Patients' experiences of seeking help for emotional concerns in primary care: doctor as drug, detective and collaborator

Background NICE guidelines for the management of emotional concerns in primary care emphasise the importance of communication and a trusting relationship, which is difficult to operationalise in practice. Current pressures in the NHS mean that it is important to understand care from a patient perspective. This study aimed to explore patients’ experiences of primary care consultations for emotional concerns and what patients valued when seeking care from their GP. Methods Eighteen adults with experience of consulting a GP for emotional concerns participated in 4 focus groups. Data were analysed thematically. Results (1) Doctor as Drug: Patients’ relationship with their GP was considered therapeutic with continuity particularly valued. (2) Doctor as Detective and Validator: Patients were often puzzled by their symptoms, not recognising their emotional concerns. GPs needed to play the role of detective by exploring not just symptoms, but the person and their life circumstances. GPs were crucial in helping patients understand and validate their emotional concerns. (3) Doctor as Collaborator: Patients prefer a collaborative partnership, but often need to relinquish involvement because they are too unwell, or take a more active role because they feel GPs are ill-equipped or under too much pressure to help. Patients valued: GPs booking their follow up appointments; acknowledgement of stressful life circumstances; not relying solely on medication. Conclusions Seeking help for emotional concerns is challenging due to stigma and unfamiliar symptoms. GPs can support disclosure and understanding of emotional concerns by fully exploring and validating patients’ concerns, taking into account patients’ life contexts. This process of exploration and validation forms the foundation of a curative, trusting GP-patient relationship. A trusting relationship, with an emphasis on empathy and understanding, can make patients more able to share involvement in their care with GPs. This process is cyclical, as patients feel that their GP is caring, interested, and treating them as a person, further strengthening their relationship. NICE guidance should acknowledge the importance of empathy and validation when building an effective GP-patient partnership, and the role this has in supporting patients’ involvement in their care

Barriers and facilitators to GP-patient communication about emotional concerns in UK primary care: a systematic review.

Background In the UK, general practitioners (GPs) are the most commonly used providers of care for emotional concerns. Objective To update and synthesize literature on barriers and facilitators to GP–patient communication about emotional concerns in UK primary care. Design Systematic review and qualitative synthesis. Method We conducted a systematic search on MEDLINE (OvidSP), PsycInfo and EMBASE, supplemented by citation chasing. Eligible papers focused on how GPs and adult patients in the UK communicated about emotional concerns. Results were synthesized using thematic analysis. Results Across 30 studies involving 342 GPs and 720 patients, four themes relating to barriers were: (i) emotional concerns are difficult to disclose; (ii) tension between understanding emotional concerns as a medical condition or arising from social stressors; (iii) unspoken assumptions about agency resulting in too little or too much involvement in decisions and (iv) providing limited care driven by little time. Three facilitative themes were: (v) a human connection improves identification of emotional concerns and is therapeutic; (vi) exploring, explaining and negotiating a shared understanding or guiding patients towards new understandings and (vii) upfront information provision and involvement manages expectations about recovery and improves engagement in treatment. Conclusion The findings suggest that treatment guidelines should acknowledge: the therapeutic value of a positive GP–patient relationship; that diagnosis is a two-way negotiated process rather than an activity strictly in the doctor’s domain of expertise; and the value of exploring and shaping new understandings about patients’ emotional concerns and their management

The Evolving Relationships Between Hospital, Physician and Patient in Modern American Healthcare

This article explores the ways in which health care has evolved over the past few years for patients, doctors and hospitals in the United States, and the impact these changes have made on modern American health care. As the amount of money the nation spends on health care continues to increase at alarming rates, patients, doctors, and hospitals all appear to have greater struggles than before.This inherent disconnection between the changes in American health care system and the satisfaction of patients and providers leaves much to be desired and considered. Before a solution can be found, however, we must first understand the problem

The relaxation of OH (v = 1) and OD (v = 1) by H2O and D2O at temperatures from 251 to 390 K

We report rate coefficients for the relaxation of OH(v = 1) and OD(v = 1) by H2O and D2O as a function of temperature between 251 and 390 K. All four rate coefficients exhibit a negative dependence on temperature. In Arrhenius form, the rate coefficients for relaxation (in units of 10–12 cm3 molecule–1 s–1) can be expressed as: for OH(v = 1) + H2O between 263 and 390 K: k = (2.4 ± 0.9) exp((460 ± 115)/T); for OH(v = 1) + D2O between 256 and 371 K: k = (0.49 ± 0.16) exp((610 ± 90)/T); for OD(v = 1) + H2O between 251 and 371 K: k = (0.92 ± 0.16) exp((485 ± 48)/T); for OD(v = 1) + D2O between 253 and 366 K: k = (2.57 ± 0.09) exp((342 ± 10)/T). Rate coefficients at (297 ± 1 K) are also reported for the relaxation of OH(v = 2) by D2O and the relaxation of OD(v = 2) by H2O and D2O. The results are discussed in terms of a mechanism involving the formation of hydrogen-bonded complexes in which intramolecular vibrational energy redistribution can occur at rates competitive with re-dissociation to the initial collision partners in their original vibrational states. New ab initio calculations on the H2O–HO system have been performed which, inter alia, yield vibrational frequencies for all four complexes: H2O–HO, D2O–HO, H2O–DO and D2O–DO. These data are then employed, adapting a formalism due to Troe (J. Troe, J. Chem. Phys., 1977, 66, 4758), in order to estimate the rates of intramolecular energy transfer from the OH (OD) vibration to other modes in the complexes in order to explain the measured relaxation rates—assuming that relaxation proceeds via the hydrogen-bonded complexes

Chemical ionization tandem mass spectrometer for the in situ measurement of methyl hydrogen peroxide

A new approach for measuring gas-phase methyl hydrogen peroxide [(MHP) CH_3OOH] utilizing chemical ionization mass spectrometry is presented. Tandem mass spectrometry is used to avoid mass interferences that hindered previous attempts to measure atmospheric CH_3OOH with CF_3O− clustering chemistry. CH_3OOH has been successfully measured in situ using this technique during both airborne and ground-based campaigns. The accuracy and precision for the MHP measurement are a function of water vapor mixing ratio. Typical precision at 500 pptv MHP and 100 ppmv H_2O is ±80 pptv (2 sigma) for a 1 s integration period. The accuracy at 100 ppmv H_2O is estimated to be better than ±40%. Chemical ionization tandem mass spectrometry shows considerable promise for the determination of in situ atmospheric trace gas mixing ratios where isobaric compounds or mass interferences impede accurate measurements

Biomass burning and urban air pollution over the Central Mexican Plateau

Observations during the 2006 dry season of highly elevated concentrations of cyanides in the atmosphere above Mexico City (MC) and the surrounding plains demonstrate that biomass burning (BB) significantly impacted air quality in the region. We find that during the period of our measurements, fires contribute more than half of the organic aerosol mass and submicron aerosol scattering, and one third of the enhancement in benzene, reactive nitrogen, and carbon monoxide in the outflow from the plateau. The combination of biomass burning and anthropogenic emissions will affect ozone chemistry in the MC outflow

Physicians\u27 ability to predict hospital length of stay for patients admitted to the hospital from the emergency department.

Accurate predictions of patient length of stay (LOS) in the hospital can effectively manage hospital resources and increase efficiency of patient care. A study was done to assess emergency medicine physicians\u27 ability of predicting the LOS of patients who enter the hospital through the ER. Results indicate that EM physicians are relatively accurate with their pediatric patients than any other age groups. In addition, as actual hospital LOS increases, the prediction accuracy decreases. Possible reasons may be due increasing medical complications associated with increasing age and this may lead to overall longer stays. Other variables such as the admitted service of the patient are not statistically significant in predicting LOS in this study. Future studies should be done in order to determine other variables that may affect LOS predictions

Physicians' Ability to Predict Hospital Length of Stay for Patients Admitted to the Hospital from the Emergency Department

Accurate predictions of patient length of stay (LOS) in the hospital can effectively manage hospital resources and increase efficiency of patient care. A study was done to assess emergency medicine physicians' ability of predicting the LOS of patients who enter the hospital through the ER. Results indicate that EM physicians are relatively accurate with their pediatric patients than any other age groups. In addition, as actual hospital LOS increases, the prediction accuracy decreases. Possible reasons may be due increasing medical complications associated with increasing age and this may lead to overall longer stays. Other variables such as the admitted service of the patient are not statistically significant in predicting LOS in this study. Future studies should be done in order to determine other variables that may affect LOS predictions

Randomized clinical trial of the effects of screening and brief intervention for illicit drug use: the Life Shift/Shift Gears study.

BackgroundAlthough screening, brief intervention, and referral to treatment (SBIRT) has shown promise for alcohol use, relatively little is known about its effectiveness for adult illicit drug use. This randomized controlled trial assessed the effectiveness of the SBIRT approach for outcomes related to drug use among patients visiting trauma and emergency departments (EDs) at two large, urban hospitals.MethodsA total of 700 ED patients who admitted using illegal drugs in the past 30 days were recruited, consented, provided baseline measures of substance use and related problems measured with the Addiction Severity Index-Lite (ASI-Lite), and then randomized to the Life Shift SBIRT intervention or to an attention-placebo control group focusing on driving and traffic safety (Shift Gears). Both groups received a level of motivational intervention matched to their condition and risk level by trained paraprofessional health educators. Separate measurement technicians conducted face-to-face follow-ups at 6 months post-intervention and collected hair samples to confirm reports of abstinence from drug use. The primary outcome measure of the study was past 30-day drug abstinence at 6 months post-intervention, as self-reported on the ASI-Lite.ResultsOf 700 participants, 292 (42%) completed follow-up. There were no significant differences in self-reported abstinence (12.5% vs. 12.0% , p = 0.88) for Life Shift and Shift Gears groups, respectively. When results of hair analyses were applied, the abstinence rate was 7 percent for Life Shift and 2 percent for Shift Gears (p = .074). In an analysis in which results were imputed (n = 694), there was no significant difference in the ASI-Lite drug use composite scores (Life Shift +0.005 vs. Shift Gears +0.017, p = 0.12).ConclusionsIn this randomized controlled trial, there was no evidence of effectiveness of SBIRT on the primary drug use outcome.Trial registrationClinicalTrials.gov NCT01683227