Tuesday, March 24, 2009

Playing the percentages.

I’m perplexed. The game I’m in is all about communication, or so I’m continually told, and continue to tell the poor benighted Med Students that draw the short stray and have to make the trek out to Ambridge for final year community based medicine teaching.

Overall I flatter myself that that is one thing I’m not too bad at. If you want a fourteen point differential diagnosis for possible causes of a raised serum custard level you might do better with that nice Dr Neighbour—he’s got Medical Membership you know—but if you want your actual diagnosis explained then I reckon I’m yer man alright.

Now, this year, as every other this past four years, I and my confreres have been surveyed. In short for a couple of weeks around New Year and carefully worked out demographically accurate sample population from our surgeries were given questionnaires to rate us and our practice on.

We have just had the results, and sure enough my mean score for 10e (How well the Dr explained your problems or any treatment that you needed?) was a respectable 86%. I also got 83% for 10d (How well the Dr involved you in decisions about your care?).

Before we get too carried away the national mean for those two parameters, throughout the U.K. was 83% and 81% respectively, so not to be sniffed at at all. Still I must confess to being mystified, since despite these encouraging stat’s 11a lobs a dirty great spanner in the works. The self same population that gave those ratings, when asked in 11a (After seeing the Dr today do you feel able to understand you problem(s) or illness?) only muster a rating of 67% where the U.K. average is 69%.

So there you have it. Despite 3% better explanations than the average, and 1% more involvement my punters are ending up 2% less clear about their problem(s) or illness than their peers. Colour me 100% baffled.

On a brighter note Mrs Antrobus was in today. At 80 plus she had an umbilical hernia repair in the winter, and is now fully recovered. For the first time in almost a decade she has a flat tum, and can see her belly button. She’s so delighted she even asked her surgeon if she can get it pierced now—“Y’know, like that Brittney?”


A punter said...

For what it's worth, I would consider question 10 as asking if my GP had told me what was wrong and discussed treatment options in a way I felt I could influence the decision. Question 11 seems to look at the wider context. Why did I develop X in the first place? It's the sort of thing I wouldn't think to ask at the time, would be nice to know, but in most cases is unanswerable.

townmouse said...

I think the problem is you had the Grundys through the surgery that day...

Swiss Missus said...

"Colour me 100% baffled."


Swap you a truss bridge (Howe type) and sunken lanes along the Way of St. James ('cos that was my line of work today) for a serum custard wotsit.

Thank you for making me laugh after a long, hard and quite perplexing day. :)


Doctor Jest said...

Nameless punter-- thanks for stopping by, and for the insight, I had been looking at the two questions as linked but of course there is no reason why they ought to be. That might go some way to explaining the discrepancy, but I'm still a little worried I and my colleagues are not hitting the mark more often if that is the case.

townmouse-- welcome. Now you mention it that was around the time we had all those interesting "continental choc's" in the surgery ;-)

Swiss mrs-- glad to be of service as ever. I'm off to google Howe type truss bridges now...

Nutty said...

Don't forget that patients don't absorb everything no matter how well you explain it. When the word cancer was chucked in my direction last week, I don't think I heard much else that was said to me by anyone at the hospital concerned.

Just as I thought I'd made sense of it with the help of the internet, two days later I was back at the hospital for more procedures. I'm sure they explained everything properly, but I had to phone the next day to get them to tell me again what they'd found.

So you can explain stuff to people, but that doesn't mean they'll take it on board. There's only so much you can do. At least if you're as nice to your patients as you sound they'll know it's ok to come back and ask you if they don't understand.

Doctor Jest said...

Nutty-- Eeek! Sorry to hear that. As you say folks don't always take everything in.

One seminal study showed we cant expect people to remember more that a third of the consultation -- probably why trhese days I find myself saying things over and over again.

And then again a word like Cancer tends to drive everything else said, both before and after it, scurrying away into the ether. I do hope you are getting better communication from them now, and that the news will be good. FWIW I'm sending what positive thoughts I can your way.