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A global and urgent need to change our behaviour

Public engagement in ethically laden pandemic planning decisions may be important for transparency, creating public trust, improving compliance with public health orders, and ultimately, contributing to just outcomes. We conducted focus groups with members of the public to characterize public perceptions about social distancing measures likely to be implemented during a pandemic. Participants expressed concerns about job security and economic strain on families if businesses or school closures are prolonged. They shared opposition to closure of religious organizations, citing the need for shared support and worship during times of crises. Group discussions elicited evidence of community-mindedness (e.g., recognition of an extant duty not to infect others), while some also acknowledged strong self-interest. Participants conveyed desire for opportunities for public input and education, and articulated distrust of government. Social distancing measures may be challenging to implement and sustain due to strains on family resources and lack of trust in government.

“Listen to the People”: Public Deliberation About Social Distancing Measures in a Pandemic
Nancy M. Baum , Peter D. Jacobson  & Susan D. Goold

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COVID-19 will impact more than those with the virus

The December, 2019 coronavirus disease outbreak has seen many countries ask people who have potentially come into contact with the infection to isolate themselves at home or in a dedicated quarantine facility. Decisions on how to apply quarantine should be based on the best available evidence. We did a Review of the psychological impact of quarantine using three electronic databases. Of 3166 papers found, 24 are included in this Review. Most reviewed studies reported negative psychological effects including post-traumatic stress symptoms, confusion, and anger. Stressors included longer quarantine duration, infection fears, frustration, boredom, inadequate supplies, inadequate information, financial loss, and stigma. Some researchers have suggested long-lasting effects. In situations where quarantine is deemed necessary, officials should quarantine individuals for no longer than required, provide clear rationale for quarantine and information about protocols, and ensure sufficient supplies are provided. Appeals to altruism by reminding the public about the benefits of quarantine to wider society can be favourable.

Brookes et al The Lancet Volume 395, Issue 10227, 14–20 March 2020, Pages 912-920

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Making it more likely you’ll be heard doctor

Background Good communication skills are integral to successful doctor–patient relationships. Communication may be verbal or non-verbal, and touch is a significant component, which has received little attention in the primary care literature. Touch may be procedural (part of a clinical task) or expressive (contact unrelated to a procedure/examination).

Aim To explore GPs’ and patients’ experiences of using touch in consultations.

Design and setting Qualitative study in urban and semi-rural areas of north-west England.

Method Participating GPs recruited registered patients with whom they felt they had an ongoing relationship. Data were collected by semi-structured interviews and subjected to constant comparative qualitative analysis.

Results All participants described the importance of verbal and non-verbal communication in developing relationships. Expressive touch was suggested to improve communication quality by most GPs and all patients. GPs reported a lower threshold for using touch with older patients or those who were bereaved, and with patients of the same sex as themselves. All patient responders felt touch on the hand or forearm was appropriate. GPs described limits to using touch, with some responders rarely using anything other than procedural touch. In contrast, most patient responders believed expressive touch was acceptable, especially in situations of distress. All GP responders feared misinterpretation in their use of touch, but patients were keen that these concerns should not prevent doctors using expressive touch in consultations.

Conclusion Expressive touch improves interactions between GPs and patients. Increased educational emphasis on the conscious use of expressive touch would enhance clinical communication and, hence, perhaps patient wellbeing and care.

Simon Cocksedge, Bethan George, Sophie Renwick and Carolyn A Chew-Graham
British Journal of General Practice

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How can you add value as a family doctor?

Ninety percent of people will consult a family doctor in 2020. The graph on the left suggests why they will do so. A significant number will have minor self limiting illness, a larger proportion will have chronic/ long-term illness and most will attend for multiple reasons. The graph on right demonstrates that most people will have risk factors for long-term illness often more than one risk factor. To reduce the risk(s) they will need to change their lifestyle. The challenge in primary care is to add value by triggering/ prompting lifestyle change. That is a very specialist skill set. Mandates a new paradigm and or a new set of tools.

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Tame Your Advice Monster Doctor

Giving advice without considering the context or the receptivity to that advice may be akin to prescribing drugs without checking for potential drug interactions or allergies. At best it may be unhelpful and at worst it can cause harm.

In his book on ‘The Advice Trap’, Bungay Stanier asks us to consider the circumstances in which we are tempted to issue advice. There is a very helpful table on page 43 in which he outlines the type of person and the type of situation in which we are tempted. Doctor’s reading the book would clearly recognise the risk: Someone apparently seeking advice and time is short; someone who doesn’t ask for advice when there is a lot at stake; and someone who challenges you and ‘that thing’ keeps recurring.

What is the evidence that doctor’s advice to lose weight achieves any results? A startling conclusion from a recent study:

There were no significant interactions between Health Care Professional’s (HCP) advice and attempts to lose weight. Obese adult’s attempt to lose weight, and not HCP’s advice to lose weight, was a predictor for healthy eating behaviors. Interventions in medical practices should train HCPs on effective strategies for motivating obese patients to adopt healthier lifestyle

Preventive Medicine

The issue of health promotion needs to take account of the circumstances of people’s lives and the complexity of the aetiology of many such problems:

Social ecological models that describe the interactive characteristics of individuals and environments that underlie health outcomes have long been recommended to guide public health practice. The extent to which such recommendations have been applied in health promotion interventions, however, is unclear. The authors developed a coding system to identify the ecological levels that health promotion programs target and then applied this system to 157 intervention articles from the past 20 years of Health Education & Behavior. Overall, articles were more likely to describe interventions focused on individual and interpersonal characteristics, rather than institutional, community, or policy factors. Interventions that focused on certain topics (nutrition and physical activity) or occurred in particular settings (schools) more successfully adopted a social ecological approach. Health education theory, research, and training may need to be enhanced to better foster successful efforts to modify social and political environments to improve health.

Shelley D. Golden, MPH and Jo Anne L. Earp, ScD

You may enjoy my podcast with Michael Bungay Stanier

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Preparation is key to the consult in medicine

It may be helpful to consider what we know about anger in medical practice. you may also enjoy my conversation with Ron Epstein

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If you’re feeling grumpy, try this trick

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Most of what happens in medicine is talk

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Interview with Michael Bungay Stanier- author of the Coaching Habit is available here.

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Your choices in medicine make the greatest difference

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There are two actors in the medical consultation

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