John Skelton

When medical schools began to recognize, a generation ago, that clinical “communication skills” could not be taken for granted among students, a process began of researching them, and introducing t...

Background: There is a growing interest in how doctors learn from narratives about individual cases, reflected, for example, in the use of e-portfolios.Aim: This study aimed to evaluate how GP trainers conceptualised ‘learning from patients’, and what use they currently made of narrative recounts in training.Design & setting: Thematic analysis (TA) and corpus-linguistic (CL) analysis, with data collected from a convenience sample of trainers in the UK, Ireland, and Spain.Method: GP trainers in the three settings were contacted, and volunteers recruited (22 in UK, 24 in Ireland, and 16 in Spain). Volunteers were interviewed and asked to offer a narrative about ‘a patient you learned from’ and whether they used narratives as a training device.Results: There were no differences between settings. Trainers described an engaged and personal relationship with patients. They described learning about themselves, the human condition, and about how to live and die well. Their narratives were structured in various ways. At times, they led to precise conclusions: at times, they were perceived as meaningful, but resisting analysis. As regards teaching through narrative, it was reported as commonly used, but present practice appears ad hoc rather than planned.Discussion: The lack of difference between settings suggests a degree of commonality about how trainers perceive learning and teaching in the areas explored, but cannot be generalised further. The level of personal engagement was more than anticipated, and suggests the label ‘doctor–patient relationship’, as the term is used, may not be adequate to describe the nature of some interactions.

This article reports changes in mindset and attitudes of a cohort of 798 NHS managers in relation to the implementation of a new NHS trust-wide performance appraisal system. This was measured through two methods: the statistical analysis of data collected before and after an intensive training/orientation intervention by means of χ2 tests; and a corpus linguistic analysis of word associations and text comments that is novel to the literature.

As the first point of contact for patients and witnesses of stroke, General Practice receptionists can be instrumental in deciding the urgency of clinical contact. Despite the considerable complexity of this task, reception staff are not clinically trained. Minimising the time taken to access thrombolysis is crucial in acute stroke as treatment must be initiated within 4.5 hours of the onset, and the earlier the better, to achieve the best outcomes. Research suggests that patients who first contact their General Practice following the onset of stroke symptoms are less likely to receive thrombolysis, in part due to significant delays within Primary Care.

Health-related quality of life is increasingly recognised as an important outcome measure that complements existing measures of clinical effectiveness. The education available on this subject for different healthcare professionals is varied. This article describes the design, implementation and evaluation of a Special Study Module on Health-Related Quality of Life for undergraduate medical students at the University of Birmingham.

Footnotes Competing interests None declared. See also Career focus

This paper considers how death and dying are presented in literature. A wide range of texts, principally but not exclusively from the English language tradition, is used to illustrate themes. Broad categories are suggested for the study of death: some authors give personal accounts of their impending death or their sense of bereavement; some use literature to structure and order our thoughts about death; and some treat death as a literary device, using it, for example, as a symbolic representation of the decay of society. It concludes that the biggest obstacles that health professionals and patients face as they attempt to understand death in literature are concerned not with a lack of appropriate emotional depth, but with difficulties either in understanding the conventions of literature or in coming to terms with the cultural gaps imposed by time and place.

Background. It is widely accepted that ‘partnership’ with patients is desirable, and that patients should be enabled to participate in decisions, but it is not clear to what extent doctor–patient interactions represent partnership in action. Objective. Our aim was to measure aspects of doctor–patient interaction through the deployment of the first person pronouns ‘I’, ‘me’, ‘we’ and ‘us’ in general practice consultations. Methods. The study design was a concordance-based language analysis of spoken data. Concordancing software was used to interrogate a database of 373 consultations with 40 doctors in UK general practice. The frequency and function of first person pronouns used in these consultations were scrutinized. Concordancing enables identification of strings of text with similar lexical properties and uses specialized statistics to assess relationships between words and phrases (‘collocates’ being words commonly found together) as well as their patterns of use (MI, mutual information, describes the likelihood of two words or phrases being associated). Analysis is therefore quantitative and qualitative. Results. Doctors use the word ‘we’ far more often than patients or companions do (doctors 23.5% and patients 2.9% of all personal pronoun occurrences). Doctors are far less likely to use ‘I’, after which a verb of thinking is usually selected (38 collocates with MI >3). However, after ‘we’, doctors select verbs of physical activity or auxiliary verbs. Three types of doctor use of ‘we’ were distinguished: to include patients (“you and I”), exclude them (“we doctors” or “we as a practice”) or to mean “all of us as human beings”. Conclusions. The findings suggest a prototypical pattern of interaction in primary care: Patient: I suffer. Doctor: I think. We will act. This, within the current paradigm which values partnership between doctor and patient, might seem encouraging; but there is evidence to suggest that power relationships in the consultation may still be unequal.