Dermatology consultations: how long do they take?

Wong, Junie Li Chun; Vincent, Rosie; Alsharqi, Ali

doi:10.7861/futurehosp.4-1-23

Cited by 7 publications

(4 citation statements)

References 4 publications

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“…The overall structure of the consultations varied according to the level of experience of the doctors, with more experienced consultants able to “cut to the chase” by not exhaustively following medical checklists. While most of the existing literature about consultation length comes from General Practice [ 55 ], this study aligns with hospital outpatient findings in which registrars took more time with patients than consultants [ 56 ]. Registrars sometimes completed a medical history before moving to the referral and this may have contributed to their longer consultations.…”

Section: Discussionsupporting

confidence: 73%

Communication in high risk ante-natal consultations: a direct observational study of interactions between patients and obstetricians

Hilder

Stubbe

Macdonald

et al. 2020

BMC Pregnancy Childbirth

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Background Effective communication is crucial to any doctor-patient consultation, not least in pregnancy where the outcome affects more than one person. While higher levels of patient participation and shared decision making are recognised as desirable, there is little agreement on how best to achieve this. Most previous research in this area is based on reported data such as interviews or surveys and there is a need for more fine-grained analysis of authentic interaction. This study aimed to identify the discourse characteristics and patterns that exemplify effective communication practices in a high-risk ante-natal clinic. Methods We video-recorded 20 consultations in a high-risk ante-natal clinic in a large New Zealand city with patients attending for the first time. Post-consultation interviews were conducted with the 20 patients and 13 obstetricians involved. Discourse analysis of the transcripts and videos of the consultations was conducted, in conjunction with thematic analysis of interview transcripts. Results Most patients reported high quality communication and high levels of satisfaction; the detailed consultation analysis revealed a range of features likely to have contributed. On the clinician side, these included clear explanations, acknowledgement of the patient’s experience, consideration of patient wishes, and realistic and honest answers to patient questions. On the patient side, these included a high level of engagement with technical aspects of events and procedures, and appropriate questioning of obstetricians. Conclusions This study has demonstrated the utility of combining direct observation of consultations with data from patient experience interviews to identify specific features of effective communication in routine obstetric ante-natal care. The findings are relevant to improvements needed in obstetric communication identified in the literature, especially in relation to handling psychosocial issues and conveying empathy, and may be useful to inform communication training for obstetricians. The presence of the unborn child may provide an added incentive for parents to develop their own health literacy and to be an active participant in the consultation on behalf of their child. The findings of this study can lay the groundwork for further, more detailed analysis of communication in ante-natal consultations.

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Section: Discussionsupporting

confidence: 73%

Communication in high risk ante-natal consultations: a direct observational study of interactions between patients and obstetricians

Hilder

Stubbe

Macdonald

et al. 2020

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

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“…The doctor-patient conversation serves as the linchpin of diagnostic medicine, enabling physicians to uncover key details that guide their clinical decisions. However, the mounting pressure of escalating patient numbers, lack of access to care 1 , short consultation times 2,3 , and the expedited adoption of telemedicine due to the COVID-19 pandemic 4 have presented formidable challenges to this conventional model of interaction. As these factors risk compromising the quality of history taking and thereby diagnostic accuracy 2 , there is an urgent need for innovative solutions that can enhance the efficacy of these crucial conversations.…”

Section: Introductionmentioning

confidence: 99%

Guidelines For Rigorous Evaluation of Clinical LLMs For Conversational Reasoning

Johri,

Jeong,

Tran

et al. 2023

Preprint

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Large Language Models (LLMs) show promise for medical diagnosis, but traditional evaluations using static exam questions overlook the complexity of real-world clinical dialogues. We introduce a multi-agent conversational framework where doctor-AI and patient-AI agents interact to diagnose medical conditions, evaluated by a grader-AI agent and medical experts. We assessed the diagnostic accuracy of GPT-4 and GPT-3.5, in conversational versus static settings using 140 cases focusing on skin diseases. Our study revealed a decline in diagnostic accuracy, unmasking key limitations in LLMs’ ability to integrate details from conversational interactions to improve diagnostic performance. We introduced Conversational Summarization, a technique that enhanced performance, and expert review identified deficiencies compared to human dermatologists in comprehensive history gathering, appropriate use of terminology, and reliability. Our findings advocate for nuanced, rigorous evaluation of LLMs before clinical integration, and our framework represents a significant advancement toward responsible testing methodologies in medicine.

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“…There is a link between increased comprehension and better memorization along with reduced preoperative anxiety (Bounif et al, 2022;Convie et al, 2020). In dermatology clinics, the visit duration is approximately 15 minutes (Davis et al, 2014;Wong et al, 2017). This turns out to be shorter (less than three minutes) in the case of a larger number of patients per day (Wooldridge et al, 2010).…”

Section: Introductionmentioning

confidence: 99%

Efficacy of informed consent process using educational videos for skin biopsy procedures

Mettarikanon,

Tawanwongsri,

Jaruvijitrattana

et al. 2023

CONT ED TECHNOLOGY

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The informed consent process is integral to medical procedures, including skin biopsies, which are the definitive method for diagnosing challenging skin lesions. Educational videos are recognized for effective delivery of information for informed consent. This study aimed to evaluate the efficacy of an informed consent process using educational videos to improve patient understanding and reduce preprocedural anxiety. This multicenter, randomized controlled study was conducted during December 2021-June 2023. Participants were randomly assigned to either the video or verbal group in a 1:1 ratio. They completed knowledge and anxiety questionnaires before and after biopsy. The final analysis included 54 participants (verbal group: n=28; video group: n=26) with a mean age of 51.9 years (standard deviation [SD] 18.1), and a balanced gender distribution. Post-intervention knowledge scores (median 10.0; IQR 8.0-10.0) significantly increased compared to pre-intervention scores (median 6.0; IQR 4.0-9.0), p<0.001. Post-intervention Spielberger state-trait anxiety inventory (STAI) scores (median 5.0; interquartile range, IQR 5.0-6.0) significantly decreased compared to pre-intervention scores (median 7.0; IQR 5.0-10.0), p<0.001. Knowledge scores increased more in the video group (median, 2.5; IQR 1.0-5.0) than in the verbal group (median, 1.5; IQR 0.0-4.0), p=0.217. There was no significant difference in STAI score changes between the video group (median 1.0, IQR 0.0-4.0) and the verbal group (median 1.0, IQR 0.0-3.0), p=0.824. Despite statistical insignificance, educational videos exhibited greater effectiveness in enhancing comprehension and demonstrated comparable efficacy in reducing anxiety compared to conventional intervention.

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Dermatology consultations: how long do they take?

Cited by 7 publications

References 4 publications

Communication in high risk ante-natal consultations: a direct observational study of interactions between patients and obstetricians

Communication in high risk ante-natal consultations: a direct observational study of interactions between patients and obstetricians

Guidelines For Rigorous Evaluation of Clinical LLMs For Conversational Reasoning

Efficacy of informed consent process using educational videos for skin biopsy procedures

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