Biomedical subjects

Elizabeth Murray

Publications and source records attributed to Elizabeth Murray.

22 records · Page 2Linked to original sources

PubMed2002

The CeMENT project: a case study in change management.

The Community Based Medical Education in North Thames (CeMENT) Project case study is a useful approach to analysing complex change facing the medical profession and all medical teachers. The project was a collaboration involving five North London medical schools to develop the community-based aspects of the undergraduate medical curriculum. The project management team was drawn from academic general practitioners, hospital specialists with expertise in medical education, and education. Complex change involving partnerships across organizational and functional boundaries is often extremely challenging in terms of coordination and management owing to its unpredictability and ownership problems. Success in change management could be enhanced by use of a framework that includes a clear statement of purpose, stakeholder concordance and trust, clear leadership and structures, and fast action together with recognition of achievements.

Clinical Clerkship↗

PubMed2002

Patients' views and feelings on the community-based teaching of undergraduate medical students: a qualitative study.

BACKGROUND: The 1993 directive Tomorrow's Doctors recommended an increase in community-based teaching. In response, many new programmes have been established focusing on the teaching of clinical skills to pairs or groups of students in general practice, when patients are asked to see the students in the practice or in their homes, specifically to assist with teaching. This differs from the traditional model of teaching primary care, when one student sits with the doctor while s/he consults. Although current research suggests that patients are happy for one student to be present during a consultation with their GP, little or nothing is known about their views of this new method of teaching basic clinical skills in the community. If the new community-based teaching programmes are to be sustainable, continuing support from the patients is necessary. Students have been taught clinical skills in the community at University College London Medical School for several years. Research has demonstrated its effectiveness and its popularity with students. However, to date, patients' views have not been explored. OBJECTIVE: Our aim was to determine the patients' views and feelings on community-based teaching, in order to discover both the positive and negative aspects for participating patients. METHOD: A qualitative semi-structured interview study was carried out in undergraduate teaching general practices in North London. RESULTS: Respondents felt very positive about participating in the community-based teaching programme. There were two underlying components to this: altruism and personal gain. Within altruism, reasons included: provision of a service to the community and repaying the system. Aspects of personal gain included: improved knowledge, improved self-esteem and companionship. Patient concerns included: embarrassment, reinforcement of the sick role and concerns about student access to notes. CONCLUSIONS: Patients enjoy their involvement in community-based teaching and perceive themselves as making a valuable contribution. The findings of the research will be reassuring for doctors who presently are involved and those who plan to be involved in the future. Doctors need to be aware of the possible shifts in the doctor-patient relationship when actively seeking patients' help in the teaching.

Altruism↗

PubMedDate not supplied

Direct-to-consumer advertising: physicians' views of its effects on quality of care and the doctor-patient relationship.

BACKGROUND: The objective of the study was to determine physicians' views of the effects of Direct-to-Consumer Advertising (DTCA) on health service utilization, quality of care, and the doctor-patient relationship. METHODS: Cross-sectional survey of a nationally representative sample of US physicians to determine their perceptions of the effects of patients discussing information from DTCA on time efficiency; requests for specific interventions; health outcomes; and the doctor-patient relationship. RESULTS: Physicians reported that more than half (56%) of patients who discussed information from DTCA in a visit did so because they wanted a specific intervention, such as a test, change in medication, or specialist referral. The physician deemed 49% of these requests clinically inappropriate. Physicians filled 69% of requests they deemed clinically inappropriate; 39% of physicians perceived DTCA as damaging to the time efficiency of the visit, and 13% saw it as helpful. Thirty-three percent of physicians thought discussing DTCA had improved the doctor-patient relationship; 8% felt it had worsened it. The effect on the relationship was strongly associated with doing what the patient wanted. CONCLUSIONS: DTCA can have good and bad effects on quality of care, the doctor-patient relationship, and health service utilization. The benefits might be maximized, and the harms minimized, by increasing the accuracy of information in advertisements; enhancing physicians' communication and negotiation skills; and encouraging patients to respect physicians' clinical expertise.

Adult↗

PubMedDate not supplied

Direct-to-consumer advertising: public perceptions of its effects on health behaviors, health care, and the doctor-patient relationship.

PURPOSE: To determine public perceptions of the effect of direct-to-consumer advertising (DTCA) of prescription medications on health behaviors, health care utilization, the doctor-patient relationship, and the association between socioeconomic status and these effects. METHODS: Cross-sectional survey of randomly selected, nationally representative sample of the US public using computer-assisted telephone interviewing. MAIN OUTCOME MEASURES: numbers and proportions of respondents in the past 12 months who, as a result of DTCA, requested preventive care or scheduled a physician visit; were diagnosed with condition mentioned in advertisement; disclosed health concerns to a doctor; felt enhanced confidence or sense of control; perceived an effect on the doctor-patient relationship; requested a test, medication change, or specialist referral; or manifested serious dissatisfaction after a visit to a doctor. RESULTS: As a result of DTCA, 14% of respondents disclosed health concerns to a physician, 6% requested preventive care, 5% felt more in control during a physician visit; 5% made requests for a test, medication change, or specialist referral, and 3% received the requested intervention. One percent of patients reported negative outcomes, including worsened treatment, serious dissatisfaction with the visit, or that the physician acted challenged. Effects of DTCA were greater for respondents with low socioeconomic status. CONCLUSIONS: DTCA has positive and negative effects on health behaviors, health service utilization, and the doctor-patient relationship that are greatest on people of low socioeconomic status. The benefits of DTCA in terms of encouraging hard-to-reach sections of the population to seek preventive care must be balanced against increased health care costs caused by clinically inappropriate requests generated by DTCA.

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