Crossley Jim, Davies Helena
Sheffield Children's NHS Trust, Sheffield Children's Hospital, Sheffield, UK.
Med Educ. 2005 Aug;39(8):807-19. doi: 10.1111/j.1365-2929.2005.02231.x.
The clinical consultation is an important aspect of the doctor's role. However, there is a particular shortage of methods for assessing its quality, and its complexity makes it a considerable assessment challenge.
What are the key components of consultations involving children?
(1) A content analysis of relevant published and unpublished literature. (2) A nominal group consensus exercise with experienced paediatricians.
The content analysis and consensus exercise suggested similar lists of doctor's characteristics, tasks and outcomes as being important components of the consultation. Doctor's characteristics include: clinical judgement, clinical knowledge, physical examination, information gathering, clinical questioning, information giving, patient-centredness, parent-centredness, interpersonal skills, and consultation management. Important tasks include: organisation and efficiency, rapport, information gathering, getting the family perspective, examination and procedures, evaluation, medically appropriate plans, family appropriate plans, enhancing understanding and recall, achieving consensus, sharing responsibility, family knows how to get further help and liaison with other relevant health-care professionals. Important outcomes include: family satisfaction, family perceptions, compliance, health, health-related problems and doctor's satisfaction. The studies reviewed in the literature also provided a catalogue of factors that have been shown to influence the doctor-patient interaction that could potentially confound the assessment of a doctor's performance. These include the doctor's: age, gender, training, speciality, income, social class and politics; the patient's: age, gender, health, prognosis, social class, education, health beliefs and preferences about control and risk. The length of the acquaintance between doctor and patient, and the workload and case-mix in the clinic also affect the interaction. In several studies it is clear that particular combinations of doctor-type and patient-type have especially good or bad interactions. CONCLUSIONS AND FURTHER WORK: These components are synthesised in a single model of the doctor-patient interaction to guide the development and evaluation of assessment instruments aimed at consultations involving children.
临床会诊是医生角色的一个重要方面。然而，评估其质量的方法特别匮乏，而且其复杂性使其成为一项颇具挑战性的评估任务。
涉及儿童的会诊的关键组成部分有哪些？
（1）对相关已发表和未发表文献进行内容分析。（2）与经验丰富的儿科医生进行名义群体共识练习。
内容分析和共识练习表明，医生的特征、任务和结果的相似列表是会诊的重要组成部分。医生的特征包括：临床判断力、临床知识、体格检查、信息收集、临床提问、信息提供、以患者为中心、以家长为中心、人际沟通技巧和会诊管理。重要任务包括：组织与效率、建立融洽关系、信息收集、了解家庭观点、检查与操作、评估、医学上合适的计划、家庭合适的计划、增强理解与记忆、达成共识、分担责任、家庭知道如何获得进一步帮助以及与其他相关医疗保健专业人员联络。重要结果包括：家庭满意度、家庭认知、依从性、健康状况、与健康相关的问题以及医生满意度。文献中综述的研究还提供了一系列已被证明会影响医患互动的因素，这些因素可能会混淆对医生表现的评估。这些因素包括医生的：年龄、性别、培训、专业、收入、社会阶层和政治立场；患者的：年龄、性别、健康状况、预后、社会阶层、教育程度、健康观念以及对控制和风险的偏好。医患之间相识的时长，以及诊所的工作量和病例组合也会影响互动。在几项研究中很明显，特定类型的医生和患者的组合具有特别好或特别差的互动。结论与进一步工作：这些组成部分被整合到一个医患互动的单一模型中，以指导针对涉及儿童的会诊的评估工具的开发和评估。
