Scandinavian Journal of Primary Health Care
ISSN: 0281-3432 (Print) 1502-7724 (Online) Journal homepage: http://www.tandfonline.com/loi/ipri20
Editorial: Quality Assessment of the Work in General Practice Niels Nørrelund To cite this article: Niels Nørrelund (1991) Editorial: Quality Assessment of the Work in General Practice, Scandinavian Journal of Primary Health Care, 9:1, 1-2, DOI: 10.3109/02813439109026573 To link to this article: http://dx.doi.org/10.3109/02813439109026573
© 1991 Informa UK Ltd All rights reserved: reproduction in whole or part not permitted Published online: 12 Jul 2009.
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Date: 14 March 2016, At: 19:03
Editorial
Downloaded by [81.7.17.171] at 19:03 14 March 2016
Quality Assessment of the Work in General Practice
The work (1) presented in this issue by P. Hjortdahl, S. Landaas, P. Urdal, M. Steinbakk, P. Fuglerud and €3. Nygaard is substantial and inspiring reading. A method of making a quick diagnosis of infection which has proved suitable in hospitals is not automatically applicable to general practice. The more encouraging it is that in more than half the cases the participating general practitioners find the examination for C-reactive protein of importance for their determination as to whether there is an infection. The examination seems to give more useful clinical information than the erythrocyte sedimentation rate. The work is illustrative of certain aspects of technology assessment. Medical Technology Assessment
A broad assessment should be adopted, in principle implicating the following fields: T H E TECHNOLOGY
Efficiency Reliability Field of application
THE PATIENT
Patient psychology Social conditions Ethical aspects
STAFFlSTRUCTURE
Working environment Organization Education
FINANCIAL CIRCUMSTANCES
Means Economics Patients’ means Staff‘s means
A few years ago I was engaged in finding out how the general practitioners communicated with their patients, and which steps they would take if met with I
Primary Health Care
a complaint of stomach ache ( 2 ) . I had the idea that the opening dialogue and examination was a kind of “technology”, to which certain rules could be applied. And I imagined that there was a certain consensus about these matters to the effect that general practitioners reacted more or less alike when confronted with a certain problem. This was far from being the case. However, I still believe this situation to be ideal, and the opening dialogue between the patient and his general practitioner must be a technology for assessment. During the recent years this subject has been taken up by a number of colleagues. Lars Christian Lassen (3) for one has dealt with the complex of problems concerning compliance and writes about his work, “The objectives of the study were to generate and test a theory about a connection between the consultation process and patient compliance with general practitioners’ medications and advice concerning life-style changes. This involved formulation of empirically based criteria for the quality of the consultation process, and if these criteria are fulfilled at an empirically established standard level, they result in great and significant improvements of compliance rates”. Lars Christian Lassen is thus trying to make an assessment of the single consultation by establishing whether a piece of advice given to the patient is taken. General practitioners want to comply with their patients’ expectations, and this aspect of the consultation has been examined by Inga Marie Lunde in “Patients’ perceptions - a shift in medical perspective” (4). She writes, “The aspects of disease lying outside the scientific biomedical area have not hitherto been of great interest in the medical research field. However, our possibility to act on the humanistic aspects in everyday clinical settings depends on insight and knowledge about these, too. Conceptualising and theorising in this complex territory is necScand J Prim Health Care 1991; 9
Downloaded by [81.7.17.171] at 19:03 14 March 2016
2
Editorial
essary to avoid being lost in one’s own experiences and in individual details.” Lunde is thus preoccupied with whether the general practitioners know their patients’ expectations and whether the patients’ desires are met. I take the consultation as a many-sided process subject to medical technology assessment. An important detail of the consultation could be bloodtests; but they are only to be taken when they are of utility value in the current situation, i.e. if they can stand up to a technology assessment. However, justified blood-tests are of minor value if not properly explained to the patient during the consultation. Accordingly, the general practitioners are forced to continue working with the consultation as a whole as well as with its many details. The work by Hjortdahl et al. on C-reactive protein is an inspiring technology assessment of a detail in the consultation in line with Kirsti Malterud’s thesis on “The encounter between the general practitioner and the female patient” (5). According to the latter author, the project is based on the hypothesis that a communicative method may influence the social relations and the transferral of knowledge in the consultation by strengthening the position of the female patient. Her aims of study were to present a systematic description and analysis of the development, characteristics, and implementation of a clinical communicative method, and to explore the knowledge about women’s health complaints revealed by the clinical method by means of a systematic description and analysis. Malterud makes detailed analyses of her consultations and introduces new standard questions, which
Scand J Prim Health Care 1991; 9
she expects will add to the equality between patient and doctor in the consultation situation. Her aim is to demonstrate that in this way general practitioners are becoming better advisers.
My Hope I presume that the general medical researchers will continue to work intensely on the consultation process and the dialogue between the patient and the general practitioner, and I am convinced that one day this technology will be subject to a quaiity assessment in line with the one so ideally introduced in this issue by Hjortdahl et al. REFERENCES 1. Hjortdahl P, Landaas S, Urdal P, Steinbakk M, Fuglerud P, Nygaard B. C-reactive protein: a new rapid assay for managing infectious disease in primary health care. Scand J Prim Health Care 1991; 9: 3-10. 2. N~rrelundN. Patienter med ondt i maven - en medicinsk teknologivurdering fra alrnen praksis 1989, eget forlag. In Danish (to be obtained from the author). 3. Lassen LC.Compliance in General Practice. Institut for almen medicin, Kebenhavns Universitet, 1989. Summary in English. 4. Lunde IM. Patients’ perceptions - a shift in medical perspective. FADL’s forlag 1990, K~benhavn.In Danish. Summary in English. 5. Malterud K. The encounter between the general practitioner and the female patient. Oslo: Tano, 1990. In Norwegian with a summary in English.
Niels N@rrelund Tjarnegirdsparken 1 DK-8570 Trustrup
ISSN: 0281-3432 (Print) 1502-7724 (Online) Journal homepage: http://www.tandfonline.com/loi/ipri20
Editorial: Quality Assessment of the Work in General Practice Niels Nørrelund To cite this article: Niels Nørrelund (1991) Editorial: Quality Assessment of the Work in General Practice, Scandinavian Journal of Primary Health Care, 9:1, 1-2, DOI: 10.3109/02813439109026573 To link to this article: http://dx.doi.org/10.3109/02813439109026573
© 1991 Informa UK Ltd All rights reserved: reproduction in whole or part not permitted Published online: 12 Jul 2009.
Submit your article to this journal
Article views: 21
View related articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ipri20 Download by: [81.7.17.171]
Date: 14 March 2016, At: 19:03
Editorial
Downloaded by [81.7.17.171] at 19:03 14 March 2016
Quality Assessment of the Work in General Practice
The work (1) presented in this issue by P. Hjortdahl, S. Landaas, P. Urdal, M. Steinbakk, P. Fuglerud and €3. Nygaard is substantial and inspiring reading. A method of making a quick diagnosis of infection which has proved suitable in hospitals is not automatically applicable to general practice. The more encouraging it is that in more than half the cases the participating general practitioners find the examination for C-reactive protein of importance for their determination as to whether there is an infection. The examination seems to give more useful clinical information than the erythrocyte sedimentation rate. The work is illustrative of certain aspects of technology assessment. Medical Technology Assessment
A broad assessment should be adopted, in principle implicating the following fields: T H E TECHNOLOGY
Efficiency Reliability Field of application
THE PATIENT
Patient psychology Social conditions Ethical aspects
STAFFlSTRUCTURE
Working environment Organization Education
FINANCIAL CIRCUMSTANCES
Means Economics Patients’ means Staff‘s means
A few years ago I was engaged in finding out how the general practitioners communicated with their patients, and which steps they would take if met with I
Primary Health Care
a complaint of stomach ache ( 2 ) . I had the idea that the opening dialogue and examination was a kind of “technology”, to which certain rules could be applied. And I imagined that there was a certain consensus about these matters to the effect that general practitioners reacted more or less alike when confronted with a certain problem. This was far from being the case. However, I still believe this situation to be ideal, and the opening dialogue between the patient and his general practitioner must be a technology for assessment. During the recent years this subject has been taken up by a number of colleagues. Lars Christian Lassen (3) for one has dealt with the complex of problems concerning compliance and writes about his work, “The objectives of the study were to generate and test a theory about a connection between the consultation process and patient compliance with general practitioners’ medications and advice concerning life-style changes. This involved formulation of empirically based criteria for the quality of the consultation process, and if these criteria are fulfilled at an empirically established standard level, they result in great and significant improvements of compliance rates”. Lars Christian Lassen is thus trying to make an assessment of the single consultation by establishing whether a piece of advice given to the patient is taken. General practitioners want to comply with their patients’ expectations, and this aspect of the consultation has been examined by Inga Marie Lunde in “Patients’ perceptions - a shift in medical perspective” (4). She writes, “The aspects of disease lying outside the scientific biomedical area have not hitherto been of great interest in the medical research field. However, our possibility to act on the humanistic aspects in everyday clinical settings depends on insight and knowledge about these, too. Conceptualising and theorising in this complex territory is necScand J Prim Health Care 1991; 9
Downloaded by [81.7.17.171] at 19:03 14 March 2016
2
Editorial
essary to avoid being lost in one’s own experiences and in individual details.” Lunde is thus preoccupied with whether the general practitioners know their patients’ expectations and whether the patients’ desires are met. I take the consultation as a many-sided process subject to medical technology assessment. An important detail of the consultation could be bloodtests; but they are only to be taken when they are of utility value in the current situation, i.e. if they can stand up to a technology assessment. However, justified blood-tests are of minor value if not properly explained to the patient during the consultation. Accordingly, the general practitioners are forced to continue working with the consultation as a whole as well as with its many details. The work by Hjortdahl et al. on C-reactive protein is an inspiring technology assessment of a detail in the consultation in line with Kirsti Malterud’s thesis on “The encounter between the general practitioner and the female patient” (5). According to the latter author, the project is based on the hypothesis that a communicative method may influence the social relations and the transferral of knowledge in the consultation by strengthening the position of the female patient. Her aims of study were to present a systematic description and analysis of the development, characteristics, and implementation of a clinical communicative method, and to explore the knowledge about women’s health complaints revealed by the clinical method by means of a systematic description and analysis. Malterud makes detailed analyses of her consultations and introduces new standard questions, which
Scand J Prim Health Care 1991; 9
she expects will add to the equality between patient and doctor in the consultation situation. Her aim is to demonstrate that in this way general practitioners are becoming better advisers.
My Hope I presume that the general medical researchers will continue to work intensely on the consultation process and the dialogue between the patient and the general practitioner, and I am convinced that one day this technology will be subject to a quaiity assessment in line with the one so ideally introduced in this issue by Hjortdahl et al. REFERENCES 1. Hjortdahl P, Landaas S, Urdal P, Steinbakk M, Fuglerud P, Nygaard B. C-reactive protein: a new rapid assay for managing infectious disease in primary health care. Scand J Prim Health Care 1991; 9: 3-10. 2. N~rrelundN. Patienter med ondt i maven - en medicinsk teknologivurdering fra alrnen praksis 1989, eget forlag. In Danish (to be obtained from the author). 3. Lassen LC.Compliance in General Practice. Institut for almen medicin, Kebenhavns Universitet, 1989. Summary in English. 4. Lunde IM. Patients’ perceptions - a shift in medical perspective. FADL’s forlag 1990, K~benhavn.In Danish. Summary in English. 5. Malterud K. The encounter between the general practitioner and the female patient. Oslo: Tano, 1990. In Norwegian with a summary in English.
Niels N@rrelund Tjarnegirdsparken 1 DK-8570 Trustrup
