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Physicians perform poorly in complex cases


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University of Illinois at Chicago (2010, July 19). Physicians can perform poorly when patients need special care, study suggests. ScienceDaily. Retrieved July 20, 2010, from http://www.sciencedaily.com/releases/2010/...00719174905.htm



ScienceDaily (July 19, 2010) ? Patients often receive inappropriate care when their doctors fail to take into account their individual circumstances, according to a new study by the University of Illinois at Chicago and the VA Center for Management of Complex Chronic Care.





The study of physician performance is the largest ever to be conducted using actors presenting as patients in doctors' offices. It appears in the July 20 issue of Annals of Internal Medicine and was funded by the Department of Veterans Affairs.


"Physicians did quite well at following guidelines or standard approaches to care, but not so well at figuring out when those approaches were inappropriate because of a particular patient's situation or life context," said Dr. Saul Weiner, associate professor of medicine and pediatrics at UIC and staff physician at the Jesse Brown VA Medical Center, who was lead author of the study

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I'm glad this is getting some attention. This is something that physicians and patients need to be aware of. Most of the less-than-competent, poorly informed doctors I've seen think they know everything, and most patients never think to question or even evaluate their doctor's competence, so nothing ever changes.

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It's good to see the "experts" are finally figuring out what we already know.


Thanks Susan!




Yes, my reaction was a big Homer Simpson type DOH! :-)



Here's a corollary issue:


July 20, 2010, 8:36 AM ET.The Pros and Cons of Opening Doctors? Notes to Patients.Patients typically have no idea what their doctor jots down about them after an office visit, and rarely read those notes, even though they have the legal right to do so. Now, an ambitious project called OpenNotes aims to change that, by giving patients access to the notes recorded after every medical encounter, according to today?s Informed Patient column.


In a paper published today in the Annals of Internal Medicine, researchers detailed the decidedly mixed reactions they received in the planning stages of the project, when they surveyed doctors and patients on their attitudes about opening doctors? notes to patients. In an unusual move, they are now widening that net, offering both medical professionals and the lay public the opportunity to weigh in with their own reactions in an online survey and on the Annals website.


?We very much want to gather both attitudes and expectations from as many people as possible,? Tom Delbanco, the project?s principal investigator, tells the Health Blog. Delbanco, a Harvard Medical School professor who sees patients at Beth Israel Deaconess Medical Center, says the public survey is based on one that was administered to 115 participating doctors and more than 8,000 patients. ?We thought it would be fascinating to have it fielded as widely as possible, both for people to test their own views and, at some point, to report on what they tell us,? he adds.


The OpenNotes project is part of a growing effort to improve doctor-patient communication and involve patients more closely in their care, in part by taking advantage of the easy access to health data provided by electronic medical records. In addition to Beth Israel, Geisinger Health System in Danville, PA, and Seattle?s Harborview Medical Center are participating in the project.


The Annals paper covers many of the pros and cons doctors and patients anticipated would come of the project. Reading doctors? notes might help improve patients? understanding of their medical condition, make them more active participants in their care and help them better prepare for the next visit ? making for more efficient and effective office encounters. Respondents also suggested that patients might be able to spot errors or misunderstandings in the record, and that doctors might complete their notes in a more timely manner if they knew they had to show them to patients.


But Delbanco?s team turned up plenty of perceived disadvantages as well, including possible patient confusion or misunderstanding of medical terms, concerns about breaches of privacy and security and more post-visit demands on doctors? time to address patients? concerns about their notes. And of course, there are worries that patients might take offense at some of the abbreviations doctors use ? ike SOB, which means Shortness of Breath to a doctor but might understandably be misunderstood as an insult.


Stephen Ross, a physician at the University of Colorado Hospital, has conducted small studies in which patients with chronic diseases were given access to doctors? notes. In and of themselves they don?t seem to help patients care for themselves better, he says, and it?s important to offer other personalized programs that assist patients directly, like helping them take their medications regularly.


But patients do appreciate the access, and making notes available ?improves the culture of care and the patient-centeredness of care,? Ross says. ?If patients could routinely look at their notes they could identify errors in the record, clarify any misunderstandings, better understand their doctors? reasoning and better communicate their own preferences when they next see the doctor.?


Photo: Associated Press


Copyright 2008 Dow Jones & Company, Inc. All Rights Reserved




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This is so true, we are living proof of this!!! Glad its getting noticed!!


I went to see my GP as specialist put me on tablets and was 10mg

I was having major head pressure, facial pain, even more anger, suicidal,crying anxious,

Foot cramps all this stuff but couldn't get hold of my specialist..


So I went to GP as you'd think you'd get some support! He said there's no point

Coming here I don't know what's wrong with you! Your under specialist

And you've had a lot of tests they may find what's wrong with you in 100 years

But its likley you'll never get better and will have to live with it

IM JUST A GP I don't know!!!!


this is another example as soon as I walk ion they've given up

And to say that sort of thing when in such a state I fell apart..


Lucy phone my mum who came to barts ewith me and she sasi he is a pratt

We heard what barts said and they know you have problems..


Then my sister had words as I was hysterical..he called me and said well drop it to 5 mg

And speak to consultant...but I have a constant battle just to get a little help..

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