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Clinical Strategies in General Practice: GPs' Perceptions
Linköping University, Department of Medicine and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medicine and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medicine and Health Sciences, General Practice. 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.
2009 (English)Article in journal (Other academic) Submitted
Abstract [en]

Background: General practice operates at the point of intersection between health care as a medical-technological and a humanistic enterprise, as manifested through the coherent attention given to both the patient as a person and to the disease.

Objective: To analyse the problem-solving strategies of GPs with regard to problems encountered and presumed patient outcomes throughout the range of problems and patients encountered in the everyday work of the GP.

Methods: Sixteen GPs from different areas of Sweden filled out questionnaires concerning 15-30 of their recent consecutive consultations.

Results: In 94% of the consultations a somatic problem was registered, in 28% of these together with a psychosocial problem. Only a small fraction (5.8%) was registered as psychosocial problems only. In most of the consultations characterised as somatic, the main emphasis was on the symptoms only, whereas emphasis was given only to the person in consultations where the problem was registered as psychosocial. Immediate problem solving was used in about half of the consultations, where the patients were more often considered to be reassured, cope better and to be satisfied. With increasing psychosocial content of the consultations, the GPs registered more dissatisfaction, both for themselves and their patients.

Limitations: The GPs were not randomly selected and the results are based solely on the GPs perceptions.

Conclusions: The GPs seemed to adjust their problem solving (immediate or gradual) to the registered problem and furthermore adjust the immediate problem solving, focusing either on the problem or on the patient as a person. This might be regarded as the quintessence of the expert skill of the experienced GP.

Place, publisher, year, edition, pages
2009.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-18481OAI: oai:DiVA.org:liu-18481DiVA: diva2:219788
Available from: 2009-05-28 Created: 2009-05-28 Last updated: 2009-08-17Bibliographically approved
In thesis
1. Outcomes from GPs' Consultations
Open this publication in new window or tab >>Outcomes from GPs' Consultations
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Resultat av konsultationer hos allmänläkare
Abstract [en]

Background and aims. Patients’ consultations with GPs can deal with a wide range of conditions and problems. Generally, consultation outcomes have been considered in evaluations but outcome has a meaning for elaboration of care beyond the graduating role of quality and other evaluation instruments. Knowledge about outcomes is needed for understanding and development. The aim of this thesis was to investigate outcomes of GPs’ consultations as directly experienced by patients and GPs and to investigate connections between clinical strategies and presumed patient outcomes.

Methods. First, concepts describing outcomes from patients’ and GPs’ viewpoints were developed from interviews in groups and individually. Secondly, based on this, questionnaires about the consultation outcomes were formulated. Then, patients and GPs answered questionnaires regarding the same recent consultation. The numbers of the different outcomes were counted and the experiences of outcomes from the same consultations were compared. Finally, another questionnaire including both the GP outcome questions and questions about the clinical situation and decisions made was answered by GPs.

Results. Concepts describing consultation outcomes were brought forward. Cure/symptom relief, reassurance, patient understanding and satisfaction were used by both patients and GPs to describe outcome of consultations. Only patients described as outcomes a confirmation of their ideas and a change in self-perception. GPs, but not patients, described the patient outcomes in terms of check-up and coping. Besides this, GPs also described other outcomes that concerned relationship-building, a change of surgery routines and self-evaluation. Selfevaluation was related to a perceived collegial consensus about right and wrong. The concordance between GPs and patients assessing the same consultations was high for satisfaction, intermediate for patient understanding and low for belief in cure/symptom relief. Clinical strategies were linked to outcomes. Immediate problem solving was registered in about half the consultations. When immediate problem solving was registered the patients were supposed to be more reassured, satisfied and coped better than after gradual problem solving. With increasing psychosocial content of the consultation the GPs registered more dissatisfaction both for themselves and their patients.

Conclusions. Change in self- perception was a prominent patient outcome. GPs’ self-evaluations ought to have the inherent possibility to serve as a basis for development of general practice.

The entire map of the encountered outcome concepts can serve as a basis for further research and development. The mapping of concepts can be of help when prioritising. Knowledge about the total picture of consultation outcomes can help the GP to understand the patients’ worlds better. It can also contribute to a realistic picture of possible consultation outcomes. The GPs seemed to adjust their problem solving (immediate or gradual) to the registered problem and furthermore adjust the immediate problem solving, focusing either on the problem or on the patient as a person.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2009. 91 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1047
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-18483 (URN)978‐91‐7393‐968‐3 (ISBN)
Public defence
2009-06-04, Aulan, Hälsans Hus, ingång 16, Campus US, Linköpings Universitet , Linköping, 13:00 (English)
Opponent
Supervisors
Available from: 2009-05-28 Created: 2009-05-28 Last updated: 2009-06-10Bibliographically approved

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André, MalinAndén, AnnikaBorgquist, LarsRudebeck, Carl-Edvard

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General PracticeFaculty of Health SciencesDepartment of Medicine and Health SciencesUnit of Research and Development in Local Health Care, County of Östergötland
Medical and Health Sciences

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