"This is not normal ... "--Signs that make the GP question the child's well-being

Lykke, Kirsten; Christensen, Pia; Reventlow, Susanne

doi:10.1093/fampra/cmn021

Cited by 20 publications

(21 citation statements)

References 20 publications

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“…4 This study has generated an empirically-based definition reflecting the everyday in general practice, leading to the suggested definition of what constitutes a case with 'a child in need' in general practice.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

“…In other Nordic studies, a lack of theoretical knowledge has been described as an obstacle to GPs' opportunity for acting professionally. 4,29 An alternative interpretation could be the lack of relevance and lack of transferability of knowledge produced in other medical specialties or disciplines to the complex reality of clinical general practice.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

“…In line with other earlier offered definitions, 1 There is an extensive theory-based literature that focuses on children in need. 3 It is known that GPs' attention is awakened when they experience a child or family behaving 'abnormally' in the surgery, 4 but empirically-based descriptions of the kind of problems children and families present to professionals like GPs are scarce. 4 To explore how children in need are identified by GPs, and why abused children are sometimes overlooked, it is important to understand the variety of all children's cases that professionals find problematic or puzzling in their everyday clinical practice.…”

Section: Introductionmentioning

confidence: 99%

“…These families often bring the problems to the attention of the GPs directly, or indirectly via other problematic issues. 4 However, even though GPs may be the first professionals to spot signs of possible child maltreatment, 3 there is no empirically-based definition of 'a child in need'. It seems crucial that such a definition is provided in order to understand future GP training needs for the improvement of child health care in general practice.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Beyond the specific child What is ‘a child's case’ in general practice?

Hølge‐Hazelton

Tulinius

2010

Br J Gen Pract

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Section: Comparison With Existing Literaturementioning

confidence: 99%

Section: Comparison With Existing Literaturementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Beyond the specific child What is ‘a child's case’ in general practice?

Hølge‐Hazelton

Tulinius

2010

Br J Gen Pract

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“…3 As GPs often see multiple family members, they can detect stressors -such as violence, parental depression, drug or alcohol abuse -that put children at risk of maltreatment. [4][5][6] They hold the continuous health record, making them a key resource for sharing information about maltreatment-related concerns. 4,7,8 Child maltreatment is common and often chronic but many affected children only occasionally, or never, reach the threshold for investigation or intervention by child protection services.…”

Section: Introductionmentioning

confidence: 99%

A simple approach to improve recording of concerns about childmaltreatment in primary care records: developing a quality improvement intervention

Woodman¹,

Allister²,

Rafi³

et al. 2012

Br J Gen Pract

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BackgroundInformation is lacking on how concerns about child maltreatment are recorded in primary care records. AimTo determine how the recording of child maltreatment concerns can be improved. Design and settingDevelopment of a quality improvement intervention involving: clinical audit, a descriptive survey, telephone interviews, a workshop, database analyses, and consensus development in UK general practice. MethodDescriptive analyses and incidence estimates were carried out based on 11 study practices and 442 practices in The Health Improvement Network (THIN). Telephone interviews, a workshop, and a consensus development meeting were conducted with lead GPs from 11 study practices. ResultsThe rate of children with at least one maltreatment-related code was 8.4/1000 child years (11 study practices, 2009-2010), and 8.0/1000 child years (THIN, 2009(THIN, -2010. Of 25 patients with known maltreatment, six had no maltreatment-related codes recorded, but all had relevant free text, scanned documents, or codes. When stating their reasons for undercoding maltreatment concerns, GPs cited damage to the patient relationship, uncertainty about which codes to use, and having concerns about recording information on other family members in the child's records. Consensus recommendations are to record the code 'child is cause for concern' as a red flag whenever maltreatment is considered, and to use a list of codes arranged around four clinical concepts, with an option for a templated short data entry form. ConclusionGPs under-record maltreatment-related concerns in children's electronic medical records. As failure to use codes makes it impossible to search or audit these cases, an approach designed to be simple and feasible to implement in UK general practice was recommended.

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How do gut feelings feature in tutorial dialogues on diagnostic reasoning in GP traineeship?

Stolper

Wiel

Hendriks

et al. 2014

Adv in Health Sci Educ

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Diagnostic reasoning is considered to be based on the interaction between analytical and non-analytical cognitive processes. Gut feelings, a specific form of nonanalytical reasoning, play a substantial role in diagnostic reasoning by general practitioners (GPs) and may activate analytical reasoning. In GP traineeships in the Netherlands, trainees mostly see patients alone but regularly consult with their supervisors to discuss patients and problems, receive feedback, and improve their competencies. In the present study, we examined the discussions of supervisors and their trainees about diagnostic reasoning in these so-called tutorial dialogues and how gut feelings feature in these discussions. 17 tutorial dialogues focussing on diagnostic reasoning were video-recorded and transcribed and the protocols were analysed using a detailed bottom-up and iterative content analysis and coding procedure. The dialogues were segmented into quotes. Each quote received a content code and a participant code. The number of words per code was used as a unit of analysis to quantitatively compare the contributions to the dialogues made by supervisors and trainees, and the attention given to different topics. The dialogues were usually analytical reflections on a trainee's diagnostic reasoning. A hypothetico-deductive strategy was often used, by listing differential diagnoses and discussing what information guided the reasoning process and might confirm or exclude provisional hypotheses. Gut feelings were discussed in seven dialogues. They were used as a tool in diagnostic reasoning, inducing analytical reflection, sometimes on the entire diagnostic reasoning process. The emphasis in these tutorial dialogues was on analytical components of diagnostic reasoning. Discussing gut feelings in tutorial dialogues seems to be a good educational method to familiarize trainees with non-analytical reasoning. Supervisors need specialised knowledge about these aspects of diagnostic reasoning and how to deal with them in medical education.

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"This is not normal ... "--Signs that make the GP question the child's well-being

Cited by 20 publications

References 20 publications

Beyond the specific child What is ‘a child's case’ in general practice?

Beyond the specific child What is ‘a child's case’ in general practice?

A simple approach to improve recording of concerns about childmaltreatment in primary care records: developing a quality improvement intervention

How do gut feelings feature in tutorial dialogues on diagnostic reasoning in GP traineeship?

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