Changes in the quality of doctor–patient communication between 1982 and 2001: an observational study on hypertension care as perceived by patients and general practitioners

Background: The rise of evidence-based medicine may have implications for the doctor–patient interaction. In recent decades, a shift towards a more task-oriented approach in general practice indicates a development towards more standardised healthcare. Objective: To examine whether this shift is accompanied by changes in perceived quality of doctor–patient communication. Design: GP observers and patient observers performed quality assessments of Dutch General Practice consultations on hypertension videotaped in 1982–1984 and 2000–2001. In the first cohort (1982–1984) 81 patients were recorded by 23 GPs and in the second cohort (2000–2001) 108 patients were recorded by 108 GPs. The GP observers and patient observers rated the consultations on a scale from 1 to 10 on three quality dimensions: medical technical quality, psychosocial quality and quality of interpersonal behaviour. Multilevel regression analyses were used to test whether a change occurred over time. Results: The findings showed a significant improvement over time on all three dimensions. There was no difference between the quality assessments of GP observers and patient observers. The three different dimensions were moderately to highly correlated and the assessments of GP observers showed less variability in the second cohort. Conclusions: hypertension consultations in general practice in the Netherlands received higher quality assessments by general practitioners and patients on medical technical quality, psychosocial quality and the quality of interpersonal behaviour in 2000–2001 as compared with the 1980s. The shift towards a more task-oriented approach in hypertension consultations does not seem to detract from individual attention for the patient. In addition, there is less variation between general practitioners in the quality assessments of more recent consultations. The next step in this line of research is to unravel the factors that determine patients' quality assessments of doctor–patient communication. (aut.ref.

Shifts in doctor-patient communication between 1986 and 2002: a study of videotaped General Practice consultations with hypertension patients

BACKGROUND: Departing from the hypotheses that over the past decades patients have become more active participants and physicians have become more task-oriented, this study tries to identify shifts in GP and patient communication patterns between 1986 and 2002. METHODS: A repeated cross-sectional observation study was carried out in 1986 and 2002, using the same methodology. From two existing datasets of videotaped routine General Practice consultations, a selection was made of consultations with hypertension patients (102 in 1986; 108 in 2002). GP and patient communication was coded with RIAS (Roter Interaction Analysis System). The data were analysed, using multilevel techniques. RESULTS: No gender or age differences were found between the patient groups in either study period. Contrary to expectations, patients were less active in recent consultations, talking less, asking fewer questions and showing less concerns or worries. GPs provided more medical information, but expressed also less often their concern about the patients' medical conditions. In addition, they were less involved in process-oriented behaviour and partnership building. Overall, these results suggest that consultations in 2002 were more task-oriented and businesslike than sixteen years earlier. CONCLUSION: The existence of a more equal relationship in General Practice, with patients as active and critical consumers, is not reflected in this sample of hypertension patients. The most important shift that could be observed over the years was a shift towards a more businesslike, task-oriented GP communication pattern, reflecting the recent emphasis on evidence-based medicine and protocolized care. The entrance of the computer in the consultation room could play a role. Some concerns may be raised about the effectiveness of modern medicine in helping patients to voice their worries

Teachers' ideas versus experts' descriptions of 'the good teacher' in postgraduate medical education: implications for implementation. A qualitative study

Contains fulltext : 96394.pdf (publisher's version ) (Open Access)BACKGROUND: When innovations are introduced in medical education, teachers often have to adapt to a new concept of what being a good teacher includes. These new concepts do not necessarily match medical teachers' own, often strong beliefs about what it means to be a good teacher.Recently, a new competency-based description of the good teacher was developed and introduced in all the Departments of Postgraduate Medical Education for Family Physicians in the Netherlands. We compared the views reflected in the new description with the views of teachers who were required to adopt the new framework. METHODS: Qualitative study. We interviewed teachers in two Departments of Postgraduate Medical Education for Family Physicians in the Netherlands. The transcripts of the interviews were analysed independently by two researchers, who coded and categorised relevant fragments until consensus was reached on six themes. We investigated to what extent these themes matched the new description. RESULTS: Comparing the teachers' views with the concepts described in the new competency-based framework is like looking into two mirrors that reflect clearly dissimilar images. At least two of the themes we found are important in relation to the implementation of new educational methods: the teachers' identification and organisational culture. The latter plays an important role in the development of teachers' ideas about good teaching. CONCLUSIONS: The main finding of this study is the key role played by the teachers' feelings regarding their professional identity and by the local teaching culture in shaping teachers' views and expectations regarding their work. This suggests that in implementing a new teaching framework and in faculty development programmes, careful attention should be paid to teachers' existing identification model and the culture that fostered it

The structure of j/i-hybrid carrageenans II. Coil–helix transition as a function of chain composition

This paper describes the effect of the k/i-ratio on the physical properties of k/i-hybrid carrageenans (synonyms: kappa-2, k-2, weak kappa, weak gelling kappa). To this end, a series of k/i-hybrid carrageenans ranging from almost homopolymeric k-carrageenan (98 mol% k-units) to almost homopolymeric-carrageenan (99 mol% i-units) have been extracted from selected species of marine red algae (Rhodophyta). The k/i-ratio of these k/i-hybrids was determined by NMR spectroscopy. Their rheological properties were determined by small deformation oscillatory rheology. The gel strength (storage modulus, G0) of the j/i-hybrids decreases with decreasing j-content. On the other hand, the gelation temperature of the k-rich k/i-hybrids is independent of their composition. This allows one to control the gel strength independent of the gelation or melting temperature. The conformational order–disorder transition of the k/i-hybrids was studied using optical rotation and high-sensitivity differential scanning calorimetry. High-sensitivity DSC showed that the total transition enthalpy of the k/i-hybrids goes through a minimum at 60 mol% k-units, whereas for the mixture of j- and i-carrageenan, the total transition enthalpy is a linear function of the composition. With respect to the ordering capability, the k/i-hybrid carrageenans seem to behave as random block copolymers with length sequence distributions truncated from the side of the small lengths. Intrinsic thermodynamic properties (e.g., transition temperature and enthalpy) of k- and i-sequences in these copolymers are close to those of their parent homopolymers. The critical sequence length for k-sequences is 2-fold of that for i-sequences

The structure of j/i-hybrid carrageenans II. Coil–helix transition as a function of chain composition

This paper describes the effect of the k/i-ratio on the physical properties of k/i-hybrid carrageenans (synonyms: kappa-2, k-2, weak kappa, weak gelling kappa). To this end, a series of k/i-hybrid carrageenans ranging from almost homopolymeric k-carrageenan (98 mol% k-units) to almost homopolymeric-carrageenan (99 mol% i-units) have been extracted from selected species of marine red algae (Rhodophyta). The k/i-ratio of these k/i-hybrids was determined by NMR spectroscopy. Their rheological properties were determined by small deformation oscillatory rheology. The gel strength (storage modulus, G0) of the j/i-hybrids decreases with decreasing j-content. On the other hand, the gelation temperature of the k-rich k/i-hybrids is independent of their composition. This allows one to control the gel strength independent of the gelation or melting temperature. The conformational order–disorder transition of the k/i-hybrids was studied using optical rotation and high-sensitivity differential scanning calorimetry. High-sensitivity DSC showed that the total transition enthalpy of the k/i-hybrids goes through a minimum at 60 mol% k-units, whereas for the mixture of j- and i-carrageenan, the total transition enthalpy is a linear function of the composition. With respect to the ordering capability, the k/i-hybrid carrageenans seem to behave as random block copolymers with length sequence distributions truncated from the side of the small lengths. Intrinsic thermodynamic properties (e.g., transition temperature and enthalpy) of k- and i-sequences in these copolymers are close to those of their parent homopolymers. The critical sequence length for k-sequences is 2-fold of that for i-sequences

Increased prevalence of cardiovascular and autoimmune diseases in periodontitis patients: a cross-sectional study

Background: Associations between periodontitis and cardiovascular and autoimmune diseases are most often assessed in patients with a particular cardiovascular or autoimmune disease. To prevent selection bias, this study assesses the existence of associations between periodontitis and cardiovascular and autoimmune diseases in patients attending a dental or periodontal clinic. Methods: Data were collected from 1,276 randomly selected dental records from patients attending a dental (n = 588) or periodontal (n = 688) clinic. Data on the prevalence of cardiovascular and autoimmune diseases were obtained from a validated health questionnaire. Data on the presence of periodontitis were taken from patients' dental records. Results: In uncontrolled analyses, the prevalence of hypertension, diabetes mellitus (DM), and rheumatoid arthritis (RA) is significantly increased in patients with periodontitis. Controlled for confounding, periodontitis was associated with DM, with an odds ratio of 4 (1.03 to 15.3), in the dental clinic. DM was not associated with periodontitis in periodontal clinics. Hypertension does not seem to be associated with periodontitis when controlling for confounders. Periodontitis may be associated with RA in both clinic types. Conclusions: The increased prevalence of cardiovascular and autoimmune diseases among patients with periodontitis attending dental or periodontal clinics may, at least in part, be influenced by confounding. However, the increased prevalence of DM and RA in patients with periodontitis could not be explained by confounding. J Periodontol 2010;81:1622-1628

Selection for Dutch postgraduate GP training; time for improvement

Item does not contain fulltextBackground: In the Netherlands we select candidates for the postgraduate GP training by assessing personal qualities in interviews. Because of differences in the ratio of number of candidates and number of vacancies between the eight departments of GP training we questioned whether the risk of being rejected diverged amongst them. Objective: The research question of this study was to which degree department of choice, candidates' characteristics and qualities assessed during interviews explain admission into GP training. Methods: A nationwide observational study was conducted of all candidates who applied for postgraduate GP training in 2009/ 2010. Application ratio per department, candidates' characteristics (gender, age, region of medical school and times of application) and qualities (motivation, orientation on the job, personal attributes and learning needs) were collected. Outcome measures were admission to interview and admission to GP training. Results: The study population addressed 542 candidates. Sixty three candidates were rejected on application letter (11.6%). So 479 candidates were admitted to the interview, of which 340 were admitted to the GP training (71%). Gender and region of medical school outside North West Europe were associated with admission to the interview. Department of choice had a strong association with admission in both stages (RR: 0.30 to 0.74; 0.20 to 0.79 respectively), while candidates' qualities explained admission (RR: 1.09- 1.25) as well. Conclusion:The influence of department of choice yields doubts about fairness of the procedure. So advantages and disadvantages of a national procedure are discussed as well as those of a competency based procedure