Courteous but not curious: how doctors’ politeness masks their existential neglect. A qualitative study of video-recorded patient consultations

Courteous but not curious: how doctors’ politeness masks their existential neglect. A qualitative study of video-recorded patient consultations — Agledahl et al. 37 (11): 650 — Journal of Medical Ethics.

This article is available freely via Open Access. Please click on the above link to view it fully.

Abstract

Objective To study how doctors care for their patients, both medically and as fellow humans, through observing their conduct in patient–doctor encounters.

Design Qualitative study in which 101 videotaped consultations were observed and analysed using a Grounded Theory approach, generating explanatory categories through a hermeneutical analysis of the taped consultations.

Setting A 500-bed general teaching hospital in Norway.

Participants 71 doctors working in clinical non-psychiatric departments and their patients.

Results The doctors were concerned about their patients’ health and how their medical knowledge could be of service. This medical focus often over-rode other important aspects of the consultations, especially existential elements. The doctors actively directed the focus away from their patients’ existential concerns onto medical facts and rarely addressed the personal aspects of a patient’s condition, treating them in a biomechanical manner. At the same time, however, the doctors attended to their patients with courteousness, displaying a polite and friendly attitude and emphasising the relationship between them.

Conclusions The study suggests that the main failing of patient–doctor encounters is not a lack of courteous manners, but the moral offence patients experience when existential concerns are ignored. Improving doctors’ social and communication skills cannot resolve this moral problem, which appears to be intrinsically bound to modern medical practice. Acknowledging this moral offence would, however, be the first step towards minimising the effects thereof.

 

Acceptability of financial incentives to improve health outcomes in UK and US samples

Acceptability of financial incentives to improve health outcomes in UK and US samples — Promberger et al. 37 (11): 682 — Journal of Medical Ethics.

This article is available freely via Open Access. Please click on the above link to view it fully.

Abstract

In an online study conducted separately in the UK and the US, participants rated the acceptability and fairness of four interventions: two types of financial incentives (rewards and penalties) and two types of medical interventions (pills and injections). These were stated to be equally effective in improving outcomes in five contexts: (a) weight loss and (b) smoking cessation programmes, and adherence in treatment programmes for (c) drug addiction, (d) serious mental illness and (e) physiotherapy after surgery. Financial incentives (weekly rewards and penalties) were judged less acceptable and to be less fair than medical interventions (weekly pill or injection) across all five contexts. Context moderated the relative preference between rewards and penalties: participants from both countries favoured rewards over penalties in weight loss and treatment for serious mental illness. Only among US participants was this relative preference moderated by perceived responsibility of the target group. Overall, participants supported funding more strongly for interventions when they judged members of the target group to be less responsible for their condition, and vice versa. These results reveal a striking similarity in negative attitudes towards the use of financial incentives, rewards as well as penalties, in improving outcomes across a range of contexts, in the UK and the USA. The basis for such negative attitudes awaits further study.

Retractions in the medical literature: how many patients are put at risk by flawed research?

Retractions in the medical literature: how many patients are put at risk by flawed research? — Steen 37 (11): 688 — Journal of Medical Ethics.

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Abstract

Background Clinical papers so flawed that they are eventually retracted may put patients at risk. Patient risk could arise in a retracted primary study or in any secondary study that draws ideas or inspiration from a primary study.

Methods To determine how many patients were put at risk, we evaluated 788 retracted English-language papers published from 2000 to 2010, describing new research with humans or freshly derived human material. These primary papers—together with all secondary studies citing them—were evaluated using ISI Web of Knowledge. Excluded from study were 468 basic science papers not studying fresh human material; 88 reviews presenting older data; 22 case reports; 7 papers retracted for journal error and 23 papers unavailable on Web of Knowledge. Overall, 180 retracted primary papers (22.8%) met the inclusion criteria. Subjects enrolled and patients treated in 180 primary studies and 851 secondary studies were combined.

Results Retracted papers were cited over 5000 times, with 93% of citations being research related, suggesting that ideas promulgated in retracted papers can influence subsequent research. Over 28 000 subjects were enrolled—and 9189 patients were treated—in 180 retracted primary studies. Over 400 000 subjects were enrolled—and 70 501 patients were treated—in 851 secondary studies which cited a retracted paper. Papers retracted for fraud (n=70) treated more patients per study (p<0.01) than papers retracted for error (n=110).

Conclusions Many patients are put at risk by retracted studies. These are conservative estimates, as only patients enrolled in published clinical studies were tallied.

Internet ‘may be changing brains’

Social network sites may be changing people’s brains as well as their social life, research suggests.

via BBC News – Internet ‘may be changing brains’.

Charity calls for ‘democratic revolution’ in care homes

A leading health charity has called for a “democratic revolution” in the way care homes in Britain are run.

via BBC News – Charity calls for ‘democratic revolution’ in care homes.

EU rules on health staff ‘put patients at risk’

Patients are being put at “unacceptable risk” because of EU rules governing the movement of health workers, peers say.

via BBC News – EU rules on health staff ‘put patients at risk’.

The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials

Source: The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials — Higgins et al. 343 — bmj.com.

This article is available freely via Open Access. Please click on the above link to view it fully.

Extract: Flaws in the design, conduct, analysis, and reporting of randomised trials can cause the effect of an intervention to be underestimated or overestimated. The Cochrane Collaboration’s tool for assessing risk of bias aims to make the process clearer and more accurate

Randomised trials, and systematic reviews of such trials, provide the most reliable evidence about the effects of healthcare interventions. Provided that there are enough participants, randomisation should ensure that participants in the intervention and comparison groups are similar with respect to both known and unknown prognostic factors. Differences in outcomes of interest between the different groups can then in principle be ascribed to the causal effect of the intervention. 1

Very low birthweights linked to autism

Source: Very low birthweights linked to autism – Health News – NHS Choices.

NHS Choices examines the science behind the newspaper headlines.

Conclusion

This study has suggested that about 5% of children of low birthweight (<2000g) in the US may go on to develop autistic spectrum disorders (ASDs). This is higher than previous estimates for the general population of children in the US (estimated at 0.9% among eight year olds). When considering these results there are both strengths, such as the prospective nature of the study, and limitations that must be taken into account:

• The children in this study were specifically assessed to see if they had autism, which means that more cases might be picked up than would be found than in the general population, who are not all assessed for autism. Ultimately, this raises the question of whether the results reflect greater prevalence among underweight babies or greater rates of diagnosis. Ideally, the study would have included a group of babies of different birthweights all born in the same period, and followed them all up and assessed them in the same way. This would also allow them to take into account any other differences between low birthweight and normal birthweight babies that could influence rates of ASDs.
• The general population prevalence figures were based on children aged eight, and these figures may differ from those found among adolescents and young adults such as those in this study.
• A high proportion (40%) of those assessed at age 16 could not be assessed again at age 21, and this could have influenced the results.
• Not all participants received all parts of the screening and diagnostic assessments.

The results of this study need to be confirmed by more robust studies with a control group of infants with normal birthweight. It is also worth bearing in mind the quote from Dorothy Bishop, professor of developmental neuropsychology at the University of Oxford, in the BBC News: ‘The association looks real, but nevertheless, most low birthweight children don’t have autism, and most children with autism don’t have low birthweight.’

 

 

 

 

 

 

 

Links to the headlines

Low birthweight ‘linked to autism’, says US study. BBC News, October 17 2011

Links to the science

Pinto-Martin JA, Levy SE, Feldman JF et al. Prevalence of Autism Spectrum Disorder in Adolescents Born Weighing <2000 Grams. Pediatrics, Published online October 17 2011

 

GPs striking off patients ‘with no warning’

Some GPs are striking off patients from practice lists without warning, the Health Service Ombudsman says.

via BBC News – GPs striking off patients ‘with no warning’.

Better hospital IT ‘would save thousands of lives’

Better use of information technology in England’s hospitals could help prevent 16,000 deaths a year, a report says.

via BBC News – Better hospital IT ‘would save thousands of lives’.

Healthy lives, healthy people: a call to action on obesity in England

Source: Healthy lives, healthy people: a call to action on obesity in England : Department of Health – Publications.

This document sets out how the new approach to public health will enable effective action on obesity and encourages a wide range of partners to play their part.

 

Change4Life three year social marketing strategy

Source:Change4Life three year social marketing strategy : Department of Health – Publications.

This document sets out a new three-year marketing strategy (2011–14) for the Change4Life programme. It is published as a companion to Healthy Lives, Healthy People: A call to action on obesity in England and describes how the Change4Life social marketing programme will support the achievement of the new national obesity ambitions, as well as promoting other, broader, lifestyle changes

 

 

Strong leadership is needed to steer NHS through planned changes, conference hears

Source: Strong leadership is needed to steer NHS through planned changes, conference hears — McGauran 343 — bmj.com.

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Healthcare in England is facing a very difficult moment similar to its “big transition” when the 2001 NHS Plan introduced targets on waiting times for hospital treatment, the former NHS chief executive, Nigel Crisp, has said.

 

DH publishes detailed plans for commissioning support

via Exclusive: DH publishes detailed plans for commissioning support | News | Health Service Journal.

This article is solely the work of the HSJ. For a full copy of the article please contact the library.

The Department of Health has identified four commissioning support functions which could be run most effectively at a national level.

Implementation and adoption of nationwide electronic health records in secondary care in England: final qualitative results from prospective national evaluation in “early adopter” hospitals — Sheikh et al. 343 — bmj.com

Source: Implementation and adoption of nationwide electronic health records in secondary care in England: final qualitative results from prospective national evaluation in “early adopter” hospitals — Sheikh et al. 343 — bmj.com.

This article is available freely via Open Access. Please click on the above link to view it fully.

 

Abstract

Objectives To evaluate the implementation and adoption of the NHS detailed care records service in “early adopter” hospitals in England.

Design Theoretically informed, longitudinal qualitative evaluation based on case studies.

Setting 12 “early adopter” NHS acute hospitals and specialist care settings studied over two and a half years.

Data sources Data were collected through in depth interviews, observations, and relevant documents relating directly to case study sites and to wider national developments that were perceived to impact on the implementation strategy. Data were thematically analysed, initially within and then across cases. The dataset consisted of 431 semistructured interviews with key stakeholders, including hospital staff, developers, and governmental stakeholders; 590 hours of observations of strategic meetings and use of the software in context; 334 sets of notes from observations, researchers’ field notes, and notes from national conferences; 809 NHS documents; and 58 regional and national documents.

Results Implementation has proceeded more slowly, with a narrower scope and substantially less clinical functionality than was originally planned. The national strategy had considerable local consequences (summarised under five key themes), and wider national developments impacted heavily on implementation and adoption. More specifically, delays related to unrealistic expectations about the capabilities of systems; the time needed to build, configure, and customise the software; the work needed to ensure that systems were supporting provision of care; and the needs of end users for training and support. Other factors hampering progress included the changing milieu of NHS policy and priorities; repeatedly renegotiated national contracts; different stages of development of diverse NHS care records service systems; and a complex communication process between different stakeholders, along with contractual arrangements that largely excluded NHS providers. There was early evidence that deploying systems resulted in important learning within and between organisations and the development of relevant competencies within NHS hospitals.

Conclusions Implementation of the NHS Care Records Service in “early adopter” sites proved time consuming and challenging, with as yet limited discernible benefits for clinicians and no clear advantages for patients. Although our results might not be directly transferable to later adopting sites because the functionalities we evaluated were new and untried in the English context, they shed light on the processes involved in implementing major new systems. The move to increased local decision making that we advocated based on our interim analysis has been pursued and welcomed by the NHS, but it is important that policymakers do not lose sight of the overall goal of an integrated interoperable solution.

Specialists condemn government’s obesity plan as too simplistic

Source: Specialists condemn government’s obesity plan as too simplistic — Mayor 343 — bmj.com.

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Experts in public health and obesity have condemned the government’s plan for reducing obesity in England because it focuses only on individual responsibility and fails to tackle the influence of the food and drinks industry, they say.

 

Doctor is suspended for prescribing a drug for pornography “addiction” without giving the risks

A doctor in private practice has been suspended for six months by the General Medical Council for giving the unlicensed hallucinogenic drug ibogaine to a man obsessed with internet pornography without fully explaining the drug’s risks

Source: Doctor is suspended for prescribing a drug for pornography “addiction” without giving the risks — Dyer 343 — bmj.com.

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Good news about the ageing brain

Source: Good news about the ageing brain — Richards and Hatch 343 — bmj.com.

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Important cognitive skills decline with age, but we retain a considerable mental richness in later life, say Marcus Richards and Stephani Hatch

 

Addiction help disadvantage for older people

Source: Addiction help disadvantage for older people | News | Health Service Journal.

This article is solely the work of the HSJ. For a full copy of the article please contact the library.

GPs and other health professionals should undergo more training to help older people who are dependent on alcohol or drugs, experts have warned.

 

Hospitals eye charges for disabled parking spaces

Source: Hospitals eye charges for disabled parking spaces | News | Health Service Journal.

This article is solely the work of the HSJ. For a full copy of the article please contact the library.

Campaigners have criticised plans to charge disabled people for parking at hospital appointments.

 

Preventing alcohol misuse in young people aged 9-11 years through promoting family communication: an exploratory evaluation of the Kids, Adults Together (KAT) Programme

Source: Abstract | Preventing alcohol misuse in young people aged 9-11 years through promoting family communication: an exploratory evaluation of the Kids, Adults Together (KAT) Programme.

Abstract (provisional)

 

Background

Alcohol misuse by young people is an important public health issue, and has led to the development of a range of prevention interventions. Evidence concerning the most effective approaches to intervention design and implementation is limited. Parental involvement in school-based interventions is important, but many programmes fail to recruit large numbers of parents. This paper reports findings from an exploratory evaluation of a new alcohol misuse prevention programme – Kids, Adults Together (KAT), which comprised a classroom component, engagement with parents through a fun evening for families with children aged 9-11 years, and a DVD. The evaluation aimed to establish the programme’s theoretical basis, explore implementation processes and acceptability, and identify plausible precursors of the intended long-term outcomes.

Methods

Documentary analysis and interviews with key personnel examined the programme’s development. Classroom preparation and KAT family events in two schools were observed. Focus groups with children, and interviews with parents who attended KAT family events were held immediately after programme delivery, and again after three months. Interviews with head teachers and with teachers who delivered the classroom preparation were conducted. Follow-up interviews with programme personnel were undertaken. Questionnaires were sent to parents of all children involved in classroom preparation.

Results

KAT achieved high levels of acceptability and involvement among both children and parents. Main perceived impacts of the programme were increased pro-social communication within families (including discussions about harmful parental alcohol consumption), heightened knowledge and awareness of the effects of alcohol consumption and key legal and health issues, and changes in parental drinking behaviours.

Conclusions

KAT demonstrated promise as a prevention intervention, primarily through its impact on knowledge and communication processes within families, and its ability to engage with large numbers of parents. A key programme mechanism was the classroom preparation’s facilitation of parental involvement in the family fun evening. The programme also incorporated features identified in the literature as likely to increase effectiveness, including a focus on harm reduction, interactive delivery, and targeting primary-school-age children. Further research is needed to test and develop programme theory through implementation