Physician Preferences for Elements of Effective Consultations
Physician Preferences for Elements of Effective Consultations
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DOI：
10.1007/s11606-009-1142-2
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发表时间：
2010-01-01
影响因子：
5.7
通讯作者：
Filice, Gregory A.
中科院分区：
文献类型：
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作者：
Boulware, David R.;Dekarske, Adrienne S.;Filice, Gregory A.
有效的沟通对于最佳的医疗咨询是至关重要的，但是目前关于医生对有效咨询的偏好的信息很少。我们邀请了明尼苏达州四家教学医院至少有一年研究生经验的医生完成了一份关于住院咨询的16个问题的互联网问卷。估计有651名医生收到了电子邮件请求。323人（50%）完成了调查。其中，54%的人在5年前完成了培训，17%的人在5年前完成了培训，30%的人是居民或研究员。大多数受访者认为咨询请求中的三个要素至关重要：要解决的具体问题（94%），打电话给谁（68%）和咨询的紧迫性（66%）。在谘询文件中，71%的被访者非常重视简明扼要的建议，64%的被访者非常重视建议背后的理据，只有7%的被访者非常重视参考文献。大多数人（69%）更喜欢以项目符号或编号格式撰写评估和建议。多数人（48%）倾向于将评估和建议分开。大多数人高度重视关于药物治疗的建议，包括剂量（80%），持续时间（80%）和通用药物名称（62%）。咨询师比咨询师更重视包括治疗持续时间在内的建议（分别为87%和65%，P = 0.004）。大多数人（63%）表示，紧急或紧急咨询需要电话请求。经常要求咨询的患者比经常回应咨询的患者更喜欢电话咨询（43%比20%，P < 0.001）。这些结果应该指导改善咨询过程中的沟通和设计电子病历系统的努力。
Effective communication is vital for optimal medical consultation, but there is little current information about physician preferences for effective consultation.We invited physicians with at least one post-graduate year of experience at four Minnesota teaching hospitals to complete a 16-question Internet questionnaire about inpatient consultations.E-mail requests were received by an estimated 651 physicians. Questionnaires were completed by 323 (50%). Of these, 54% had completed training > 5 years before, 17% had completed training < 5 years before, and 30% were residents or fellows. Three elements were considered essential in consultation requests by most respondents: the specific question to be addressed (94%), whom to call with the response (68%), and consultation urgency (66%). In the consultation note, 71% of subjects placed high importance on simple, concise recommendations and 64% on the rationale behind them, while only 7% placed high importance on citing references. Most (69%) preferred that assessments and recommendations be written in bulleted or numbered format. A plurality (48%) preferred that assessments and recommendations be separated. Most placed high value on recommendations regarding drug therapy that specify dose (80%), duration (80%), and generic medication name (62%). Requesters placed greater importance than consultants (87% vs. 65%, respectively, P = 0.004) on recommendations that included duration of therapy. The majority (63%) stated that telephone requests were needed for emergent or urgent consultations. Those who usually requested consultations were more likely than those who usually responded to consultation requests to prefer telephone requests for routine consultations (43% vs. 20%, P < 0.001).Physicians agreed on many essential elements for effective consultations. These results should guide efforts to improve communication in the consultation process and design electronic medical record systems.