Bmc Fam Pract
-
In Australia and in the United Kingdom (UK) access to specialists is sanctioned by General Practitioners (GPs). It is important to understand how practitioners determine which patients warrant referral. ⋯ GPs' referral decisions for patients with lower bowel symptoms are similar in the two countries. We question the wisdom of streaming referrals from primary care without a strong evidence base and an effective intervention for implementing guidelines. We conclude that implementation must take into account the profile of patients but also the characteristics of GPs and referral policies.
-
Multimorbidity has been defined as the co-existence of two or more chronic conditions. It has a profound impact on both the individuals affected and on their use of healthcare services. The limited research to date has focused on its epidemiology rather than the development of interventions to improve outcomes in multimorbidity patients, particularly for patients aged less than 65 years. Potential barriers to such research relate to methods of disease recording and coding and examination of the process of care. We aimed to assess the feasibility of identifying younger individuals with multimorbidity at general practice level and to explore the effect of multimorbidity on the type and volume of health care delivered. We also describe the barriers encountered in attempting to carry out this exploratory research. ⋯ This study highlights the importance of multimorbidity in general practice and indicates that it is feasible to identify younger patients with multimorbidity through their GP records. This is a first step towards planning a clinical intervention to improve outcomes for such patients in primary care.
-
The decision to issue sickness certification in Sweden for a patient should be based on the physician's assessment of the reduction of the patient's work capacity due to a disease or injury, not on psychosocial factors, in spite of the fact that they are known as risk factors for sickness absence. The aim of this study was to investigate the influence of medical factors and functioning on sick listing probability. ⋯ The strongest predictors for sickness certification were patient's and GP's assessment of reduced work capacity, with a striking concordance between physician and patient on this assessment. When patient's complaints were judged to be non-somatic the risk of sickness certification was enhanced.
-
Literature exists regarding the perioperative role of internists. Internists rely on this literature assuming it meets the needs of surgeons without actually knowing their perspective. We sought to understand why surgeons ask for preoperative consultations and their view on the internist's role in perioperative medicine. ⋯ Surgeons perceive the most important roles for the internist as cardiac risk stratification and medication management. Areas of controversy identified amongst the surgeons included who should inform the patient of their operative risk, and whether the internist should follow the patient daily postoperatively. Unclear expectations have the potential to impact on patient safety and informed consent unless acknowledged and acted on by all. We recommend that internists performing perioperative consults communicate directly with the consulting physician to ensure that all parties are in accordance as to each others duties. We also recommend that the teaching of perioperative consults emphasizes the interdisciplinary communication needed to ensure that patient needs are not neglected when one specialty assumes the other will perform a function.
-
In medical malpractice litigations in recent years in Japan, it is notable that the growing number of medical litigation cases includes the issue of a doctor's explanation to the patient as a pivotal point. The objective of this study was to identify factors of physicians' communication skills with patients, as related to their legal liability, and differences in doctors' communication skills with patients by the type of medical facility. ⋯ These findings are beneficial for the prevention of medical disputes and improvement of patient-physician communication.