The consultation as an interpretive dialogue about the child's health needs

Lykke, Kirsten; Christensen, Pia; Reventlow, Susanne

doi:10.1093/fampra/cmq111

Cited by 8 publications

(12 citation statements)

References 16 publications

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“…For example, in this study, the researcher identified text units in which the GPs describe their experiences using knowing-in-action mode and reflection-in-action mode. For more details see Lykke [17,19]. To ensure credibility and to control the researcher’s bias, the other authors reviewed parts of the transcripts and took part in the interpretation, development, and elaboration of the analysis.…”

Section: Methodsmentioning

confidence: 99%

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GPs’ strategies in exploring the preschool child’s wellbeing in the paediatric consultation

2013

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BackgroundAlthough General Practitioners (GPs) are uniquely placed to identify children with emotional, social, and behavioural problems, they succeed in identifying only a small number of them. The aim of this article is to explore the strategies, methods, and tools employed by GPs in the assessment of the preschool child’s emotional, mental, social, and behavioural health. We look at how GPs address parental care of the child in general and in situations where GPs have a particular awareness of the child.MethodTwenty-eight Danish GPs were purposively selected to take part in a qualitative study which combined focus-group discussions, observation of child consultations, and individual interviews with GPs.ResultsAnalysis of the data suggests that GPs have developed a set of methods, and strategies to assess the preschool child and parental care of the child. They look beyond paying narrow attention to the physical health of the child and they have expanded their practice to include the relations and interactions in the consultation room. The physical examination of the child continues to play a central role in doctor-child communication.ConclusionThe participating GPs’ strategies helped them to assess the wellbeing of the preschool child but they often find it difficult to share their impressions with parents.

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Section: Methodsmentioning

confidence: 99%

“…This article draws on data from a qualitative study investigating GPs’ experiences of exploring a child’s wellbeing in the setting of a consultation [17-19]. The focus is on the child’s psychosocial health.…”

Section: Introductionmentioning

confidence: 99%

GPs’ strategies in exploring the preschool child’s wellbeing in the paediatric consultation

2013

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“…A study by Lykke et al. found that subsequent consultations helped in involving parents in the assessment of the well-being of their children and that the continuity enabled the GP to bring up the difficult health issues over time [24]. Hence, it is important to further investigate how the balancing of trust and power is weighted with the severity of the health issue and the aspect of time.…”

Section: Discussionmentioning

confidence: 99%

“…One could argue that in this study, the use of humour was furthermore an indirect way of addressing a difficult or sensitive health issue. Other studies on GP’s perspectives suggest a concern among GPs on touching upon difficult or sensitive health issues in favour of maintaining a close relationship with their patients [12,14,16,23,24]. In these studies, the GPs expressed worries about intruding on the patient’s private life and harming the relationship when raising questions about sensitive or difficult health issues.…”

Section: Discussionmentioning

confidence: 99%

Balancing trust and power: a qualitative study of GPs perceptions and strategies for retaining patients in preventive health checks

Broholm-Jørgensen

Guassora

Reventlow

et al. 2017

Scandinavian Journal of Primary Health Care

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ObjectiveLittle is known about how strategies of retaining patients are acted out by general practitioners (GPs) in the clinical encounter. With this study, we apply Grimens’ (2009) analytical connection between trust and power to explore how trust and power appear in preventive health checks from the GPs’ perspectives, and in what way trust and power affect and/or challenge strategies towards retaining patients without formal education.DesignData in this study were obtained through semi-structured interviews with GPs participating in an intervention project, as well as observations of clinical encounters.ResultsFrom the empirical data, we identified three dimensions of respect: respect for the patient’s autonomy, respect for professional authority and respect as a mutual exchange. A balance of respect influenced trust in the relationship between GP and patients and the transfer of power in the encounter. The GPs articulated that a balance was needed in preventive health checks in order to establish trust and thus retain the patient in the clinic. One way this balance of respect was carried out was with the use of humour.ConclusionsTo retain patients without formal education in the clinical encounter, the GPs balanced trust and power executed through three dimensions of respect. In this study, retaining patients was equivalent to maintaining a trusting relationship. A strategic use of the three dimensions of respect was applied to balance trust and power and thus build or maintain a trusting relationship with patients.Key pointsLittle is known about how strategies for retaining patients are acted out by GPs in preventive health checks. Retaining patients requires a balance of trust and power, which is executed through three dimensions of respect by the GPs.Challenges of recruiting and retaining patients in public health initiatives might be associated with the balance of respect.

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“…Asking participants to recount narratives based on experience also helps to elicit accounts that move beyond the socially acceptable or familiar 22. A study using focus groups to investigate child safeguarding by GPs in Denmark noted that the GPs appeared to be most comfortable with case-based discussion17 and this approach appeared to be acceptable to participants and to generate rich data in our two pilot interviews.…”

Section: Methodsmentioning

confidence: 99%

Responses to concerns about child maltreatment: a qualitative study of GPs in England

Woodman¹,

Gilbert

Allister

et al. 2013

BMJ Open

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ObjectivesTo provide a rich description of current responses to concerns related to child maltreatment among a sample of English general practitioners (GPs).DesignIn-depth, face-to-face interviews (November 2010 to September 2011). Participants selected and discussed families who had prompted ‘maltreatment-related concerns’. Thematic analysis of data.Setting4 general practices in England.Participants14 GPs, 2 practice nurses and 2 health visitors from practices with at least 1 ‘expert’ GP (expertise in child safeguarding/protection).ResultsThe concerns about neglect and emotional abuse dominated the interviews. GPs described intense and long-term involvement with families with multiple social and medical problems. Narratives were distilled into seven possible actions that GPs took in response to maltreatment-related concerns. These were orientated towards whole families (monitoring and advocating), the parents (coaching) and children (opportune healthcare), and included referral to or working with other services and recording concerns. Facilitators of the seven actions were: trusting relationships between GPs and parents, good working relationships with health visitors and framing the problem/response as ‘medical’. Narratives indicated significant time and energy spent building facilitating relationships with parents with the aim of improving the child's well-being.ConclusionsThese GPs used core general practice skills for on-going management of families who prompted concerns about neglect and emotional abuse. Policy and research focus should be broadened to include strategies for direct intervention and on-going involvement by GPs, such as using their core skills during consultations and practice systems for monitoring families and encouraging presentation to general practice. Exemplars of current practice, such as those identified in our study, should be evaluated for feasibility and acceptability in representative general practice settings as well as tested for efficacy, safety and cost. The seven actions could form the basis for the ‘lead professional’ role in general practice as proposed in the 2013 version of ‘Working Together ’guidance.

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The consultation as an interpretive dialogue about the child's health needs

Abstract: The study indicates that through open reflective dialogue the GP is able to assess the child and strengthen mutual trust in the doctor-parent relationship to the benefit of children with special needs.

Cited by 8 publications

References 16 publications

GPs’ strategies in exploring the preschool child’s wellbeing in the paediatric consultation

GPs’ strategies in exploring the preschool child’s wellbeing in the paediatric consultation

Balancing trust and power: a qualitative study of GPs perceptions and strategies for retaining patients in preventive health checks

Responses to concerns about child maltreatment: a qualitative study of GPs in England

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