General practitioners' perceptions of dealing with patients with pressured speech: a qualitative study.

BACKGROUND: Empathetic listening can be particularly challenging with patients presenting pressured speech, while time pressure and costs limit practitioners' availability. We aimed to explore general practitioners' (GPs') experiences when encountering a patient with pressured speech without pathological syndrome. METHODS: Using a thematic analysis method, 19 semi-structured interviews were conducted with GPs purposively sampled in Ile-de-France region. RESULTS: Three themes emerged. First, misgivings were aroused when meeting a patient with pressured speech, including frustration, displeasure, and a struggle to maintain focus. Second, huge efforts were needed to adhere to the appropriate clinical reasoning and care for these patients who need more time and energy. The very definition of this condition varies from one clinician to another, and for some, psychiatric conditions were systematically associated. Third, implementation of specific strategies was required to adjust to these patients: trying to create distance with the patient, to organize a framework in which the patient with pressured speech can express him or herself, and even strategies to increase GPs' availability. CONCLUSION: The time and energy required to provide adequate care for patients presenting with pressured speech make it quite challenging, and this builds up pressure in the waiting room. But when medical demands take this form, there is a risk that clinicians will reject the patient or refer early to mental health services, leading to growing feelings of abandonment, the neglect of organic issues, and medical nomadism. Initial and continuing medical training focussing on advanced communication skills and multifocal approaches can foster long-term follow-up.

Experiences of French medical students during their clerkship in adolescent psychiatry: a qualitative study.

The epidemiology of adolescent psychiatric disorders and the relational complexity of their management make exposure to adolescent psychiatry essential during medical school. However, some clinical particularities can complicate the students' learning experiences. Our work aimed to explore the experience of being a medical student during clerkships in adolescent psychiatry. Following the Interpretative Phenomenological Analysis qualitative approach, 20 semi-structured face-to-face interviews were conducted with medical students at the end of their clerkship in adolescent psychiatry. Three super-ordered themes emerged to describe their experience: in-depth self-exploration calling on emotions, thoughts and experiences; changes in the view of adolescent mental health; better understanding of the role and meaning of adolescent psychiatric care and how to approach it. Identification between students and patients could result from time-related factors (the end of adolescent brain remodeling, long, demanding studies, and financial and material dependence). In addition, the predominant use of non-analytical clinical reasoning processes-less valued in the rest of the graduate curriculum-poses a challenge for students. Indeed, for a student to find his or her place in adolescent psychiatry requires the student to reinvent him or herself, because the codes are different (no gown, less well-defined tasks, etc.). Finally, the excess prevalence of mental disorders among medical students requires increased vigilance on the part of tutors. For all these reasons, close, attentive tutoring seems essential to support students, while these clerkships afford a real opportunity for students to broaden their interpersonal skills.