In your message dated Sunday 14, July 1996 Adrian wrote :
> Fascinating.
> "Listen to the patient - he will tell you the diagnosis" Who said
that?
>
> In order to back up masterly inactivity, we could do with an
extension
> backward from that study, which I am not aware of having been done.
>
> If the GPs in that study had recorded provisional diagnoses at the
various
> stages...
>
> Patient's opinion, receptionist's opinion (as these were probably
mostly
> emergency referrals?) GPs opinion on hearing what the problem was,
on
> entering the house/patient arriving at surgery, after taking
history, after
> examination, after special tests if any...
You're right! That's a doable research project for gp-uk. Great!
We'd have to think carefully about the different types of request for
consultation (home visit in hours, late home visit, "urgent"
appointment, routine appointment, out of hours consultation, etc). One
of the difficulties in actually doing the study as a collaborative
effort is going to be different kinds of organisation of OOH or even
how in hours home visiting or urgent surgery appointment are arranged.
For instance some GPs vet all requests for home visits, others leave
it to receptionists to simply accept the calls, others use practice
nurses, etc.
There's also a difference in the stage at which the diagnostic process
begins. If a patient simply books a routine appointment, then the
process begins when he arrives in the consulting room; if a patient
asks for a late call and is put through to the GP, then it begins
then. The other problem in general practice is to determine when the
diagnostic process ends! - how do you define a single diagmostic
episode?
Perhaps we should confine this study (I am assuming some people will
be interested in doing it) to requests for urgent appointments and
acute home visits. A subset of these is whether or not the GP is
involved in vetting the request (and, of course, when the GP has made
a diagnosis on the basis of a telephone call and decided not to visit,
say, there would have to be some sort to follow up to check that the
diagnosis made over the phone was correct).
When you think about it, it's not that easy, is it? I'll think about
it a bit more.
Toby
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