Frits Bareman

Relationships between attitude towards menopause, well-being and medical attention among women aged 45–60 years

This study aims to answer the following questions: (i) what is the attitude of women in the climacteric years towards menopause, (ii) what is the association between attitude towards menopause and well-being and (iii) to what extent is medical attention determined by both well-being and attitude towards menopause. All 2729 women aged 45-60 years living in a suburb of Rotterdam were sent a questionnaire, of these 1947 (71.3%) were returned. Attitude was measured on a 5-point rating scale using 28 items that have been used in other studies. Well-being was measured by the Inventory of Subjective Health and three subscales of the Sickness Impact Profile. Medical attention was measured by asking the women whether they were currently being treated by a general practitioner or specialist. Results show that three clusters of attitudes towards menopause exist: two clusters encompasses items reflecting attitudes towards disadvantages and advantages of the menopause, one cluster encompasses items reflecting attitudes towards (medical) treatment of the menopause. On the whole, women answer neutrally to items relating menopause with the disadvantages and tend to agree with items relating menopause with the advantages. The women slightly agree, premenopausal women more than others, with items that are in favour of treatment of menopausal complaints. Agreement with items on the disadvantage cluster is moderately associated with a low level of well-being, whereas agreement with items on the advantage cluster is slightly associated with a high level of well-being; the treatment cluster is not associated with well-being. Both well-being and agreement with items on the treatment cluster are statistically significantly associated with medical attention. Apart from these variables, the womans ideas about treatment are also related to medical attention.

Women's opinion on withdrawal bleeding with hormone replacement therapy

The objective of the study was to assess the opinion of women about the use of hormone replacement therapy (HRT) in relation to continuation or re-induction of bleeding periods after menopause. The design was a population-based cross-sectional study using a postnatal questionnaire in Krimpen aan den IJssel, a commuter suburb of Rotterdam. The participants were all 2729 women living in Krimpen aan den IJssel aged 45-60 years, of whom 1947 (71.3%) responded. The main outcome measure was an opinion on monthly or trimonthly withdrawal bleedings with HRT. The results showed 16.9% of all women have no or little objection to use of HRT with monthly withdrawal bleedings. There is a marked difference between premenopausal women (32.4% have no or little objection) and postmenopausal women (only 9.2% have no or little objection). Trimonthly cycles during HRT tend to be perceived as more acceptable (41.4% of premenopausal women and 11.8% of postmenopausal women have no or little objection). It is concluded that a reasonable proportion of premenopausal women accept continuation of periodic bleeding with HRT. There is a preference for trimonthly cycles rather than monthly withdrawal bleedings. Most postmenopausal women object to having withdrawal bleedings with HRT, irrespective of a monthly or trimonthly cycle. Research should continue on schedules without withdrawal bleedings.

Duration of hormonal replacement therapy in general practice; a follow-up study

OBJECTIVES To assess the mean duration of use of HRT in general practice and to identify determinants of the duration of HRT use. METHODS A general population of 1689 women aged 45-60 years and enlisted in five group practices of general practitioners were followed for 9 months to trace first HRT prescriptions. All 103 women who were prescribed HRT were followed for a period of 2.25 years. Duration of HRT was assessed by using the data provided on the dispensing of HRT. Possible determinants of duration of use, such as attitude towards menopause, menopausal status and another six variables were measured by means of a questionnaire. RESULTS None of the 103 women received HRT for a preventive purpose; the main indication was menopausal complaints. More than 60% of the women stopped their HRT within 6 months and only 8% of the women remained on HRT for more than 2 years. The mean duration of use was 7 months. Determinants that significantly predicted the duration of HRT use were age, attitude towards treatment of the menopause and the group practice. CONCLUSIONS The mean duration of HRT use is very short, despite the fact that the most prevalent indication is the alleviation of menopausal symptoms. Apparently, Dutch women are presently unwilling to take HRT for longer periods.

Vasomotor symptoms and well-being in the climacteric years

OBJECTIVES To determine more closely the relationship between vasomotor symptoms, well-being and climacteric status according to the last menstrual bleeding and according to the women themselves. METHODS A population-based cross-sectional study was executed using a postal questionnaire. Well-being of women with and without vasomotor symptoms was compared, for the different menopausal statuses. All 2729 women living in a commuter suburb of Rotterdam aged 45-60 years were approached of whom 1947 (71.3%) responded. Well-being was measured by the Inventory of Subjective Health (ISH) and three subscales of the Sickness Impact Profile (SIP). RESULTS The results showed that the relationship between vasomotor symptoms and well-being was dependent on climacteric status. Pre- and (middle and late) postmenopausal women with vasomotor symptoms more often experienced a relatively lower level of well-being compared to women without these symptoms. However, when the prevalence of vasomotor symptoms is as its peak, i.e. in late perimenopause, a difference in the level of well-being between women with and without vasomotor symptoms was absent. CONCLUSIONS It is concluded that well-being and vasomotor symptoms were inversely related in all menopausal statuses except for the (late) perimenopausal phase. For this no somatic explanation seems plausible. A more social scientific explanation is suggested.

“Doctor, please tell me it’s nothing serious”: an exploration of patients’ worrying and reassuring cognitions using stimulated recall interviews

BackgroundMany patients who consult their GP are worried about their health, but there is little empirical data on strategies for effective reassurance. To gain a better understanding of mechanisms for effective patient reassurance, we explored cognitions underlying patients’ worries, cognitions underlying reassurance and factors supporting patients’ reassuring cognitions.MethodsIn a qualitative study, we conducted stimulated recall interviews with 21 patients of 12 different GPs shortly after their consultation. We selected consultations in which the GPs aimed to reassure worried patients and used their videotaped consultation as a stimulus for the interview. The interviews were analysed with thematic coding and by writing interpretive summaries.ResultsPatients expressed four different core cognitions underlying their concerns: ‘I have a serious illness’, ‘my health problem will have adverse physical effects’, ‘my treatment will have adverse effects’ and ‘my health problem will negatively impact my life’. Patients mentioned a range of person-specific and context-specific cognitions as reasons for these core cognitions. Patients described five core reassuring cognitions: ‘I trust my doctor’s expertise’, ‘I have a trusting and supporting relationship with my doctor’, ‘I do not have a serious disease’, ‘my health problem is harmless’ and ‘my health problem will disappear.’ Factors expressed as reasons for these reassuring cognitions were GPs’ actions during the consultation as well as patients’ pre-existing cognitions about their GP, the doctor-patient relationship and previous events. Patients’ worrying cognitions were counterbalanced by specific reassuring cognitions, i.e. worrying and reassuring cognitions seemed to be interrelated.ConclusionsPatients described a wide range of worrying cognitions, some of which were not expressed during the consultation. Gaining a thorough understanding of the specific cognitions and tailoring reassuring strategies to them should be an effective way of achieving reassurance. The identified reassuring cognitions can guide doctors in applying these strategies in their daily practice.

Uitwisselen van ervaringen in de huisartsopleiding

SamenvattingVeen M, Snijders Blok B, Bareman F, Bueving H. Uitwisselen van ervaringen in de huisartsopleiding Huisarts Wet 2015;58(1):6-10.Achtergrond Om inzicht te krijgen in de ontwikkeling en achtergronden van het uitwisselen van ervaringen (UvE; ‘spuien’, leren van ervaringen, onderlinge consultatie) plaatsen wij deze onderwijsvorm in een historisch kader.MethodeWe hebben schriftelijke bronnen onderzocht en semigestructureerde interviews afgenomen bij (oud-)stafleden die bij de ontwikkeling van het UvE betrokken waren.ResultatenDe motivatie om het UvE in de huisartsopleiding op te nemen hangt samen met de maatschappelijke, sociale en onderwijskundige context van de jaren zeventig van de vorige eeuw. De opleiding richtte zich niet alleen op het medische aspect van het huisartsenvak, maar vooral ook op de arts-patiëntrelatie en de rol die de persoonlijkheid van de dokter hierin speelde. Het UvE vormde de basis van het onderwijsprogramma, waarin de vrijheid van aios om hun opleiding vorm te geven vooropstond. Het UvE stelde aios in staat om hun ervaringen te delen en van elkaar te leren, en diende daarnaast als bron van het resterende onderwijs op de terugkomdag. De Balint-methode was een belangrijke inspiratiebron voor huisartsen uit die tijd en diende als model voor het invoeren van het UvE en het daarbij betrekken van gedragswetenschappers. Het UvE moest na de basisopleiding een cultuuromslag bewerkstelligen en bijdragen aan de profilering van de huisartsgeneeskunde als ‘continue, integrale en persoonlijke zorg’. Tegenwoordig is het terugkomdagonderwijs van tevoren vastgesteld en is de bronfunctie van het UvE komen te vervallen. Ook het doel van het realiseren van een cultuuromslag is niet langer relevant. Het tweeledige doel om aios van elkaars ervaringen te laten leren en onderlinge steun te ervaren is echter onverminderd van kracht gebleven.Conclusie De kern van het UvE is door de jaren heen niet veranderd. De plaats die het binnen het curriculum inneemt is verschoven – het UvE vormt niet langer de basis van het onderwijs, maar maakt onderdeel uit van de reguliere onderwijsprogramma’s. De nadruk is meer komen te liggen op structuur en inhoud.AbstractVeen M, Snijders-Blok B, Bareman F, Bueving H. Experiential learning during general practice education and training. Huisarts Wet 2015;58(1):6-10.Background To gain insight into the background and development of experience-sharing during general practice training, from a historical perspective.Method The literature was searched and members of staff who were involved in the development of experiential learning were interviewed.Results The motivation to incorporate experiential learning in general practice education and training is a consequence of the social and educational context of the 1970s. Training not only focuses on the medical aspects of general practice but especially on the doctor–patient relationship and the role of the doctor’s personality in this. Experiential learning formed the basis of the educational programme, in which emphasis was on the freedom of trainee doctors to structure their own education. Experiential learning enabled students to share their experiences and to learn from each other and formed the basis of education and training on refresher days. The Balint method was a source of inspiration for GPs in the 1970s and served as model for the introduction of experiential learning and the involvement of behavioural scientists. After the undergraduate phase of training, experiential learning was expected to bring about a change of culture and contribute to general practice medicine as ’continuous, integral, and personalized care’. Nowadays, the content of refresher days is established in advance and the function of experience-sharing as the source of the educational programme on refresher days has elapsed. The aim of cultural changes is also no longer relevant. However, the goal that general practice trainees share experiences and support each other is still very relevant.Conclusion The essence of experiential learning has not changed over the years, but its place in the medical curriculum has. It no longer forms the basis of medical education but is part of the educational programme. Nowadays, emphasis is more on structure and content.

Waarover gaat het Uitwisselen van Ervaringen in de huisartsopleiding

SamenvattingHet Uitwisselen van Ervaringen (UvE) op de terugkomdag – welke huisarts is er niet groot mee geworden? Al ruim vier decennia is het een deel van de huisartsopleiding en het neemt op alle instituten nog steeds een belangrijke plaats in. Sommigen zullen het zich herinneren als ‘spuien’, ‘onderlinge consultatie’ of de ‘ervaringsronde’. In de eerste jaren van de huisartsopleiding in Nederland besloeg het UvE soms de hele terugkomdag. Een aantal verschillen daargelaten is de opzet op elk instituut dezelfde: onder begeleiding van een huisartsdocent en/of gedragswetenschapper bespreken aios wat ze die week hebben meegemaakt.

Developing skilled doctor–patient communication in the workplace: a qualitative study of the experiences of trainees and clinical supervisors

To inform the development of recommendations to facilitate learning of skilled doctor–patient communication in the workplace, this qualitative study explores experiences of trainees and supervisors regarding how trainees learn communication and how supervisors support trainees’ learning in the workplace. We conducted a qualitative study in a general practice training setting, triangulating various sources of data to obtain a rich understanding of trainees and supervisors’ experiences: three focus group discussions, five discussions during training sessions and five individual interviews. Thematic network analysis was performed during an iterative process of data collection and analysis. We identified a communication learning cycle consisting of six phases: impactful experience, change in frame of reference, identification of communication strategies, experimentation with strategies, evaluation of strategies and incorporation into personal repertoire. Supervisors supported trainees throughout this process by creating challenges, confronting trainees with their behaviour and helping them reflect on its underlying mechanisms, exploring and demonstrating communication strategies, giving concrete practice assignments, creating safety, exploring the effect of strategies and facilitating repeated practice and reflection. Based on the experiences of trainees and supervisors, we conclude that skilled communication involves the development of a personal communication repertoire from which learners are able to apply strategies that fit the context and their personal style. After further validation of our findings, it may be recommended to give learners concrete examples, opportunities for repeated practise and reflection on personal frames of reference and the effect of strategies, as well as space for authenticity and flexibility. In the workplace, the clinical supervisor is able to facilitate all these essential conditions to support his/her trainee in becoming a skilled communicator.