How digital technologies can support self-care (2)

15 July, 2020

Clin Chem Lab Med 2019; 57(3): 375-382 Opinion Paper https://pubmed.ncbi.nlm.nih.gov/30375343/

Syed Ghulam Sarwar Shah*, Amir Hannan, Bruce Elliott, Ingrid Brindle, Haughton Thornley Patient Participation Group and Richard Fitton

“The view of a general practitioner on immediate access for patients to their laboratory test results”

https://doi.org/10.1515/cclm-2018-0743 Received July 16, 2018; accepted October 4, 2018; previously published online October 31, 2018

"Abstract: This position paper presents the role of laboratory test results in traditional general practice and provides a recommendation for responsible sharing of results with patients for improved safety, efficiency and outcomes. This paper looks at the relationship between the laboratory, the general practitioner consultation, the patient, safety and general practice capacity. We suggest changes in the traditional practice of communicating laboratory test results whereby normal or abnormal results are made available to patients as soon as they become available. We also endorse the opinion that using online tools such as email or text messages could enhance the provision of rapid access to laboratory test results for patients."

Consultations

Consultation is the most important process in the primary care healthcare environment. It is therefore imperative to explain and understand the following issues: What are consultations in English General Practice? How can they be made more effective and safer? How can access to laboratory results help?

In “Clinical thinking and practice: diagnosis and decision in patient care” [8], the authors describe the consultation that comprises eight stages (Table 2).

Table 2: Stages of consultation.

Stage Description

1 History

2 Examination

3 Differential diagnosis

4 Investigations and tests

5 Working diagnosis

6 Communication to the patient (including the meaning of results)

7 Implementation of treatment (including targets for results)

8 Continuing care (including the monitoring of results)

The consultation is described as “‘the central act of medicine’ which ‘deserves to be understood’. It is clearly central to the transaction between doctors and patients and central to the relationship between doctors and patients” [10].

In addition, The Consultation � An Approach to Learning and Teeaching [10] describes seven tasks which taken together form comprehensive and coherent aims for any consultation. From observation, seven tasks were detailed which together form comprehensive aims for the consultation (Table 3).

Table 3: Tasks in the consultation.

Number Task (and sub-task)

1. To define the reason for the patient’s attendance, including:

a. The nature and history of the problems

b. Their aetiology

c. The patient’s ideas, concerns and expectations

d. The effects of the problems

2. To consider other problems:

a. Continuing problems

b. At-risk factors

3. With the patient, to choose an appropriate action for each problem

4. To achieve a shared understanding of the problems with the patient

5. To involve the patient in the management and encourage him/her to accept appropriate responsibility

6. To use time and resources appropriately:

a. In the consultation

b. In the long term

7. To establish and maintain a relationship with the patient which helps to achieve the other tasks

HIFA profile: Richard Fitton is a retired family doctor - GP, British Medical Association. Professional interests: Health literacy, patient partnership of trust and implementation of healthcare with professionals, family and public involvement in the prevention of modern lifestyle diseases, patients using access to professional records to overcome confidentiality barriers to care, patients as part of the policing of the use of their patient data

Email address: richardpeterfitton7 AT gmail.com