Tag: doctor–patient interaction

Categories : HospitalsTags : Leave a comment

Does Giving Lifestyle Advice Really Work?

On By ModernMedia
Photo by Cottonbro on Pexels

Healthcare professionals are increasingly giving advice to patients on how to improve their health, but there is often a lack of scientific evidence if this advice is actually beneficial. This is according to a study from the University of Gothenburg, which also guides towards more effective recommendations.

The researchers do not criticise the content of the advice – after all, it is good if people lose weight, stop smoking, eat a better diet or exercise more. But there is no evidence that patients actually do change their lifestyle after receiving this advice from healthcare professionals.

“There is often a lack of research showing that counselling patients is effective. It is likely that the advice rarely actually helps people,” says study lead author Minna Johansson, Associate Professor at Sahlgrenska Academy at the University of Gothenburg and General Practitioner at Herrestad’s Healthcare Center in Uddevalla.

Few pieces of advice are well-founded

The study, published in the Annals of Internal Medicine, was conducted by an international team of researchers. They have previously analysed medical recommendations from the National Institute for Health and Care Excellence (NICE) in the UK. This organisation is behind 379 recommendations of advice and interventions that healthcare professionals should give to patients, with the aim of changing their lifestyle.
 
In only 3% of cases there were scientific studies showing that the advice has positive effects in practice. A further 13% of this advice had some evidence, but with low certainty. The researchers also reviewed additional guidelines from other influential institutions around the world and found that these often overestimate the positive impact of the advice and rarely take disadvantages into account.
 
“Trying to improve public health by giving lifestyle advice to one person at a time is both expensive and ineffective. Resources would probably be better spent on community-based interventions that make it easier for all of us to live healthy lives,” says Minna Johansson, who also believes the advice could increase stigmatisation for people with, eg, obesity.

Showing the way forward

Today’s healthcare professionals would not be able to give all the advice recommended while maintaining other care. The researchers’ calculations show that in the UK, for example, five times as many nurses would need to be hired, compared to current levels, to cope with the task.
 
The study also presents a new guideline to help policy makers and guideline authors consider the pros and cons of the intervention in a structured way before deciding whether or not to recommend it.
 
Victor Montori, Professor of Medicine at the Mayo Clinic in the United States is a co-author of the study:
“The guideline consists of a number of key questions, which show how to adequately evaluate the likelihood that the lifestyle intervention will lead to positive effects or not,” says Victor Montori.

Source: University of Gothenburg

Categories : General Interest HospitalsTags : Leave a comment

Meeting at Eye Level in Hospitals Improves Patient Experience and Outcomes

On By ModernMedia

Review of research suggests patients feel better when providers sit or crouch during bedside conversations

Photo by National Cancer Institute on Unsplash

Doctors and other healthcare workers, you may want to sit down for this news. A systematic review of studies suggests that getting at a patient’s eye level when talking with them about their diagnosis or care can really make a difference. 

Their findings, published in the Journal of General Internal Medicine, revealed that sitting or crouching at a hospitalised patient’s bedside was associated with more trust, satisfaction and even better clinical outcomes than standing, according to the review of evidence.

The study’s authors, from the University of Michigan and VA Ann Arbor Healthcare System, note that most of the studies on this topic varied with their interventions and outcomes, and were found to have high risk of bias. 

So, the researchers sat down and figured out how to study the issue as part of their own larger evaluation of how different nonverbal factors impact care, perceptions and outcomes.

Until their study ends, they say their systematic review should prompt clinicians and hospital administrators to encourage more sitting at the bedside. 

Something as simple as making folding chairs and stools available in or near patient rooms could help – and in fact, the VA Ann Arbor has installed folding chairs in many hospital rooms at the Lieutenant Colonel Charles S. Kettles VA Medical Center.

Nathan Houchens, MD, the U-M Medical School faculty member and VA hospitalist who worked with U-M medical students to review the evidence on this topic, says they focused on physician posture because of the power dynamics and hierarchy of hospital-based care. 

We hope our work will bring more recognition to the significance of sitting and the general conclusion that patients appreciate it.”

-Nathan Houchens, M.D.

An attending or resident physician can shift that relationship with a patient by getting down to eye level instead of standing over them, he notes. 

He credits the idea for the study to two former medical students, who have now graduated and gone on to further medical training elsewhere: Rita Palanjian, M.D., and Mariam Nasrallah, M.D. 

“It turns out that only 14 studies met criteria for evaluation in our systematic review of the impacts of moving to eye level, and only two of them were rigorous experiments,” said Houchens. 

“Also, the studies measured many different things, from length of the patient encounter and patient impressions of empathy and compassion, to hospitals’ overall patient evaluation scores as measured by standardised surveys like the federal HCAHPS survey.”

In general, he says, the data paint the picture that patients prefer clinicians who are sitting or at eye level, although this wasn’t universally true. 

And many studies acknowledged that even when physicians were assigned to sit with their patients, they didn’t always do so – especially if dedicated seating was not available. 

Houchens knows from supervising U-M medical students and residents at the VA that clinicians may be worried that sitting down will prolong the interaction when they have other patients and duties to get to. 

But the evidence the team reviewed suggests this is not the case. 

He notes that other factors, such as concerns about infection transmission, can also make it harder to consistently get to eye level. 

“We hope our work will bring more recognition to the significance of sitting and the general conclusion that patients appreciate it,” said Houchens. 

Making seating available, encouraging physicians to get at eye level, and senior physicians making a point to sit as role models for their students and residents, could help too. 

A recently launched VA/U-M study, funded by the Agency for Healthcare Research and Quality and called the M-Wellness Laboratory study, includes physician posture as part of a bundle of interventions aimed at making hospital environments more conducive to healing and forming bonds between patient and provider. 

In addition to encouraging providers to sit by their patients’ bedsides, the intervention also includes encouraging warm greetings as providers enter patient rooms and posing questions to patients about their priorities and backgrounds during conversations.

The researchers will look for any differences in hospital length of stay, readmissions, patient satisfaction scores, and other measures between the units where the bundle of interventions is being rolled out, and those where it is not yet.

Source: University of Michigan

Categories : Obstetrics & GynaecologyTags : Leave a comment

Choice of Words Matters for PCOS Patients’ Wellbeing

On By ModernMedia
Photo by Sora Shimazaki on Pexels

The choice of words that doctors doctors use when diagnosing female patients with polycystic ovary syndrome (PCOS) can negatively impact their wellbeing and how they view their condition later on in life, according to new research published in the British Journal of General Practice.  

PCOS can result in a range of physical symptoms, such as dysmenorrhoea or amenorrhoea, and metabolic issues. University of Surrey researchers found that the use of the word ‘raised’ by practitioners when discussing test results can lead to higher levels of body dissatisfaction and dieting behaviour amongst women, whilst the use of the word ‘irregular’ can result in concerns about fertility. 

Jane Ogden, Professor of Health Psychology at the University of Surrey, said: “Diagnostic consultations may take a few minutes, yet how these minutes are managed, what words are used and how this makes a patient feel may change how they make sense of their condition and influence their wellbeing in the longer term. It is important that doctors have an awareness of the words they use and think about how they could be perceived by patients.”  

In one of the first studies of its kind, researchers investigated the impact of PCOS diagnostic consultations and whether the language used impacted the subsequent wellbeing of patients.

To assess the impact, researchers surveyed 147 females with PCOS and asked about their satisfaction with their consultation, the language used during it and their overall wellbeing.  

Researchers found that those who had felt uncomfortable with the consultation process were more likely to report poorer body esteem, reduced quality of life and greater concerns about health in later life. Over a quarter of those surveyed were dissatisfied with how doctors managed their distress and were unhappy with the lack of rapport they had with their practitioners.  

Prof Ogden added: “Words matter, as patients often replay conversations that they have had with doctors in a bid to make sense of situations. Although words such as ‘raised’ and ‘irregular’ are simple words they are vague which can cause women to worry, as they automatically think the worst, as they have not been provided with all the facts. Such anxiety at the time of diagnosis, can negatively impact how they feel about themselves as their life progresses.” 

Source: University of Surrey