dorte kjeldmand, gp, phd
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The future role of general practice - continuing professional development and the wellbeing of the GP. Dorte Kjeldmand, GP, PhD University of Uppsala, Sweden Department of Public Health and Caring Sciences Section for Health Services Research Eksjö Primary Care Centre, Sweden. - PowerPoint PPT PresentationTRANSCRIPT
The future role of general practice - continuing professional development and the wellbeing of the GP
Dorte Kjeldmand, GP, PhD
University of Uppsala, Sweden Department of Public Health and Caring Sciences Section for Health Services Research
Eksjö Primary Care Centre, Sweden
The Doctor,
the Task and the Group
Balint Groups as a Means of Developing New Understanding in the Physician-Patient Relationship
The task, - the core of the medical profession
The encounter with the patient To make contact and understand what
the patient needs and what kind of help s/he wants
To contribute to increasing the patient’s understanding and competence in his/her situation
To be able to use ones professional competence for the benefit of the patient without being consumed oneself
But -
It keeps you going
and
it wears you out
Problems:
Overworked and tired GPs, who are frustrated and confused about their role
This may lead to burn-out
Many consider early retirement
This might be the GP – caught between a rock and a hard place
More problemsThe public’s trust in the health care system has declined
Patients are dissatisfied
Physicians’ role and authority is questioned
In a modern, secularized society people seek health care for existential frustration and discontent
Demands and guidelines. Evidence-based medicine versus patient-centeredness? Or both?
Can Balint groups contribute to the solution of these problems?
The main aim of the thesis:
To study Balint groups and their effect on GPs
Participants in study 1
GPs in south-east Sweden
4 Balint groups
26 Balint participants, 20 (77%) answered
26 reference physicians, 21 (81%) answered
12 in Balint group for more than 1,5 years
5 for less than 1,5 years (3 no answer)
49 VAS-questions, 3 examples:49 VAS-questions, 3 examples:
• Do you sometimes refer patients or take ”unnecessary” tests in order to end the consultation?
___________________________________________________
0 1 2 3 4 5 6 7 8 9 10 Yes, often No, never
• Can you take your coffee break every day? _______________________________________________________________________
0 1 2 3 4 5 6 7 8 9 10No, never Yes, always
• Do you find patients with psychosomatic problems a time-consuming burden?
______________________________________________0 1 2 3 4 5 6 7 8 9 10Yes No
* **
* **
***
Results
Experienced Balint doctors compared to reference group
02468
10Workload
Health*
Satisfaction***
Control***
Training***
Co-operation**
Quality*
Psychosomatic***
Balint > 1.5 years n=12
Reference group n=21
Validity of the reference group
0
2
4
6
8
10Workload
Health
Satisfaction
ControlTraining
Co-operation
Quality
Working environment study
Referencegroup
Validity
Results 0
2
4
6
8
10
Reference group, n=21
Balint < 1.5 years, n=5 Balint > 1.5 years, n=12
Mean of all questions,change by time in Balintgroup
***
Informants and method study 29 GPs: 4 women and 5 men (age: 42-60)
Duration of Balint group participation: 2-14 years
From 6 different groups with 6 different leaders in southern Sweden
Audio-taped, transcribed verbatim
Analysis: Gunnar Karlsson’s EPP-method (Empirical Phenomenological Psychological)
Findings: (interrelating themes):
In the Balint group the physician’s
Professional identity
Competence
Sense of security
are developed through
Parallel processes: physician-patient
physician-Balint group
leading to increased
Satisfaction and endurance in work
And so what?
If the method is so fantastic
Why are Balint groups so rare?
Why is it difficult to recruit members to start new groups?
Why do some members drop out?
Could Balint groups possibly have drawbacks?
Could this alsobe a member of a Balint group?
Informants and methods study 3
Questionnaire:
Balint group leaders at the 14. International Balint congress 2005 (51 answers)
Interviews:
8 Balint group leaders
From Sweden, Israel, USA, Denmark and England
Age 50-77 years, 2-33 years experience
4 GPs, 2 psychiatrists, 2 psychologists
Analysis: Systematic text condensation inspired by Malterud
Findings:
10 % drop-outs from Balint groups, connected to these themes:
The individual: needs, sensitivity, practicalities
The group: group processes, conscious or unconscious wishes and motivations (obligatory groups), scapegoats, rivalry, hidden agendas, leader interventions
The environment: the health care paradigm, acceptance, time, money, attitudes to patients and other human beings (e.g. physicians)
Balint group activity
Strengthens and develops professional identity
Promotes patient-centeredness
Strengthens relations between colleagues
Increases feeling of control in work
Increases understanding of what happens in human relations
Should be conducted professionally
Should be voluntary