Biomedical subjects

J M Bensing

Publications and source records attributed to J M Bensing.

At least 37 records · Page 2Linked to original sources

PubMed1999

Complaints of fatigue: related to too much as well as too little external stimulation?

Fatigue has been acknowledged as a widespread problem associated with a variety of factors. In the present paper, we attempt to explain fatigue complaints on the basis of Pennebaker's (1982) "competition of cues" notion. Competition of cues suggests that both extremely low and extremely high levels of external stimulation in daily life may be related to relatively higher frequencies of complaint. The dimensional structure of external stimulation is first explored and then the shape of the relation between external stimulation (i.e., stimuli perceived in daily life) and fatigue was studied in a sample of 777 general-practice patients. Other risk factors for fatigue and moderating factors are also taken into consideration. Results show that quantity and quality of external stimulation can be distinguished. Both high quantity (high "experienced overload") and low quality (low "attractiveness of external stimulation") are related to higher fatigue frequencies. "Experienced overload" is a particularly strong predictor, in addition to "perceived health" of fatigue complaints. It is concluded that the "quality-quantity model for understanding fatigue" proposed here highlights psychological factors important for any theoretical framework of fatigue.

Adolescent↗

PubMed1999

Non-verbal behaviour in nurse-elderly patient communication.

This study explores the occurrence of non-verbal communication in nurse-elderly patient interaction in two different care settings: home nursing and a home for the elderly. In a sample of 181 nursing encounters involving 47 nurses a study was made of videotaped nurse-patient communication. Six non-verbal behaviours were observed: patient-directed eye gaze, affirmative head nodding, smiling, forward leaning, affective touch and instrumental touch. With the exception of instrumental touch these non-verbal behaviours are important in establishing a good relationship with the patient. To study the relationship between non-verbal and verbal communication, verbal communication was observed using an adapted version of Roter's Interaction Analysis System, which distinguishes socio-emotional and task-related communication. Data were analysed in hierarchical linear models. The results demonstrated that nurses use mainly eye gaze, head nodding and smiling to establish a good relation with their patients. The use of affective touch is mainly attributable to nurses' personal style. Compared to nurses in the community, nurses in the home for the elderly more often display non-verbal behaviours such as patient-directed gaze and affective touch.

Aged↗

PubMed1999

Factors related to nurse communication with elderly people.

This study explores variables that might influence nurses' communication with elderly patients. Three groups of variables arise from the literature that seem to affect the quality or quantity of nurse-patient communication: variables related to nurses, to patients, and to the setting in which nursing care takes place. The study was conducted in two different care settings: a home for elderly people and a home care organization. In a sample of 181 video-taped nursing encounters, involving 47 nurses and 109 patients a study was made of nurse-patient communication. In addition, relevant data related to patients, nurses and situation were gathered by questionnaires and were combined with the results of observations of videotaped nurse-patient interactions. It was found that the educational level of nurses was related most strongly to the way nurses communicate with their elderly patients. Patient characteristics such as age, gender and subjective state of health appeared to play a minor role in the way nurses communicate.

Aged↗

PubMed1999

Teaching clinically experienced physicians communication skills. A review of evaluation studies.

CONTEXT: Interest in the teaching of communication skills in medical schools has increased since the early seventies but, despite this growing interest, relatively limited curricular time is spent on the teaching of communication skills. The limited attention to the teaching of these skills applies even more to the physicians' clinical years, when attention becomes highly focused on biomedical and technical competence. Continuing training after medical school is necessary to refresh knowledge and skills, to prohibit decline of performance and to establish further improvements. OBJECTIVE: This review provides an overview of evaluation studies of communication skills training programmes for clinically experienced physicians who have finished their undergraduate medical education. The review focuses on the training objectives, the applied educational methods, the evaluation methodology and instruments, and training results. METHODS: CD-ROM searches were performed on MedLine and Psychlit, with a focus on effect-studies dating from 1985. RESULTS: Fifteen papers on 14 evaluation studies were located. There appears to be some consistency in the aims and methods of the training programmes. Course effect measurements include physician self-ratings, independent behavioural observations and patient outcomes. Most of the studies used inadequate research designs. Overall, positive training effects on the physicians' communication behaviour are found on half or less of the observed behaviours. Studies with the most adequate designs report the fewest positive training effects. CONCLUSION: Several reasons are discussed to explain the limited findings. Future research may benefit from research methods which focus on factors that inhibit and facilitate the physicians' implementation of skills into actual behaviours in daily practice.

Communication↗

PubMed1999

Gender differences in fatigue: biopsychosocial factors relating to fatigue in men and women.

BACKGROUND: Fatigue is a common problem, which is found more frequently among women than men. To date, neither the etiology of fatigue nor the factors that explain the gender difference in its incidence are still fully understood. METHODS: In a sample of men (n = 4,681) and women (n = 4,698) (age range, 15-64 years) in the Dutch National Survey of Morbidity and Interventions in General Practice, the gender differences in the underlying biological, psychological, and social factors of fatigue were analyzed. RESULTS: Both general and gender-specific factors were recognized. Men and women who experience complaints of fatigue appeared to be younger and more highly educated. They had more acute health complaints and more psychosocial problems and also showed a lower level of perceived health. Among women, only gender-specific biological complaints and psychosocial problems were related to fatigue. In addition, relevant sociodemographic variables included taking care of young children and being employed. Among men, fatigue was particularly related to having handicaps and severe chronic complaints. Taking care of young children did not make a difference in the male sample. CONCLUSIONS: Fatigue can only be adequately understood in a multicausal model with biomedical and psychosocial factors. Complaints of fatigue are too often ignored in general practice. By adopting a patient-centered style of communication, physicians can acquire a more complete picture of the patients' fatigue.

Adolescent↗

PubMed1998

General practitioners' attributions of fatigue.

In this paper general practitioners' (GPs') somatic-psychosocial attributions of fatigue are examined. The attribution process during medical consultations was studied by relating the GPs' judgements of the somatic-psychosocial character of their patients' fatigue to patient-related characteristics, on the one hand, and medical-consultation characteristics on the other hand. The study was based on 2097 contact registrations from the Dutch National Study of Morbidity and Intervention in General Practice by the NIVEL (Netherlands Institute of Primary Health Care). In order to explain the GPs' attributions, patient-related characteristics were added stepwise in a multiple regression analysis. Sociodemographic characteristics explained only 1.8% of the variance. Other complaints explained an additional 14.3% with psychosocial complaints being most influential. Knowledge of an underlying disease/problem explained an additional 9.9% of the variance. All of the characteristics together explained 26.0% of the attributions by the GPs. More psychosocially-attributed fatigue was found to correlate with consultations characterized by less physical examination, more diagnostic procedures to reassure, fewer diagnostic procedures to discover underlying pathology, more counselling, less medical treatment, less prescription and a longer duration than consultations with more somatically attributed fatigue. It is concluded that GPs do not discriminate between social groups when attributing fatigue to either somatic or psychosocial causes. The presence and character of other complaints and underlying diseases/problems, rather, relate to the GPs' somatic psychosocial attributions, which are then associated with particular aspects of the consultation.

Adult↗

PubMed1998

Assessment of distress associated with tinnitus.

This paper focuses upon the quality of the Dutch translation of the STSS (Subjective Tinnitus Severity Scale), a scale which assesses the severity of tinnitus and the related distress. Research has been done on the psychometric qualities of this scale, its relationship with loudness-matching procedures and several psychological variables. Data presented on 104 tinnitus patients demonstrated the reliability of the STSS with a coefficient alpha of 0.71. Factor analysis revealed four factors: emotional distress, intrusiveness, annoyance and cognitive distress. With regard to the validity, significant correlations of a moderate degree were found with several unitary subjective scales measuring the same construct (rs = 0.50, p < 0.001 and rs = 0.43, p < 0.01). Correlational research demonstrated that the STSS is independent of the loudness of tinnitus as measured by matching procedures (rs = 0.00). In contrast, significant correlations of a moderate magnitude were found with anxiety (rs = 0.33, p < 0.001) and depression (rs = 0.31, and rs = 0.35, p < 0.001).

Anxiety↗

PubMed1998

Gender and communication style in general practice. Differences between women's health care and regular health care.

OBJECTIVES: Differences were investigated between general practitioners providing women's health care (4 women) and general practitioners providing regular health care (8 women and 8 men). Expectations were formulated on the basis of the principles of women's health care and literature about gender differences. METHODS: Data were used from 405 videotaped consultations of female patients (over 15 years). Roter's Interaction Analysis System (RIAS) was used to measure the verbal affective and instrumental behavior of the doctors and their patients. These data were supplemented by various nonverbal measures. The data were analyzed by means of multilevel analysis. RESULTS: Doctors in the women's health care practice (called Aletta) look at their patients and talk with them more than other doctors. The general practitioners have approximately the same affective behavior, but the Aletta doctors show more verbal attentiveness and warmth. They also give more medical information and advice. Most of the characteristics of Aletta doctors fit female doctors providing regular health care too. Male doctors show a less communicative behavior in most respects. The differences between general practitioners are reflected in their patients' communication style. CONCLUSIONS: The integration into regular care of some aspects of doctor-patient communication that were found in women's health care might be desirable in the light of the further improvement of the quality of care for women and men.

Affect↗

PubMed1997

[Indications for management in long-term, physically unexplained fatigue symptoms].

In meetings arranged by the minister of Public Health, Welfare and Sports between general practitioners and specialists concerning chronic fatigue syndrome (CFS), suggestions for the diagnosis, treatment and assistance and support of patients with protracted physically unexplained fatigue symptoms, were established in the light of current scientific insight. The term 'CFS' is applicable in cases of fatigue complaints, of at least 6 months' standing, reported by the patient himself and evaluated medically, for which no physical explanation has been found and which cause considerable disabilities in professional social and/or personal functioning. The management depends on the duration of the illness. A distinction is made between an acute phase (up to one month after the first consultation; the policy is mostly expectative), a subacute phase (until 6 months after the onset of the complaints and disabilities; the management is aimed at making the patient accept the condition and persuading him or her to make an effort to promote health) and a chronic phase (from 6 months after the onset of the complaints and disabilities; the management is aimed at health-promoting behaviour and cognitions). Further (laboratory) examinations are useful only if the symptoms have not disappeared after one month (this is the case in approximately 20% of the patients); such examinations may be useful in older patients earlier. It is important that the CFS patient learns to realize that it is useless to continue to spend energy on searching for causes and possible therapies, but that he should try to promote his own health, for instance by means of a quantified programme of activities linked to a time schedule (instead of to a level of fatigue).

Clinical Protocols↗

PubMed1997

Patient preference for genders of health professionals.

Preferences for physicians' gender is an obvious and well documented example of considerations of patients' attitudes. But research carried out in this field is rather limited to the domain of family medicine. This article describes preferences for 13 different health professions: surgeons, neurologists, anaesthetists, internists, general practitioners, psychiatrists, psychologists, social workers, hospital and district nurses, home helps, gynaecologists and midwives. Our investigation also concerns the reasons for people's preferences. In February 1993 a self-administered survey was completed and returned by 961 out of 1113 (response 86%) participants of the Dutch Health Care Consumers Panel, a panel resulting from a random sample of Dutch households. On a range of different health professions a varying minority of patients prefer a care provider of a particular gender. There are virtually no sex preferences for the more "instrumental" health professions (e.g. surgeons, anaesthetists). Gender preferences are stronger for those health professions more likely engaged in intimate and psychosocial health problems (e.g. gynaecologists and GPs). Preferences expressed do not relate to sex stereotypes of gender differences in instrumentality, expertise, efficiency, consultation length, and personal interest. The majority of persons who prefer female health professionals indicate that they talk more easily to females than to males, and feel more at ease during (internal) examination by females than by males. Persons who prefer male health professionals use the same reasons in favour of males. The discussion relates to gender differences in the communication style of male and female physicians.

Choice Behavior↗

PubMed1997

The role of communication in nursing care for elderly people: a review of the literature.

Communication in nursing care is an important topic assessing the specific needs of elderly patients and providing nursing care that is tailored to the individual patient's needs. In this review of the literature, we describe the role attributed to communication in theoretical nursing models and we report how research in communication in nursing elderly patients has taken place over the last ten years. It appears that since the eighties there has been an increase in observation studies into nurse-patient communication. There still is, however, a lack of observation instruments to do justice to the interactive nature of nurse-patient communication. Special attention should be paid to reliability and validity.

Aged↗

PubMed1997

Sex differences in persistent fatigue.

This study examines factors differentiating women and men who suffer from fatigue. It is based on diaries kept by Dutch citizens over a 21-day period between 1987-88. The majority of those with persistent fatigue complaints (PFs) were male, middle-aged, lower-educated and unemployed, and they had more psychological and psycho-social problems than the incidental fatigue sufferers (IFs). Factors differentiating the PFs from the IFs are not the same for both sexes. Moreover, on a number of socio-demographic variables PF men and women differed less from each other than IF men and women. Future research should focus on the gender-specificity of the factors that lead to the development of persistent fatigue.

Adult↗

PubMed1996

Factors influencing the type of health problems presented by women in general practice: differences between women's health care and regular health care.

OBJECTIVE: Differences between health problems presented by women (aged 20-45) to female "women's health care" doctors and both female and male regular health care doctors were investigated. This article explores the relationship of patients' roles (worker, partner, or parent) and the type of health care, controlling for education, to the presentation of psychological, social, and purely somatic problems in general practice. METHOD: Data was derived from a "women's health care" practice and twenty-one group practices providing regular care. The doctors registered detailed information about all patient contacts during a three-month period. Logistic regression analysis was used in order to calculate the likelihood of women attending their doctor to present with psychological, social, or somatic health problems. RESULTS: We found that the effect of education was much stronger than the effect of roles. Women attending women's health care presented more psychological and social problems and less somatic problems than women visiting regular health care doctors. Patients of female and male doctors providing regular care did not differ in this respect between each other. CONCLUSIONS: This study showed that patient characteristics, like roles and education, are related to the type of health problems presented to general practitioners. The type of health care was also important in explaining differences in the problems presented to them. Future research in primary care should include doctor characteristics to better understand how these characteristics might relate to patient outcomes.

Adult↗

PubMed1994

[Mental problems in family practice more variable and diffuse that in psychiatry].

OBJECTIVE: To describe the epidemiology of mental problems in general practice, from the viewpoint of the general practitioner (GP). DESIGN: Descriptive population survey. SETTING: Data were collected from the National Study of Morbidity and Interventions in General Practice. METHOD: In 1987-1988 we used an interview to assess health status and medical consumption of 10,350 persons, aged 15 and over. At the same time they were screened for mental illness using the General Health Questionnaire (GHQ). For three months, all doctor-patient contacts, the reason for contact (classified in ICPC) and the GP's assessment of possible psychological factors in the reason for contact were recorded. RESULTS: Of the patients with a high GHQ score only one third explicitly mentioned his psychological problems to the GP, 70 were recognized by the GP as having psychological problems in the three month period and besides psychological problems this group showed much more acute and chronic physical illness. Patients scoring high on the GHQ have more symptoms, but in general not other symptoms than mentally 'healthy' people have. CONCLUSION: Screening-programmes on mental illness are not recommended because of the impossible of determining the groups at risk. Prevention might be possible in patients with a high frequency in doctor-patient contacts and many physical complaints. A public health approach, encouraging patients to discuss psychological problems directly with their GP, might be sensible.

Adolescent↗

PubMed1994

Consultations for women's health problems: factors influencing women's choice of sex of general practitioner.

AIM: This study set out to examine the degree to which women choose to visit a woman doctor for women's health problems and the determinants of this choice. The differences between women and men doctors with regard to treating women's health problems were also studied. METHOD: Data from the Dutch national survey of general practice were used. All group practices with both women and men general practitioners were selected. Analyses were restricted to consultations among women aged 15-65 years about menstruation, the menopause, vaginal discharge, breast examination and cervical smear tests. RESULts. Given the size of their female practice population, women doctors saw considerably more women with women's health problems than did their male colleagues. Women were more likely to consult a woman general practitioner if she was more available (that is, working longer hours), and younger women were more likely than older women to choose women general practitioners. Sex differences in the treatment of women's health problems were small and mainly related to the verbal part of the consultation: counselling and providing information. The doctors' availability and their certainty about the working diagnosis explained differences in the verbal aspects of consultations. Women general practitioners had longer consultations than their male colleagues mainly because more health problems were presented per consultation. CONCLUSION: In order to increase the possibility of patients choosing women general practitioners, policy should be directed towards the education of more women general practitioners and women general practitioners should be encouraged to work more days a week.

Adult↗

PubMed1993

Gender differences in practice style: a Dutch study of general practitioners.

The differences between female and male general practitioners (GPs) were studied regarding three different factors: 1) Do female GPs see more female patients than their male colleagues in the same practice?; 2) Are female GPs confronted with different types of health problems from their male colleagues?; and 3) Do female GPs provide different services to their patients? Data from the Dutch National Study on Morbidity and Interventions in General Practice were used. All practices in this study with both female (n = 23) and male (n = 27) GPs were selected. This resulted in detailed data on 47,254 consultations, 62% of which were with female patients. The three research questions all received an affirmative response: 1) female patients tend to choose female general practitioners; 2) female GPs see different health problems from their male colleagues, and that is only partly because the patient so chooses; and 3) besides the expected differences in female-specific problems, there is a clear GP-gender effect in the presence of 'social' and 'metabolic' problems in the female GP's consultations. Some differences in the provision of services between male and female GPs occurred, with female GPs spending more time on their patients and having a stronger tendency to provide continuity of care. In addition to a gender effect (both physician and patient) a part-time effect in most issues studied was observed.

Adolescent↗

PubMed1992

Instrumental and affective aspects of physician behavior.

In a semi-replication study, 103 videotaped real-life general practice consultations of patients with hypertension were observed with Roter's interaction Analysis System (RIAS). RIAS consists of a detailed category system meant to measure each verbal utterance of physician and patient (distinguished in task-related behavior and socio-emotional behavior) and a set of global affect-ratings. In this article, only general practitioner (GP) behavior is studied. GP's behavior is related to panel-assessed quality of care on three separate dimensions (technical-medical, psychosocial, and the management of the physician-patient relationship). A remarkably high percentage of the variance in the quality assessments (ranging from 59% to 70%) was explained by RIAS. The global affect-ratings proved to have the strongest influence in all quality assessments. In addition, task-related behavior seems to be more important in medical technical behavior, whereas socio-emotional behavior, and especially the psychotherapeutic categories like reflecting, paraphrasing, showing agreement, and others, seem to be more important in the other quality measures. The results are compared with Roter's study; similarities and differences are discussed in light of adjustments in the methodology. A plea is made for cross-cultural comparisons in physician behavior.

Adult↗

PubMed1985

Evaluation of an interview training course for general practitioners.

This article describes the evaluation of an experimental training in doctor-patient communication for general practitioners. The training was based on Rogerian theory and accommodated to the specific situation of the general practitioner. The main concept of this theory is the notion of 'unconditional positive regard'. It was expected that doctors would change their communication behaviour and that as a result patients would talk more about their psychosocial problems. The training was restricted to the diagnostic process, no therapeutic interventions were taught. The effects of this training have been measured by comparing video-tapes of live doctor-patient consultations, before and 3 months after the training. The most important result of this evaluation study turned out to be the change of the doctor's behaviour in the expected direction, but surprisingly the outcome of the consultation did not change at all: the doctors were empathically listening, but the patients did not talk more about their problems. Creating room for patients is not sufficient to induce them to discuss their personal problems with their doctors. Perhaps they do not feel like discussing their personal problems with them at all.

Communication↗