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



> Date:          Thu, 8 Oct 1998 21:21:56 +0100
> Importance:    Normal
> Subject:       GP questions
> From:          Dr John Williams <[log in to unmask]>
> To:            Dr Trisha Greenhalgh <[log in to unmask]>,
>                "[log in to unmask]" 
<[log in to unmask]>
> Cc:            evidence-based-health <[log in to unmask]>
> Reply-to:      Dr John Williams <[log in to unmask]>

> Apologies if this arrives twice but first posting seems to have got lost in
> the works
>
> Trish
>
> I think that you and Martin addressing different problems - general and more
> specific - both very interesting.
>
> Martin with the more general approach writes
> > >The reason for this question - how can we provide answers to family
> > >practitioners when we don't know what questions they are asking!
> > This would
> > >give us some idea of the scope and quantity
>
> and suggests categorising the questions later.
>
>
> Your approach -
> >"What questions
> > pertaining
> > to clinical [research] evidence arise in real time during routine
> > interviews
> > between GPs/family practitioners and patients?"
>
> is more specific - aims to get rid of "fuzziness" and concentrate on things
> that relate to "clinical [research] evidence".  Understandably you suggest
> doing this exercise "with time to reflect and write, and not get too
> bothered about running late".  But that just isn't "real time" to a simple
> GP.  It would probably be looking at something quite different.
>
>
> Being one of "the many" who struggle even with straight forward things like
> standard deviations I could manage with recording "fuzzy" questions that
> just pop up during the consultation but would have to think harder to
> determine whether a particular question was evidence related or not.  In
> fact the effort of overcoming the "fuzziness" might be quite inhibiting
> within the 7 - 10 minute consultation time frame because I'm already
> thinking (or should be) about things that relate to the patient in front of
> me, just left, or the one about to come in (and being male can't
> multi-task!).  I have a strong suspicion that the best framed evidence
> related questions may be the ones that linger long enough to form themselves
> when I'm away from the consultation / bed side.  A lot just fade away and
> are irretrievably lost before they even form...
>
> Is there something to be said for starting by piloting this with Martin's
> more general approach?  It might give some insights into what we really need
> to support our decision making processes. For ease of use and saving of time
> many of us might even be able to put his excel spread sheet into a window
> just a simple "alt tab" or "mouse click" away from our clinical system. If
> you and others think I'm way off target I'll sink back silently into "lurker
> mode" below the parapet again - and take my mouse with me!!  :-)
>
> John Williams
>
> > -----Original Message-----
> > From: [log in to unmask]
> > [mailto:[log in to unmask]]On Behalf Of Dr
> > Trisha Greenhalgh
> > Sent: 07 October 1998 00:43
> > To: [log in to unmask]
> > Cc: [log in to unmask]
> > Subject: Re: GP questions
> >
> >
> > Martin
> >
> > Well done for taking up the dare!
> >
> > I think we need a more focused question: perhaps "What questions
> > pertaining
> > to clinical [research] evidence arise in real time during routine
> > interviews
> > between GPs/family practitioners and patients?"
> >
> > (The above is an attempt to address fuzziness such as: (a) we
> > also think of
> > questions while driving home, but those are different from the ones that
> > come up during the consultation  (b) my nurse comes up with different
> > questions from the ones I come up with because she sees different people
> > with a different agenda  (c) during a consultation the patient
> > comes up with
> > different questions to me  (d) many of my questions are not about research
> > evidence but about resources, values, my own personal uncertainties about
> > things other than knowledge, etc etc.  Hence the question above pertains
> > only to a small part of the totality of the questioning process in primary
> > care.  I'm sure it can be improved.)
> >
> > I would suggest we all (i.e. everyone who wants to) do TEN
> > patients properly
> > (i.e. with time to reflect and write, and not get too bothered
> > about running
> > late), rather than a whole surgery.  Everyone sends to a single contact (I
> > nominate you Martin, as you dared to make this real, but I'll
> > split the work
> > if you send some on to me! Alternatively you review the
> > literature and I'll
> > code the Qre's - who's counting?).
> >
> > May I also I also suggest a core of volunteers (that's you and
> > me, plus - at
> > a guess - Toby, Atle, Paul K, and the other dozen or so GPs who
> > can't resist
> > regular input to this list) each individually look at a sample of (say) 50
> > questions and put together some themes.  We then share/combine
> > what we come
> > up with and test the framework formally against the remainder of
> > the responses.
> >
> > Then we all write a paper - HA!
> >
> > trish
> >
> > At 09:59 06/10/98 +0100, you wrote:
> > >This idea is for general or family practitioners anywhere in the
> > world. I have
> > >used e-mail lists and apologise for cross posting.
> > >
> > >What sort of questions (and how many) will arise from your next
> > monday morning
> > >surgery. (i acknowldge that monday's are odd and would be happy
> > to accept any
> > >day of the week)
> > >
> > >The reason for this question - how can we provide answers to family
> > >practitioners when we don't know what questions they are asking!
> > This would
> > >give us some idea of the scope and quantity
> > >
> > >Trish Greenhalgh wrote to the EBH list about this and it
> > prompted an idea. As
> > >there are so many of us on these lists why don't we do a study. Again
> > accepting
> > >that all of us are for many reasons one or two standard
> > deviations from the
> > >normal it would still be valuable.
> > >
> > >DON'T DO THIS YET !!!!
> > >
> > >- lets wait until we have heard everyone's comments
> > >
> > >A very basic idea is that we collect at our next surgery
> > >
> > >presenting complaint
> > >age
> > >sex
> > >problem
> > >
> > >question (we would categorise later)
> > >
> > >
> > >
> > >send on e-mail - preferably on excel which we have formatted
> > >with your geographical location
> > >{enclosed version 5 excel sheet}
> > >
> > >You can see i have been very informal - perhaps this is too loose -
> > >
> > >If we bashed out a surgery each we could soon get a decent database of
> > >questions. Volunteers could then categorise and send the results
> > back to all
> > >who took part. I am happy to co-ordinate this. If it looks worth
> > publsihing on
> > >pulped tree we can assign/choose parts of the paper to write.
> > >
> > >The great thing is that each of us has only to do one surgery.
> > If we want to
> > >alter the data collection slightly - feel that we need more
> > information etc
> > >then we can just do it again. Simple -
> > >
> > >The first thing is to get a list of names of people who are
> > interested. Then
> > >agree the format of the data collection sheet. Then do it.
> > >
> > >thanks for your help
> > >
> > >martin dawes
> > >
> > >
> > >
> > >Dr Martin Dawes
> > >MD FRCGP
> > >Lecturer in Primary Care
> > >University of Oxford
> > >Institute of Health Sciences
> > >Old Rd, Headington
> > >OXFORD OX3 7LF
> > >Tel (44) 1865 226700
> > >
> > >
> > >Attachment Converted: C:\eudora\Attach\question template.xls
> > >
> > Dr Trish Greenhalgh
> >
> > Senior lecturer in primary health care
> > Unit for Evidence-Based Practice and Policy
> > Department of Primary Care and Population Sciences
> > University College London and Royal Free Schools of Medicine
> > Whittington Campus
> > London N19 5NF
> >
> > Personal Assistant and Unit Administrator (Marcia Rigby):  + 44
> > (0) 171 288 3246
> > Fax: + 44 (0) 171 281 8004
> > web http://www.ucl.ac.uk/primcare-popsci/uebpp/uebpp.htm
> > email [log in to unmask]
>
> > -----Original Message-----
> > From: [log in to unmask]
> > [mailto:[log in to unmask]]On Behalf Of Dr
> > Trisha Greenhalgh
> > Sent: 07 October 1998 00:43
> > To: [log in to unmask]
> > Cc: [log in to unmask]
> > Subject: Re: GP questions
> >
>
>
Janet Harris
Director of Health Care & Health Sciences
Centre for Professional Development
Department for Continuing Education
University of Oxford
67 St Giles
Oxford  OX1 3LU
Tel  (44)  1865 288174


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