I'm looking at this from a slightly different angle.
My research is a knowledge elicitation project using qualitative interviews
base on consultation transcripts, trying to find what knowledge the GP used
in the consultation.
I have found that:
1. The co operative process of researcher + transcript + GP yields more
knowledge items than the sum of the individual approaches.
2. A "straightforward" consultation (e.g. for uti) yields above 70 discrete
items of knowledge.
3. The classification of knowledge in use that I am generating (by a
grounded theory approach) seems to show the GP's role as integrating
generalisable medical "fact", with GP craft knowledge, context specific
knowledge (about the individual/ family/ community) and process knowledge
about the consultation etc.
4. In every consultation so far there has been at least one instance of
cognitive dissonance between "gold standard" guidelines or evidence (that
the GP is fully aware of) and the practitioner's custom and practice, or
what the practitioner did for the specific patient.
I realise that this is not necessarily "questions", but my commonest
contribution to the interview is on the lines of "what knowledge lies behind
that (question/ statement/ decision)?", "where does that knowledge come
from?".
So far I have done a pilot of the method and got an outline classification
(which is still evolving). I've got 12 months part time research grant to
develop the project. Starting this week.
How does this fit in with other peoples' ideas?
Paul
Paul Robinson
GP and Course Organiser
Scarborough
-----Original Message-----
From: [log in to unmask]
[mailto:[log in to unmask]] On Behalf Of Dr Martin
Dawes
Sent: 09 October 1998 14:41
To: [log in to unmask]
Cc: Dr Trisha Greenhalgh; [log in to unmask]; Dr John Williams;
[log in to unmask]
Subject: RE: GP questions
aaah
but it aint really 7 minutes but is 7 years with 3.5* 7 minute consultations
per year so i and you share a developing relationship - and the people in
birmingham and ?cardiff (nigel stott et al) are trying to anylse sequential
consultations - very diff research - if you look at what we do in one
consult
you only get the snapshot - not the video.
martin
-----Original Message-----
From: Janet Harris [SMTP:[log in to unmask]]
Sent: 09 October 1998 09:11
To: Dr Trisha Greenhalgh; [log in to unmask]; Dr John Williams
Cc: evidence-based-health
Subject: Re: GP questions
Dear Martin, Trish, John, Ati etc etc:
Your idea about GP questions is fascinating - we'll see if there
are any interested parties on the EBHC course.
Can I jump into this discussion from the research point of view?
Given the time constraints and the lack of information, it seems
really useful to simply start by recording questions. Then you are
capturing the range of questions, across different doctors and
different patients, in different practices, from fuzzy to
evidence-related. Once you have questions from a number of
practices, a group could work on identifying themes and
categories....it's a grounded approach to reviewing the questions
that get asked. Questions could be sorted first into categories, and
then a more focused review of the questions could be done to identify
those which have an evidence base. The information generated would
support both Martin's and John's interests.
There is a third potential project in here (just what you need!)
about the nature of doctor/patient discussions, decision trees and
informed decision making. What do doctors choose to ask patients,
and why? When you have 7 minutes, what information gets sifted and
prioritised? How does that influence understanding of risk, and
decisions about treatment?
Janet Harris
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