Key study:savage And Armstrong

Question 1

Context

Answer 1

A number of studies have shown that general practitioners who use a sharing style during consultations tend to achieve greater levels of patient satisfaction and their patients are more willing to follow medical advice.
A sharing style actively involves the patient in the consultation such as asking them what they think is wrong with them and how they would like the doctor to help them. The traditional style of consultation is directed style. This involves the doctor making the diagnosis after listening to the patient’s symptoms and telling them what treatment they need. This is seen as paternalistic, where the doctor is seen as the authority figure who is in control of the patient’s wellbeing for their own good, but in doing so, limits their autonomy

Question 2

What is the aim

Answer 2

-to investigate the effects of directing or sharing styles of consultation on patient satisfaction at a doctor surgery.

Question 3

What is the sample

Answer 3

-359 patients to begin with who were consulting with 1 general practitioner , however some patients were not eligible to participate and therefore excluded

-All the patients were aged between the 16 and 75 years
-Patients gave a written consent for the sessions to audio recorded

Question 4

What was the exclusion criteria

Answer 4

patients were excluded if;
-they were presenting with a life threatening condition
-the doctor thought they would be upset by taking part in the study.
if the practitioner thought they would be incapable of completing part of the study.
-this left a total of 200 patients who completed all parts of the study.

Question 5

Describe the experimental design

Answer 5

independent measures using a randomised trial

-It is independent measures because separate ss were used in either the sharing or directing style of diagnosis. so their data will be independent of each other.
-It is a randomised trial because ss were divided into either the sharing or directing style at random

Question 6

What was the methodology

Answer 6

field experiment

Question 7

Describe the procedure

Answer 7

• A set of cards was produced using a random number genarator to randomly allocate patients to either a directing or sharing style.

-These cards contained prompts covering the 5 main part of the consulation i.e
1)Judgement - this is a serious problem (directed)
why do you thinks this happened(sharing)
2) Diagnosis - you are suffering from (directing)
what do you think is wrong?(sharing)
3)Treatment - it is essential that you take this medication (directing)
would you like a prescription (sharing)
4) Prognosis - you should be better in _ days (directing)
what do these symptoms or problems mean to you (sharing)
5) Follow up and closure - come and see me in _ days (directing)
are there any other problems (sharing)

-The cards were placed face down on the doctors desk and turned over immediately following the patients description of the problem.

-The consultation then began as either sharing or directing style.

Question 8

What happened at the end of the consultation

Answer 8

-At the end of the consultation the patients completed a questionnaire handed to them by the a receptionist.

-The questionnaire measured their satisfaction with the consulation style.
-Satisfaction was measured in 5 ways
1) whether the patient felt they had been greatly helped
2) Whether the patient felt that they had recieved excellent help from the doctor
3) whether the pateint percieved the doctor to have excellent understanding of their problem
4) whether the pateint felt much better after consultation
5) Whether the pateint was able to discuss their problem well.

• A secon questionnaire with a stamped envelope was then given to each pateint , with instructions to fill it in and post it after one week

Question 9

what are the 5 main parts of the consultation

Answer 9

1)Judgement -
2) Diagnosis
3)Treatment )
4) Prognosis -
5) Follow up and closure -

Question 10

Explain judgement

Answer 10

this is a serious problem (directed)
why do you thinks this happened(sharing)

Question 11

Explain diagnosis

Answer 11

you are suffering from (directing)
what do you think is wrong?(sharing)

Question 12

Explain treatment

Answer 12

it is essential that you take this medication (directing)
would you like a prescription (sharing)

Question 13

Explain prognosis

Answer 13

you should be better in _ days (directing)
what do these symptoms or problems mean to you (sharing)

Question 14

Explain follow up and closure

Answer 14

come and see me in _ days (directing)
are there any other problems (sharing)

Question 15

Describe the results

Answer 15

A significantly higher percentage of patients who had the the directing style of consultation, indicate that they had received an excellent explanation and the practitioner had a complete understanding of their problem. Both immediately following the consultation and one week later

• ## The directing style produced a significantly better perception of the doctors explanation and understanding after one week among patients who rarely attended surgery, those whom he thought had a physical problem and those who received a prescription

Question 16

What was the conclusion

Answer 16

simple physical illnesses that respond to the traditional biomedical approach of diagnosisand treatment will seem to benefit from the directing style.
While chronic and psychological illnesses benefit more from the sharing style

Question 17

evaluation