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Biomedical subjects

L Ridsdale

Publications and source records attributed to L Ridsdale.

14 recordsLinked to original sources

Doctors' interviewing technique and its response to different booking time.

There is a burgeoning literature on communication in general practice. It is often assumed that trained GPs know and practice the techniques described, but that time is a major constraint. In two experimental studies patients were given shorter or longer appointments, and the doctors' use of different verbal interventions was measured. Our analysis focused on how individual doctors varied in their use of interviewing techniques according to the time available. When more time was available some interventions were used more frequently by all doctors, but for other interventions the response was variable. For example, GPs who normally used facilitation frequently used it more often when greater time was available, whereas doctors who used this technique less frequently tended not to change when more time was available. This suggests that, at least in the short term, there is a differential response to changes in the time available in the consultation, with increased time being a necessary but not sufficient condition to promote the greater use of the communication techniques which doctors use less frequently.

Communication

When keeping secrets may cause harm.

A GP is not informed that her patient is HIV-positive. The question is posed-should doctors in special clinics act on the assumption that patients do not want their GP informed? It is argued that this assumption may be false, and that it may deny patients the offer of appropriate and timely support.

Confidentiality

Patient contact and list size.

The size of a doctor's list affects the attitudes of both the doctor and his patient. Furthermore, both GP and patient satisfaction about a consultation increases with the consultation time. What is the optimal list size?

Appointments and Schedules

Study of the effect of time availability on the consultation.

This study looked at the effect of different appointment time intervals on process and outcome measures in the consultation. Over a five-month period patients attending a two-partner surgery were non-systematically allocated to appointments at five, 10 or 15 minute intervals. Consultations were audiotaped and analysed. When appointments were scheduled at longer intervals, doctors asked significantly more questions and made significantly more statements explaining the problem and its management, while patients asked significantly more questions and made significantly more statements of their own ideas about the problem. In consultations booked at shorter intervals patients were significantly more likely to report in satisfaction questionnaires that they had little or far too little time available. The implications of the results for future planning are discussed.

Appointments and Schedules

Thoracolumbar intraspinal tumours presenting features of raised intracranial pressure.

Five patients are described in whom a benign or malignant thoracolumbar tumour, producing increased level of cerebrospinal fluid protein, was associated with hydrocephalus or papilloedema or both. A review of the clinical and laboratory features in these and 40 published cases underlines the difficulty in explaining the increased intracranial pressure in such patients. Slow absorption of cerebrospinal fluid as a result of the elevated protein levels or recurrent subarachnoid bleeding may play a part. When patients are discovered to have communicating hydrocephalus or a syndrome resemlbing benign intracranial hypertension, the finding of increased cerebrospinal fluid protein or any symptoms or signs relative to the spine should suggest the possibility of an intraspinal tumour.

Adult