Niels Lynöe

Informed consent in clinical training--patient experiences and motives for participating.

The purpose of this study was to assess patients attitudes to and experiences of participating in the clinical training of medical students. Samples of patients (nu2003=u2003582) selected at random from six different departments (gynaecology, psychiatry, internal medicine, paediatrics, urology and a health care centre with general practitioners) were interviewed by means of a questionnaire. The patients were selected from those who had consulted the actual departments in the last six months of 1995. Four hundred and forty‐one patients (76%) answered the questionnaire. Seventy‐one per cent of all patients had experience of participating; of these 41% had estimated that they had once or several times participated without being informed. Eighty per cent felt aggrieved if they were not informed. On average 88% were, in principle, positive to participating. Of those who were, in principle, negative a majority had negative experiences of participating. Elderly patients tended to accept participating more often without being informed. Almost all patients seemed to be positive to participating in the education of medical students, although a silent precondition might be that patients should be informed and given the opportunity to abstain.

The attitudes of patients and physicians towards placebo treatment--a comparative study.

Placebo treatment in clinical practice can be given either in order to comply with the wishes of the patient, or with the purpose of doing good and not causing harm. In the former instance, the procedure may be in accordance with the interests of the patient, yet be in conflict with the interests of the medical profession. In the latter instance, the procedure presupposes that in most cases the patient has not been informed of the nature of the treatment; this type of procedure may jeopardize a trusting patient-doctor relationship. Therefore, it is of interest to investigate both the extent to which patients and physicians feel they can accept placebo treatment and a paternalistic attitude, and in which particular situations. In order to shed some light on this matter, we compiled a questionnaire built around three case histories which problematize placebo treatment and paternalistic acts. The questionnaire was distributed to 100 patients and 100 physicians. 83 patients and 94 physicians responded. The results show that patients and physicians do not automatically follow specific group interests. Physicians are more inclined to respect the patients option to refuse medical treatment than the patients are inclined to respect a physicians professional autonomy. Patients appear more to be paternalistic in their judgements than physicians, but one cannot rule out the possibility that the answers of the physicians reflect the fact that placebo treatment represent a socially undesirable behaviour. We conclude that theoretical and normative analyses of the perspective of the actors ought to be supplemented by empirical research.(ABSTRACT TRUNCATED AT 250 WORDS)

Patients frequently consulting general practitioners at a primary health care centre in Sweden — A comparative study

The purpose of this study was to describe the sociodemographic patterns, consultations and the nature of problems of frequent attenders (FAs) at general practitioners at a primary health care centre. The design was a comparative study of FAs (≥5 consultations during 1991) (n = 179) and a contrast group of patients (CPs) matched by age and sex (1-4 consultations during 1991, n = 179). Data from medical records, appointment system, mortality and marital status were recorded. FAs comprised 1.7% of the inhabitants. Boys, middle-aged females, retired males and females and especially very old females were more frequent among FAs than their sections of the population would imply. FAs accounted for 15% and CPs for 4% of the consultations, 6.3 and 1.7 consultations on average, respectively. The average booked time for consultations during 1991 was 140 minutes for FAs and 35 minutes for CPs. Continuity was higher among older than younger FAs. Contacts other than medical consultations comprised a substantial part of the work with FAs, especially among middle-aged and elderly FAs. Problems arising from the musculoskeletal system, psychological and social problems were most common among FAs, often in combination, while chronic diseases such as cardiovascular diseases and diabetes were not crucial for frequent attending. Few FAs consulted as frequently in the preceding years and the following year, as in 1991, but still they accounted for more consultations than CPs during these years. More female FAs than males and CPs were divorced. The study indicates that FAs require a long-term strategy where continuity and accessibility are often important. They might also have profited by more time. However, FAs were a heterogeneous group of patients and follow-up studies and individual studies of FAs would be of interest.

Physicians and Alternative Medicine – An Investigation of Attitudes and Practice

In the present paper, the attitudes of three different groups of physicians toward treatment with alternative medicine have been investigated. One of the groups studied consisted of randomly selected licenced physicians from the Swedish National Board of Health and Welfare. The other two groups conprised two different associations of physicians involved with alternative medicine. One third of the former groups were positively disposed toward one or more of the alternative medical technologies, while the latter groups were more positive toward alternative medicine in general. Attitudes, along with motives for such interest, varied depending on the orientations of the different interest groups. The most common motives for expressing interest in alternative medicine included a feeling of clinical powerlessness in the face of certain problems for which patients consult a physician, and a dissatisfaction with the scientific approach of academic medicine. A minority stated that their interest in alternative medicine pre-dated their medical education. Physicians interest in alternative medicine can be understood both as a critical reaction to academic medicine and as evidence that some alternative medical technologies are effective. Hence there is a need to determine whether there are shortcomings to be found in academic medical education and scientific ideals, and also to assess alternative medical technologies at regular intervals.

Ethical and professional aspects of the practice of alternative medicine

Ethical and Professional Aspects of the Practice of Alternative Medicine. Lynöe, N. (Department of Social Medicine, University of Umeå, Sweden). The question of who should provide alternative medical treatment raises a number of different problems of both an ethical and a professional nature. Providing medical treatment, including alternative medical treatment, presupposes that the physician in question possesses diagnostic competence. It is in the best interests of society that medical care is safe, and therefore society must monitor the medical profession, e.g. in order to assure itself that the treatment provided is in agreement with the tenet of science and proven experience. The democratization of the patient-doctor relationship and the liberalization of the availability of medical and alternative medical treatments means that society also has an interest in ensuring that physicians offer alternative medical treatments or cooperate with practitioners of alternative medicine. A question is whether this is also of interest to the physicians? Another question touching on professional ethics is whether the doctor has the same responsibility to respect the desire of a patient to receive alternative medical treatment as he would have to respect the patients right to forgo ordinary medical treatment. These questions are analysed here against the background of the perspective of the relevant interest groups and are graded with regard to the disease and treatment concerned, how far the disease has advanced, the age of the patient, and whether or not the patient is competent to make his own decisions. These considerations are relevant in a discussion of who is qualified to provide or prescribe alternative medical treatment. This study points out that the individual physician should have the possibility to compromise and improvise from case to case. In order to shed further light on these matters it is also pointed out that there is a need for empirical investigations of how patients/laymen consider the ethical dilemmas in specific situations.

Is frequent attendance a persistent characteristic of a patient? Repeat studies of attendance pattern at the family practitioner

Objective – To assess the extent of frequent attendance as a persistent characteristic of patients by repeat studies of attendance at a health centre. Design – A follow-up of frequent attenders and compared patients from 1991 among frequent attenders in 1996. Setting – Mariehem health centre in Umeå in northern Sweden providing care for 10u2008500 and 12u2008000 inhabitants in 1991 and 1996, respectively. Subjects – Frequent attenders, defined as patients who had at least 5 consultations with physicians during 1 year at the health centre, compared to attenders who had between 1 and 4 consultations in 1991 and 1996. Results – The proportion of people who lived in the area and consulted a doctor at the health centre at least once during 1 year increased from 40.0% in 1991 to 45.2% in 1996. The number of frequent attenders increased from 179 to 303 and they took 15% and 20% of all consultations in 1991 and 1996, respectively. Twenty-five patients (21 females and 4 males) were identified as frequent attenders in both years. Conclusion – With the exception of a small group of patients, mostly females, frequent attendance seems not to be a persistent characteristic of patients.

Attitudes and practices among Ethiopian health care professionals in psychiatry regarding compulsory treatment.

Attitudes and practices among Ethiopian health care professionals in psychiatry regarding compulsory treatment.

Is the Effect of Alternative Medical Treatment Only a Placebo Effect

A common assertion about alternative medical technologies is that their results are solely built upon the placebo effect. The reason for this assertion is due to the facts that the placebo effect is perceived as an irrational quantity, and that the placebo effect is considered unspecific. If it is possible to rehabilitate the placebo effect by interpreting it as a specific effect, what consequences would it have for school medicine and the view of certain alternative medical technologies? To answer these question it is necessary to investigate just what sort of phenomenon the placebo effect is, and what determines its dimensions.

Clinical cancer research : some aspects on doctors' attitudes to informing participants

With the aim to investigate the information policy of oncologists when recruiting patients for clinical trials a postal questionnaire was sent to 412 members of the Swedish Society of Oncology (response rate 74%). Depending on the situation, 20-40% of the doctors perceive that randomization before consent is an acceptable procedure. A majority of the physicians maintain that cancer patients are able to cope with adequate information but 45% of the doctors fear that the patients may withdraw from participating if they are adequately informed. It seems to be important to study the relationship between the quality of information given to participants and the motives they have for accepting or declining to participate.

Theoretical and empirical problems in the assessment of alternative medical technologies.

Critical situations help to clarify and define otherwise indistinct and vague phenomena. The paradigm-collision which occurs when assessing alternative medical phenomena against the background of a medical school paradigm is analogous to a critical situation. An analysis of the conditions for such an appraisal has helped to highlight aspects which are not normally ascribed any great significance in the assessment of technology. It turns out that theoretical requirements, the specific concept and certain irrational elements play a large role in the assessment of medical and alternative medical technology. One conclusion is that in the appraisal of e.g. alternative medical technology, one must take into account these conditions for forming a judgement, as a basic requirement for an objective appraisal of the technology in question.