Patient cues and medical interviewing in general practice: examples of the application of sequential analysis

2003 ◽  
Vol 12 (2) ◽  
pp. 115-123 ◽  
Author(s):  
Christa Zimmermann ◽  
Lidia Del Piccolo ◽  
Maria Angela Mazzi
Keyword(s):  
Primary Care ◽  
Pattern Recognition ◽  
General Practice ◽  
Communication Skills ◽  
Sequential Analysis ◽  
Formal Training ◽  
Medical Interview ◽  
Medical Interviewing ◽  
Lag Sequential Analysis ◽  
Pattern Recognition Analysis

SUMMARYAims – To illustrate how sequence analysis may be applied to the medical interview to: 1. explore how physicians without formal training in communication skills elicit and respond to patient cues and expression of expectations and opinions; and 2. test the hypothesis that physicians' closed ended questions determine the use of subsequent closed ended questions. Methods – 238 consultations in primary care, coded with the Verona Medical Interview Classification System, were analysed. Lag 1 analysis was applied to study which physician behaviour precedes and follows patient cues. Pattern recognition analysis for five lag sequences was performed to test the occurrence of predefined specific code chains, where a closed and an open ended question were followed either by two closed-ended questions or by two patient facilitating interventions Results – Patients' cue offers were most likely after facilitative interventions, but not after open-ended questions; physicians were most likely to respond to these expressions with facilitation. Physicians' tendency to use closed ended questions increased after previous closed questions and decreased after an open-ended question. Conclusions – Lag sequential analysis and pattern recognition analysis are useful methods to study exploratory and theory driven hypotheses and allow an initial approach to validate the supposed appropriateness of specific physician interventions.Declaration of Interest: none.

scholarly journals Understanding the primary care paradigm: an experiential learning focus of the early veterinary graduate

2017 ◽  
Vol 181 (18) ◽  
pp. 480-480 ◽  
Author(s):  
William H R Dixon ◽  
Tierney Kinnison ◽  
Stephen A May
Keyword(s):  
Primary Care ◽  
Pattern Recognition ◽  
General Practice ◽  
Experiential Learning ◽  
Clinical Reasoning ◽  
Time Pressure ◽  
Clinical Skills ◽  
Transition To Practice ◽  
Veterinary Profession ◽  
Key Skills

At a time where high levels of stress are reported in the veterinary profession, this study explores the challenges that veterinary graduates encounter when they enter general (first opinion) practice. Participants had written reflective accounts of their ‘Most Puzzling Cases’ for the postgraduate Professional Key Skills module of the Certificate in Advanced Veterinary Practice, offered by the Royal Veterinary College. Reasons that a case was puzzling, or became challenging, were thematically analysed. Fifteen summaries were analysed. Three core themes were identified: ‘clinical reasoning’, centred on the limitations of pattern recognition and the methods used to overcome this; the ‘veterinary healthcare system’, focusing on the need for continuity of care, time pressure and support in the transition to practice; and the ‘owner’, looking at the broader clinical skills needed to succeed in general practice. Clinical reasoning was raised as an issue; discussion of when pattern recognition is not appropriate and what to do in these cases was common. A lack of experience in general practice case types, and how to best operate in the resource-constrained environment in which they present, is the likely cause of this, suggesting that a greater focus on the primary care paradigm is needed within veterinary education.

Pattern recognition analysis of Angelicae Radix

Planta Medica ◽  
2008 ◽  
Vol 74 (09) ◽  
Author(s):  
XL Piao ◽  
HH Yoo ◽  
SY Park ◽  
JH Park
Keyword(s):  
Pattern Recognition ◽  
Pattern Recognition Analysis

Dermatology in primary care: an audit of the proportion of patients who present to general practice with a dermatological problem that could be self-managed

2020 ◽  
Vol 70 (suppl 1) ◽  
pp. bjgp20X711053
Author(s):  
Luamar Dolfini ◽  
Yogesh Patel
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Acne Vulgaris ◽  
Clinical Information ◽  
Electronic Record ◽  
Self Management ◽  
Considerable Proportion ◽  
Dry Skin ◽  
Record System ◽  
Common Skin

BackgroundA considerable proportion of GPs’ workload is dermatological. It is important to investigate what common skin conditions encountered in primary care can be self-managed, in an effort to alleviate the burden on primary care.AimThe purpose of the audit was to identify the proportion of consultations that are dermatological in nature and analyse potential for self-management by patients.MethodData was collected using the patient electronic record system (EMIS) in general practice. A search was made for all consultations from the 17 April to 15 May 2019, which included all new presenting complaints that were dermatological in nature. The criteria for self-management included advising over the counter (OTC) medication or reassurance. On the other hand, a case was deemed not self-manageable if prescription only medication (POM) was prescribed or if a referral to dermatology was made.ResultsThere were a total of 2175 consultations, where 246 (11.31%) cases were dermatological. Of the 246, 80 cases (32.5%) could be self-managed. There were 46 different dermatological presenting complaints of which the 5 most common included: rash (51 cases), dermatitis (44 cases), acne vulgaris (13 cases), moles (12 cases), dry skin (11 cases). None of the acne or moles cases could be self-managed, whereas 23%, 68.2%, 72.7% of rashes, dermatitis, and dry skin cases, respectively, could be self-managed.ConclusionCertain dermatological conditions have more potential for self-management than others. Research into teledermatology as a means of addressing patient concern and providing clinical information is important in order to reduce unnecessary consultations.

The Impact of COVID-19 on Primary Care General Practice Consultations in a Teaching Hospital in Shanghai, China

2020 ◽  
Author(s):  
Zhongqing Xu ◽  
Jingchun Fan ◽  
Jingjing Ding ◽  
Xianzhen Feng ◽  
Shunyu Tao ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Teaching Hospital ◽  
The Impact

scholarly journals Cross sectional study estimating prevalence of heart failure and left ventricular systolic dysfunction in community patients at risk

Heart ◽  
2001 ◽  
Vol 86 (2) ◽  
pp. 172-178 ◽  
Author(s):  
O W Nielsen ◽  
J Hilden ◽  
C T Larsen ◽  
J F Hansen
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
General Practice ◽  
Heart Disease ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Ventricular Systolic Dysfunction ◽  
Cross Sectional ◽  
General Practices

OBJECTIVETo examine a general practice population to measure the prevalence of signs and symptoms of heart failure (SSHF) and left ventricular systolic dysfunction (LVSD).DESIGNCross sectional screening study in three general practices followed by echocardiography.SETTING AND PATIENTSAll patients ⩾ 50 years in two general practices and ⩾ 40 years in one general practice were screened by case record reviews and questionnaires (n = 2158), to identify subjects with some evidence of heart disease. Among these, subjects were sought who had SSHF (n = 115). Of 357 subjects with evidence of heart disease, 252 were eligible for examination, and 126 underwent further cardiological assessment, including 43 with SSHF.MAIN OUTCOME MEASURESPrevalence of SSHF as defined by a modified Boston index, LVSD defined as an indirectly measured left ventricular ejection fraction ⩽ 0.45, and numbers of subjects needing an echocardiogram to detect one case with LVSD.RESULTSSSHF afflicted 0.5% of quadragenarians and rose to 11.7% of octogenarians. Two thirds were handled in primary care only. At ⩾ 50 years of age 6.4% had SSHF, 2.9% had LVSD, and 1.9% (95% confidence interval 1.3% to 2.5%) had both. To detect one case with LVSD in primary care, 14 patients with evidence of heart disease without SSHF and 5.5 patients with SSHF had to be examined.CONCLUSIONSSHF is extremely prevalent in the community, especially in primary care, but more than two thirds do not have LVSD. The number of subjects with some evidence of heart disease needing an echocardiogram to detect one case of LVSD is 14.

Estimating pertussis incidence in general practice using a large Australian primary care database

Vaccine ◽  
2021 ◽  
Author(s):  
Robert Neil F. Leong ◽  
James G Wood ◽  
Bette Liu ◽  
Robert Menzies ◽  
Anthony T. Newall
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Primary Care Database ◽  
Care Database

Teaching communication skills to pre-clinical medical students: a general practice based approach

1979 ◽  
Vol 13 (2) ◽  
pp. 82-85 ◽  
Author(s):  
D. ARMSTRONG ◽  
B. H. HICKS ◽  
P. M. HIGGINS ◽  
J. A. WEINMAN
Keyword(s):  
General Practice ◽  
Medical Students ◽  
Communication Skills

scholarly journals Mental Illness in Primary Care Settings

1985 ◽  
Vol 9 (1) ◽  
pp. 12-13 ◽  
Author(s):  
Greg Wilkinson
Keyword(s):  
Primary Care ◽  
Mental Illness ◽  
General Practice ◽  
Social Security ◽  
General Practitioners ◽  
Research Unit ◽  
Practice Research ◽  
Policy Makers ◽  
Department Of Health ◽  
Primary Care Settings

A Conference on the above topic took place at the Institute of Psychiatry, London, on 17 and 18 July 1984. The Conference was sponsored by the Department of Health and Social Security and was organized by the General Practice Research Unit. Over 100 invited clinicians, research workers and policy-makers took part. The majority of the participants were either psychiatrists or general practitioners, but representatives of all relevant disciplines attended.

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