practice, heuristics
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-13635DOI: 10.1093/fampra/cmg503OAI: oai:DiVA.org:liu-13635DiVA: diva2:21089
Available from: 2003-03-29 Created: 2003-03-29 Last updated: 2009-08-17
In thesis
1. Rules of Thumb and Management of Common Infections in General Practice
Open this publication in new window or tab >>Rules of Thumb and Management of Common Infections in General Practice
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
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.

Place, publisher, year, edition, pages
Institutionen för hälsa och samhälle, 2004
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 840
Keyword
General practice, rules of thumb, decision making, respiratory tract infections, urinary tract infections, diagnostic tests, C-reactive protein test, antibiotic prescribing
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:liu:diva-5183 (URN)91-7373-812-3 (ISBN)
Public defence
2004-03-12, Aulan, Hälsans hus, Campus US, Linköpings universitet, Linköping, 13:00 (English)
Opponent
Note
On the day of the public defence the status of the articles IV and V was: Accepted.Available from: 2003-03-29 Created: 2003-03-29

Open Access in DiVA

No full text

Other links

Publisher's full textLink to Ph.D. Thesis

Authority records BETA

André, MalinBorgquist, LarsMölstad, Sigvard

Search in DiVA

By author/editor
André, MalinBorgquist, LarsMölstad, Sigvard
By organisation
Department of Medicine and Health SciencesFaculty of Health SciencesUnit of Research and Development in Local Health Care, County of Östergötland
Medical and Health Sciences

Search outside of DiVA

GoogleGoogle Scholar

doi
urn-nbn

Altmetric score

doi
urn-nbn
Total: 79 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf