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"McDaniel, Susan H"
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Storylines of family medicine III: core principles—primary care, systems and family
Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine, as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In ‘III: core principles—primary care, systems, and family’, authors address the following themes: ‘Continuity of care—building therapeutic relationships over time’, ‘Comprehensiveness—combining breadth and depth of scope’, ‘Coordination of care—managing multiple realities’, ‘Access to care—intersectional, systemic, and personal’, ‘Systems theory—a core value in patient-centered care’, ‘Family-oriented practice—supporting patients’ health and well-being’, ‘Family physician as family member’ and ‘Family in the exam room’. May readers develop new understandings from these essays.
Journal Article
Patient Trust: Is It Related to Patient-Centered Behavior of Primary Care Physicians?
Background: Patients' trust in their health care providers may affect their satisfaction and health outcomes. Despite the potential importance of trust, there are few studies of its correlates using objective measures of physician behavior during encounters with patients. Methods: We assessed physician behavior and length of visit using audio tapes of encounters of 2 unannounced standardized patients (SPs) with 100 community-based primary care physicians participating in a large managed care organization. Physician behavior was assessed via 3 components of the Measure of Patient-Centered Communication (MPCC) scale. The Primary Care Assessment Survey (PCAS) trust subscale was administered to 50 patients from each physician's practice and to SPs. We used multilevel modeling to examine the associations between physicians' Patient-Centered Communication during the SP visits and ratings of trust by both patients and SPs. Results: Component 1 of the MPCC, which explored the patient's experience of the disease and illness, was independently associated with patient's rating of trust in their physician. A 1 SD increase in this score was associated with 0.08 SD increase in trust (95% confidence interval 0.02-0.14). Each additional minute spent in SP visits was also independently associated with 0.01 SD increase in patient trust. (95% confidence interval 0.0001-0.02). Component 1 and visit length were also positively associated with SP trust ratings. Conclusions: Physician verbal behavior during an SP encounter is associated with trust reported by SPs and patients. Research is needed to determine whether interventions designed to enhance physicians' exploration patients' experiences of disease and illness improves trust.
Journal Article
Physicians Criticizing Physicians to Patients
ABSTRACT
BACKGROUND
Teamwork is critical to providing excellent healthcare, and effective communication is essential for teamwork. Physicians often discuss patient referrals from other physicians, including referrals from outside their primary institution. Sharing conflicting information or negative judgments of other physicians to patients may be unprofessional. Poor teamwork within healthcare systems has been associated with patient mortality and lower staff well-being.
OBJECTIVE
This analysis explored how physicians talk to patients with advanced cancer about care rendered by other physicians.
DESIGN
Standardized patients (SPs) portraying advanced lung cancer attended covertly recorded visits with consenting oncologists and family physicians.
PARTICIPANTS
Twenty community-based oncologists and 19 family physicians had encounters with SPs.
APPROACH
Physician comments about care by other physicians were extracted from transcriptions and analyzed qualitatively. These comments were categorized as Supportive or Critical. We also examined whether there were differences between physicians who provide supportive comments and those who provided critical comments.
KEY RESULTS
Fourteen of the 34 encounters (41 %) included in this analysis contained a total of 42 comments about the patient’s previous care. Twelve of 42 comments (29 %) were coded as Supportive, twenty-eight (67 %) as Critical, and two (4 %) as Neutral. Supportive comments attributed positive qualities to another physician or their care. Critical comments included one specialty criticizing another and general lack of trust in physicians.
CONCLUSION
This study described comments by physicians criticizing other physicians to patients. This behavior may affect patient satisfaction and quality of care. Healthcare system policies and training should discourage this behavior.
Journal Article
A Curriculum for an Interprofessional Seminar on Integrated Primary Care: Developing Competencies for Interprofessional Collaborative Practice
Health care is increasingly delivered through team-based, collaborative strategies with interprofessional education as an important mechanism for building interprofessional practice competencies. This paper describes an Interprofessional Seminar on Integrated Primary Care (IS-IPC) designed
to meet this educational need with interprofessional teambased learning as the foundation of an iterative process such that education and practice inform one another. The IS-IPC can be used to educate an interprofessional group of learners about key topics relevant to working together in integrated
primary care. The IS-IPC describes steps in developing an interprofessional seminar, common challenges, and their solutions in creating interprofessional learning experiences, and eight foundational content modules containing an outline and curricular resources. The IS-IPC facilitates interprofessional
educator partnerships at the local level and can be customized to fit the local environment, pedagogical philosophy, and learning objectives.
Journal Article
The Psychotherapy of Genetics
The evolution of genomic science and its effect on medicine and health care offer opportunities for family therapists to participate in the comprehensive care of patients and families with genetic disorders. This article provides an overview of what we now know about the psychological and interpersonal experience of patients and families facing some of these illnesses. Case examples illustrate the process of decision‐making about testing and treatment, and the importance of understanding developmental issues and transgenerational family dynamics in any related psychotherapy. Challenging emotional issues include managing anger, ambivalence, and guilt; challenging interpersonal issues include dealing with differing coping and communication styles, decisions about disclosure and secrets, and conflict resolution. Family‐oriented interventions include individual, couple, and family therapy, and psychoeducational groups. Recommendations are made for family therapists to participate as part of the genetic healthcare team.
Journal Article
Physician Responses to Ambiguous Patient Symptoms
Objective: To examine how primary care physicians respond to ambiguous patient symptom presentations. Design: Observational study, using thematic analysis within a larger cross‐sectional study employing standardized patients (SPs), to describe physician responses to ambiguous patient symptoms and patterns of physician‐patient interaction. Setting: Community‐based primary care offices within a metropolitan area. Participants: Twenty‐three primary care physicians (internists and family physicians). Method: Participating physicians had 2 unannounced SP visits randomly inserted into their daily practice schedules and the visits were audiotaped and transcribed. A coding system focusing on physician responses to concerned patients presenting with ambiguous symptoms was developed through an inductive process. Thematic analyses were then applied to coded data. Results: Physicians' responses to ambiguous symptoms were categorized into 2 primary patterns: high partnering (HP) and usual care (UC). HP was characterized by greater responsiveness to patients' expression of concern, positivity, sensitivity to patients' clues about life circumstances, greater acknowledgment of symptom ambiguity, and solicitation of patients' perspectives on their problems. UC was characterized by denial of ambiguity and less inclusion of patients' perspectives on their symptoms. Neither HP physicians nor UC physicians actively included patients in treatment planning. Conclusions: Primary care physicians respond to ambiguity by either ignoring the ambiguity and becoming more directive (UC) or, less often, by acknowledging the ambiguity and attempting to explore symptoms and patient concerns in more detail (HP). Future areas of study could address whether physicians can learn HP behaviors and whether HP behaviors positively affect health outcomes.
Journal Article
Lyman C. Wynne M.D. Ph.D.: Master Mentor, Family Therapy Pioneer, and Scholar
When the family therapy that he had helped to pioneer came under fire from the National Association for the Mentally 111 (NAMI), Lyman made it his business to listen carefully to what NAMI had to say, decide what were justifiable complaints, and set about to change the approach of family therapists to the families of the seriously mentally ill. With the significant help of the chair of psychiatry, Eric Caine, and mentors in the Department of Psychiatry and on our Board, two of our junior Wynne Center faculty, Wendy Nilsen Ph.D. and Ellen Poleshuck Ph.D., received K23 Career Development Awards from the NIMH in 2006 and 2007 (Wendy to develop foster parent interventions to improve child outcomes, and Ellen to adapt interpersonal therapy for women with comorbid pain and depression in underserved women seeking help in ob/gyn clinics). Using the Wynnes' contribution as seed money, we hope in the coming decade to grow into a mature research center that will contribute to the health and well-being of families who are challenged by mental illness, physical illness, or social problems.
Journal Article
E-Mail Communication as an Adjunct to Systemic Psychotherapy
E-mail offers a powerful vehicle for communicating; any vehicle for communication can be used in psychotherapy. This paper represents some beginning thoughts, based on a series of cases, about the usefulness of e-mail as an adjunct to systemic psychotherapy. It does not address the issue of using the Internet therapy, but rather describes the use of e-mail to augment, extend, deepen, inform, enrich, & prepare for in-person psychotherapy. I begin with a review of what is known about the larger issue of therapeutic uses of writing, of which e-mail writing is a subset. 11 References. Adapted from the source document.
Journal Article