-
The Journal of the Royal College of... Nov 1978My experiences of growing up in a general practitioner's home and practice led me to want to be a general practitioner myself.The early 1950s were critical years for...
My experiences of growing up in a general practitioner's home and practice led me to want to be a general practitioner myself.The early 1950s were critical years for general practice. Three developments - the foundation and work of the College, the introduction of vocational training, and the development of postgraduate medical centres - have led to its revival.The next main change may well be the interest in, and development of, clinical standards. In my opinion this ought to be done by general practitioners themselves rather than by society via the Ombudsman.
Topics: Clinical Competence; Family Practice; Humans; Medical Audit; United Kingdom
PubMed: 739471
DOI: No ID Found -
Journal of the Advanced Practitioner in... Jan 2022
PubMed: 35186400
DOI: 10.6004/jadpro.2022.13.1.9 -
Trials Jan 2011Systematic reviews have shown uncertainty about the size or direction of any 'trial effect' for patients in trials compared to those treated outside trials. We are not... (Review)
Review
BACKGROUND
Systematic reviews have shown uncertainty about the size or direction of any 'trial effect' for patients in trials compared to those treated outside trials. We are not aware of any systematic review of whether there is a 'trial effect' related to being treated by healthcare practitioners or institutions that take part in research.
METHODS
We searched the Cochrane Methodology Register and MEDLINE (most recently in January 2009) for studies in which patients were allocated to treatment in one or other setting, and cohort studies reporting the outcomes of patients from different settings. We independently assessed study quality, including the control of bias in the generation of the comparison groups, and extracted data.
RESULTS
We retrieved and checked more than 15,000 records. Thirteen articles were eligible: five practitioner studies and eight institution studies. Meta-analyses were not possible because of heterogeneity. Two practitioner studies were judged to be 'controlled' or better. A Canadian study among nurses found that use of research evidence was higher for those who took part in research working groups and a Danish study on general practitioners found that trial doctors were more likely to prescribe in accordance with research evidence and guidelines. Five institution studies were 'controlled' but provided mixed results. A study of North American patients at hospitals that had taken part in trials for myocardial infarction found no statistically significant difference in treatment for patients in trial and non-trial hospitals. A Canadian study of myocardial infarction patients found that trial participants had better survival than patients in the same hospitals who were not in trials or those in non-trial hospitals. A study of general practices in Denmark did not detect differences in guideline adherence between trial and non-trial practices but found that trial practices were more likely to prescribe the trial sponsor's drugs. The other two 'controlled' studies of institutions found lower mortality in trial than non-trial hospitals.
CONCLUSIONS
The available findings from existing research suggest that there might be a 'trial effect' of better outcomes, greater adherence to guidelines and more use of evidence by practitioners and institutions that take part in trials. However, the consequences for patient health are uncertain and the most robust conclusion may be that there is no apparent evidence that patients treated by practitioners or in institutions that take part in trials do worse than those treated elsewhere.
Topics: Attitude of Health Personnel; Clinical Trials as Topic; Evidence-Based Medicine; General Practitioners; Guideline Adherence; Health Knowledge, Attitudes, Practice; Hospitals; Humans; Medical Staff, Hospital; Nurse Practitioners; Practice Guidelines as Topic; Practice Patterns, Physicians'; Risk Assessment; Treatment Outcome
PubMed: 21251306
DOI: 10.1186/1745-6215-12-16 -
JAMA Network Open Mar 2023Human papillomavirus vaccination coverage rates lie below desired thresholds in Switzerland. Because general practitioners are the main contact for the relatively rare...
IMPORTANCE
Human papillomavirus vaccination coverage rates lie below desired thresholds in Switzerland. Because general practitioners are the main contact for the relatively rare health issues of many Swiss young adults, primary care offers an important opportunity to provide catch-up human papillomavirus vaccination.
OBJECTIVE
To examine the knowledge, experiences, and attitudes of Swiss university students in the context of receiving human papillomavirus vaccination during primary care visits.
DESIGN, SETTING, AND PARTICIPANTS
This self-administered, cross-sectional, web-based survey study was conducted among students of 3 universities and 1 educational institution for health professions in the Swiss Canton of Zurich. Specific questions about human papillomavirus vaccination experience were directed to respondents who had received at least 1 dose administered by a general practitioner. Responses were collected during 12-week intervals between November 11, 2020, and April 7, 2021, and data were analyzed from August 3 to August 30, 2022.
MAIN OUTCOMES AND MEASURES
The primary outcome was whether human papillomavirus vaccination had been administered on the patient's or the general practitioner's initiative.
RESULTS
The responses of 5524 participants (median [IQR] age, 23 [21-25] years; 3878 women [70.2%]) were analyzed. The survey completion rate was 90.9% (5524 of 6076 students who consented to participate). A total of 2029 respondents (1792 women [46.2%] and 237 men [14.6%]) reported having received at least 1 human papillomavirus vaccination dose, of whom 740 (36.5%) had received at least 1 dose administered by a general practitioner. Among these, 190 respondents (25.7%) reported that vaccine administration had occurred on their request rather than on their general practitioner's initiative. Among all respondents, 4778 (86.5%) wanted to obtain more information about human papillomavirus vaccination at a general practitioner's office, and 2569 (55.3%) rated acute consultations in general practice as inappropriate for addressing human papillomavirus vaccination.
CONCLUSIONS AND RELEVANCE
The findings of this survey study of Swiss university students suggest that primary care shows a high potential for increasing human papillomavirus vaccination coverage rates in Switzerland. However, there was room for improvement in the proactivity of general practitioners, especially with men, and in the attitudes of students toward the appropriateness of acute consultations in general practice for addressing human papillomavirus vaccination.
Topics: Male; Young Adult; Humans; Female; Adult; Universities; Human Papillomavirus Viruses; Papillomavirus Infections; Cross-Sectional Studies; Switzerland; Uterine Cervical Neoplasms; Papillomavirus Vaccines; Health Knowledge, Attitudes, Practice; Vaccination; Students; Primary Health Care
PubMed: 36943263
DOI: 10.1001/jamanetworkopen.2023.3949 -
BMC Medical Ethics Mar 2020This paper considers ethical dilemmas arising where a patient asks their General Practitioner for advice and their personal opinion regarding whether or not to have an...
BACKGROUND
This paper considers ethical dilemmas arising where a patient asks their General Practitioner for advice and their personal opinion regarding whether or not to have an abortion. Patients often seek their General Practitioner's advice regarding treatments and procedures, which may occasionally lead to the General Practitioner facing a difficult dilemma of whether to share their personal opinion with their patient. As General Practitioners are more accessible as the first point of contact for patients and often have a closer relationship with them, they may be particularly exposed to such situations. Additionally, the significance of abortion as a sensitive topic and the fact the General Practitioner may have their own personal viewpoint on its morality may make it particularly difficult for them to know how to respond to such a request.
MAIN TEXT
This paper explores the difficulties arising in such a situation and considers whether it could ever be ethically justifiable for General Practitioners to express their opinions on such a matter. We consider the duties of a doctor, and highlight the need for clearer guidance for healthcare professionals on managing tensions in their professional boundaries between their personal moral views and their professional responsibilities. A range of ethical viewpoints are considered to explore how a doctor might ap, in particular the principle of autonomy, virtue ethics, and consequentialism.
CONCLUSIONS
This article recognises that a General Practitioner in a situation such as this faces many ethical challenges. We propose that offering their opinion to the patient where specifically requested may be morally justifiable. A virtue ethics approach in particular requires that the General Practitioner applies practical wisdom to make this decision, and where they do disclose their opinion ensure this is done so in such a manner that it does not harm the patient and promotes flourishing. We encourage GPs and other healthcare professionals to consider their own moral perspectives on sensitive issues such as abortion, and reflect on how their moral viewpoints have the potential to influence their practice. In doing so, we hope clinicians can be better should they be faced with a situation such as this.
Topics: Abortion, Induced; Ethical Theory; Female; General Practitioners; Humans; Morals; Pregnancy; Virtues
PubMed: 32164682
DOI: 10.1186/s12910-020-0464-9 -
Acta Ortopedica Brasileira 2022Evaluate the scapular movement of Crossfit® practitioners and identify whether they present an increased incidence of scapular dyskinesis (SD) compared to...
OBJECTIVE
Evaluate the scapular movement of Crossfit® practitioners and identify whether they present an increased incidence of scapular dyskinesis (SD) compared to non-practitioners.
METHOD
A transversal study was evaluated quantitatively and dynamically, using retro-reflective spherical markers, the scapular movements of ten volunteers composing the control group, and 11 Crossfit® practitioners. The control group's results were used as a normality parameter and compared to those of the Crossfit® practitioner's group.
RESULTS
It was identified that the superior scapular rotation in the ascending phase is inferior in the group of Crossfit® practitioners (p = 0.02).
CONCLUSION
The regular practice of Crossfit® causes scapular dyskinesis (SD), with alteration in the scapular superior rotation movement. .
PubMed: 36506859
DOI: 10.1590/1413-785220223002e251074 -
BMC Primary Care Jul 2022The potential for data collected in general practice to be linked and used to address health system challenges of maintaining quality care, accessibility and safety,...
OBJECTIVE
The potential for data collected in general practice to be linked and used to address health system challenges of maintaining quality care, accessibility and safety, including pandemic support, has led to an increased interest in public acceptability of data sharing, however practitioners have rarely been asked to share their opinions on the topic. This paper attempts to gain an understanding of general practitioner's perceptions on sharing routinely collected data for the purposes of healthcare planning and research. It also compares findings with data sharing perceptions in an international context. MATERIALS AND METHODS: A mixed methods approach combining an initial online survey followed by face-to-face interviews (before and during COVID-19), designed to identify the barriers and facilitators to sharing data, were conducted on a cross sectional convenience sample of general practitioners across Western Australia (WA).
RESULTS
Eighty online surveys and ten face-to-face interviews with general practitioners were conducted from November 2020 - May 2021. Although respondents overwhelmingly identified the importance of population health research, their willingness to participate in data sharing programs was determined by a perception of trust associated with the organisation collecting and analysing shared data; a clearly defined purpose and process of collected data; including a governance structure providing confidence in the data sharing initiative simultaneously enabling a process of data sovereignty and autonomy.
DISCUSSION
Results indicate strong agreement around the importance of sharing patient's medical data for population and health research and planning. Concerns pertaining to lack of trust, governance and secondary use of data continue to be a setback to data sharing with implications for primary care business models being raised.
CONCLUSION
To further increase general practitioner's confidence in sharing their clinical data, efforts should be directed towards implementing a robust data governance structure with an emphasis on transparency and representative stakeholder inclusion as well as identifying the role of government and government funded organisations, as well as building trust with the entities collecting and analysing the data.
Topics: Australia; COVID-19; Cross-Sectional Studies; General Practitioners; Humans; Information Dissemination
PubMed: 35773626
DOI: 10.1186/s12875-022-01759-y -
London Journal of Primary Care 2016Outlining an educational initiative for those who work in the National Health Service (NHS), this article argues that literary reflection has been too easily seen as a...
Outlining an educational initiative for those who work in the National Health Service (NHS), this article argues that literary reflection has been too easily seen as a simple tool which may improve the practitioner's empathic skills and benefit patient-centred care. Using anecdotal feedback, the author reports ways in which a series of literary workshops held for professionals in the NHS have added to practitioners' general sense of well-being. Feedback shows that participants perceived literature in the workshop setting as being more than an enabler of 'empathy'. They reported that reflecting on literature in a group setting is an opportunity to think about their own autonomy, pleasure and creativity. The article concludes with a reflection about priorities in regulatory culture, its relationship to burnout, and ideas for future work.
PubMed: 28250831
DOI: 10.1080/17571472.2016.1163950 -
Health (London, England : 1997) Sep 2023Sophisticated algorithms are used daily to search through hundreds of medical journals in order to package updated medical insights into commercial databases. Healthcare...
Sophisticated algorithms are used daily to search through hundreds of medical journals in order to package updated medical insights into commercial databases. Healthcare practitioners can access these searchable databases-called Point of Care (PoC) tools-as downloadable apps on their smartphones or tablets to comprehensively and efficiently inform patient diagnosis and treatment. Because racist biases are unintentionally incorporated into the search reports that the companies generate and that practitioners regularly access, the aim of this article is to examine how healthcare practitioners' "pre-existing" racial stereotypes interact with pithy conclusions about race and ethnicity in PoC tools. I use qualitative research methods (content analysis, discourse analysis, open-ended semi-structured interviews, and role play) to frame the analysis within the Public Health Critical Race Praxis (PHCRP). This approach facilitates an understanding of how biological racism-the use of scientific evidence to support inherent differences between races-that is embedded in PoC algorithms informs a practitioner's assessment of a patient, and converges with persistent racial bias in medical training, medical research and healthcare. I contextualize the study with one semi-structured interview with an Editor of a leading PoC tool, MedScope (pseudonomized), and 10 semi-structured interviews with healthcare practitioners in S.E. Ontario, Canada. The article concludes that PoC tools and practitioners' personal biases contribute to racial prejudices in healthcare provision. This warrants further research on racial bias in medical literature and curriculum design in medical school.
Topics: Humans; Racism; Point-of-Care Systems; Delivery of Health Care; Ethnicity; Canada
PubMed: 34875900
DOI: 10.1177/13634593211061215 -
The Buffalo Medical Journal and Monthly... Apr 1848
PubMed: 35374193
DOI: No ID Found