Jane Sutton

Experiencing “The Other Side”: A Study of Empathy and Empowerment in General Practitioners Who Have Been Patients

Work-related pressures and susceptibility to health problems mean that many general practitioners (GPs) will, at some stage, experience the role of patient. However qualitative evidence about their experiences of illness and patienthood is sparse. Our study offers an interpretative perspective on GPs’ experiences of illness and the influence that this has had on their practice. Seventeen GPs who had experienced significant illness took part in semistructured interviews. Data were analyzed using interpretative phenomenological analysis (IPA). The findings highlight the relationship between empathy and empowerment and explore the role of self-disclosure of GP status by GPs in consultations. We make suggestions as to how empathy in doctor—patient relationships can be developed through consideration of power and status as well as through interaction with patients from similar backgrounds. Future research should focus on more specific ways to integrate these ideas into medical training.

Involving patients as advisors in pharmacy practice research: what are the benefits?

Objective To describe the ways in which members of the public with a chronic condition were involved as advisors in a research project exploring pharmacist supplementary prescribing. The primary objective was to be able to reflect upon the benefits and difficulties of this approach so that the patient perspective can be accommodated more fully in future research.

Relationship between personality traits and pharmacist performance in a pharmacy practice research trial

Background: Pharmacy practice research is one avenue through which new pharmacy services can be integrated into daily pharmacy practice. However, pharmacists’ participation in this research has not been well characterized. Drawing from the literature on work performance and personality traits, 4 hypotheses were developed to gain insight into pharmacists’ performance in a pharmacy practice research trial. Methods: This study was an observational, cross-sectional survey of pharmacists participating in a research trial. All pharmacists were asked to complete the Big Five Inventory (BFI), a validated, reliable instrument of personality traits. These results were then compared with measures of pharmacists’ performance in the trial. Results: Thirty pharmacists expressed interest in participating in the trial; 23 completed the BFI and 14 actively participated in the pharmacy practice research trial. No statistically significant differences were identified in the examination of the predetermined hypotheses. Exploratory analyses revealed significant relationships between the BFI trait of extroversion and pharmacists’ participation in the study, obtaining prescribing authority for the study and the number of patients lost to follow-up. Discussion: In addition to identifying a number of personality traits that have been shared by other samples of pharmacists, this work suggests the possibility of an interaction between pharmacists’ personality traits and their performance in a pharmacy practice research trial. Conclusion: Future research should better characterize the relationship between pharmacists’ personality traits and participation in pharmacy practice research trials to gain insight into the context of pharmacy practice and how pharmacists are integrating this research into their practices.

“It’s crucial they’re treated as patients”: ethical guidance and empirical evidence regarding treating doctor–patients

Ethical guidance from the British Medical Association (BMA) about treating doctor–patients is compared and contrasted with evidence from a qualitative study of general practitioners (GPs) who have been patients. Semistructured interviews were conducted with 17 GPs who had experienced a significant illness. Their experiences were discussed and issues about both being and treating doctor–patients were revealed. Interpretative phenomenological analysis was used to evaluate the data. In this article data extracts are used to illustrate and discuss three key points that summarise the BMA ethical guidance, in order to develop a picture of how far experiences map onto guidance. The data illustrate and extend the complexities of the issues outlined by the BMA document. In particular, differences between experienced GPs and those who have recently completed their training are identified. This analysis will be useful for medical professionals both when they themselves are unwell and when they treat doctor–patients. It will also inform recommendations for professionals who educate medical students or trainees.

The influence of organisational climate on care of patients with schizophrenia: a qualitative analysis of health care professionals’ views

Background Organizational climate relates to how employees perceive and describe the characteristics of their employing organization. It has been found to have an impact on healthcare professionals’ and patients’ experiences of healthcare (e.g. job satisfaction, patient satisfaction), as well as organizational outcomes (e.g. employee productivity). This research used organizational theory to explore dynamics between health care professionals (pharmacists, doctors and nurses) in mental health outpatients’ services for patients taking clozapine, and the perceived influence on patient care. Setting Seven clozapine clinics (from one NHS mental health Trust in the UK) which provided care for people with treatment resistant schizophrenia. Methods This study used qualitative methods to identify organizational climate factors such as deep structures, micro-climates and climates of conflict that might inhibit change and affect patient care. Using Interpretative Phenomenological Analysis, semistructured interviews were conducted with 10 healthcare professionals working in the clinics to explore their experiences of working in these clinics and the NHS mental health Trust the clinics were part of. Main outcome measure Health Care Professionals’ perceptions of the care of patients with treatment resistant schizophrenia. Results Three superordinate themes emerged from the data: philosophy of care, need for change and role ambiguity. Participants found it difficult to articulate what a philosophy of care was and in spite of expressing the need for change in the way the clinics were run, could not see how ‘changing things would work’. There was considerable role ambiguity with some ‘blurring of the boundaries between roles’. Factors associated with organizational climate (role conflict; job satisfaction) were inhibiting team working and preventing staff from identifying the patients’ health requirements and care delivery through innovation in skill mix. There were mixed attitudes towards the pharmacist’s inclusion as a team member. Conclusions Our findings suggest deficiencies within the clinics that may be manifestations of the wider culture of the NHS. The implications for mental health outpatient clinics are that local initiatives are crucial to the implementation of recovery models; clear guidance should be provided on the skill mix required in clozapine clinics and interprofessional learning should be encouraged to reduce role conflict.

Clinical governance issues arising from the Mental Health and Learning Disabilities Pharmacy Workforce Survey (England) 2006.

Objectives In the last 10 years changes in the Governments agenda for medicines management and improved patient safety have resulted in unprecedented calls for the provision of mental health pharmacy services. This has not been reflected in pharmacy workforce planning or budgets. We aim to ascertain pharmacy staffing levels in Mental Health Trusts and whether supply of medicines and delivery of clinical pharmacy services are at an appropriate level.

A diary study of community pharmacists' mental workload

BackgroundMental Workload (MWL) is a widely studied concept within the human factors and patient safety fields. MWL is measured to identify how busy employees are, the complexity of tasks being carried out and whether additional tasks can be added to their current workload without reducing task performance or safety. [1] To date, the MWL of community pharmacists (CPs) practising in the United Kingdom (UK) has not been measured. This study aimed to measure CPs’ MWL throughout a day in their usual practice. MethodFollowing receipt of university ethics approval a convenience sample of 104 CPs who had participated in an earlier study were invited to participate. The 104 CPs were strategically recruited through superintendent pharmacists and social media to be demographically representative of UK CPs. Fifty CPs expressed interest in this follow-up study and were posted a diary containing questions on demographics, the enhanced and locally commissioned services offered and seven copies of the NASA Task Load Index (TLX).[2] The NASA-TLX is a self-report measure of MWL that measures six facets of MWL (time pressure, mental effort, mental demand, physical demand, task frustration and performance concern), each rated on an 11 point scale (0-10). The mean of the scores on the six items provides an overall MWL score. Participants were asked to complete between two and seven MWL ratings over one day and received a £5 highstreet voucher for their participation. MWL ratings were plotted against time of day. Bivariate correlations were produced between overall MWL and the demographic characteristics of participants. Potentially significant relationships were explored further with an independent t-test. ResultsForty CPs (19 men) returned their diaries (response rate of 38%) and a total of 186 MWL ratings were made across the diaries, providing sufficient power to carry out the planned analyses. MWL ratings were plotted against time of day. Peaks in overall MWL were seen at 11 o’clock in the morning and five o’clock in the afternoon. Time pressure, mental and physical demand were the highest rated facets of MWL. Bivariate correlations revealed no relationship between participant sex, age, pharmacy experience, or the type of community pharmacy CPs worked in and overall MWL. However, the correlations indicated a relationship between overall MWL and whether the CP worked full time (> 35 hours a week) or part-time (48 ratings were from part-time CPs). An independent t-test showed that part-time CPs reported significantly lower overall MWL (mean = 4.39) compared to full-time CPs (mean = 5.14) (t (184) =2.29, p < .05, r= .17).Discussion and ConclusionsThese results suggest that MWL peaks for many CPs at specific times of the day and that part-time CPs experience significantly less MWL compared to their full-time colleagues. However, the effect size of this difference was small. The diary ratings also suggest that time pressure, mental and physical demands are the primary sources of MWL that CPs experience. This initial study highlights the impact working patterns have on MWL and has implications for the times of day that safety critical tasks are carried out by CPs. References 1. Wickens CD, Hollands JG, Banbury S, Parasuraman R. Mental workload, stress, and individual differences: cognitive and neuroergonomic perspectives. Engineering psychology and human performance (international edition). 4th ed. Upper Saddle River (NJ): Pearson; 2013. p. 346-76. 2. Hart SG, Staveland LE. Development of the NASA-TLX (Task Load Index); results of empirical and theoretical research. In: Hancock PA, Meskkati N, editors. Human Mental Workload. Amsterdam, Netherlands: North-Esland; 1988.BackgroundSelf-care support by healthcare professionals (HCPs) is a distinct holistic, patient-centred approach to managing LTCs.1 People with LTCs are regular users of community pharmacies, and dispensing and other services provide opportunities for self-care support. This study aimed to explore the views of people with LTCs on self-care and how they utilise community pharmacy for support.MethodsSemi-structured, face-to-face interviews were conducted with people with LTCs between May 2013 and June 2014. Participants were approached via a convenient sample of one General Practice and four community pharmacies in Northwest England, and four pharmacists in two Health Boards in Scotland. Forty-four participants in England and twenty-three in Scotland were identified purposively; fifteen in England and nine in Scotland were recruited and interviewed to achieve maximal variation2 of LTC type and demographics. Interview topics were developed from the literature and used as a framework for the analysis. Topics covered living with LTCs and undertaking self-care, sources of self-care support, and use of community pharmacy. All interviews were audio-taped, transcribed verbatim and analysed thematically. Interviews and data analysis were undertaken simultaneously until data saturation was reached. NHS Research Ethics and RD the few who had experience of these services did not view them as a resource to improve their self-care behaviours. While some participants recognized the support that community pharmacy provided to them such as with minor ailments and some public health services (e.g. stop smoking), most appeared reluctant to acknowledge community pharmacy?s role in supporting their LTCs needs, including self-care.ConclusionsWhile study participants with LTCs engaged in self-care supported by their family, friends and some HCPs, they did not view community pharmacy as playing much of a role in the management and self-care support of their LTCs. The perspectives and needs of people with LTCs need to be better understood, so that community pharmacy services can be designed so as to contribute to their self-care needs.References1. Kennedy, A., A. Rogers, and P. Bower, Support for self care for patients with chronic disease. BMJ, 2007. 335(7627): p. 968-70.2. Creswell, J.W., Qualitative inquiry & research design: choosing among five approaches. 2006, Thousand Oaks, California: SAGE Publications, Inc.