ABSTRACT
BACKGROUND: Previously it was shown that during a series of out-patient consultations dysfunctional complaint-related cognitions and anxiety diminished significantly in patients with functional abdominal complaints (IBS). The aim of the present study was to assess the maintenance of positive changes initiated during medical consultations in the patients' complaint-related cognitions and anxiety, as well as the influence of these cognitions on the severity of the complaints, 6 months after the first visit to the out-patient clinic. METHODS: One hundred and five consecutive patients with IBS referred by their general practitioners to the out-patient clinic for internal medicine completed questionnaires about their complaints and their complaint-related cognitions and anxiety before the first and after the last out-patient visit and again at follow-up, 6 months after the first out-patient consultation. RESULTS: Positive changes in the patients' complaint-related cognitions during the consulting period were found to persist during the follow-up period. Improvement in abdominal complaints at follow-up was found to be related to the level of the patients' state anxiety, fear of cancer, and catastrophizing cognitions at the last out-patient visit. CONCLUSIONS: Medical consultations can bring about long-lasting positive changes in prognostically unfavourable cognitions and anxiety. These changes appear to be related to a better outcome of IBS.
Subject(s)
Anxiety/therapy , Attitude to Health , Colonic Diseases, Functional/psychology , Colonic Diseases, Functional/therapy , Patient Education as Topic/standards , Ambulatory Care/methods , Female , Follow-Up Studies , Humans , Male , Matched-Pair Analysis , Patient Satisfaction , Prospective Studies , Severity of Illness Index , Treatment OutcomeABSTRACT
This study explored the changes in complaint-related cognitions and anxiety of 110 consecutive out-patients with functional abdominal complaints (irritable bowel syndrome), during a series of consultations. Patients' anxiety, fear of cancer, somatic attribution concerning intestines or stomach and catastrophizing cognitions appeared to diminish significantly during the consulting period. Positive changes in patients' psychological attribution and somatic attribution appeared to be related to doctors' correct perceptions of these attributions. Catastrophizing cognitions diminished significantly more when patients saw the same doctor throughout the consultations. As changes in attributions and catastrophizing cognitions appeared to be related to doctor-patient interaction, it is conceivable that doctors could learn to influence cognitions even more.
Subject(s)
Abdominal Pain/diagnosis , Anxiety/etiology , Attitude to Health , Dependency, Psychological , Physician-Patient Relations , Referral and Consultation , Abdominal Pain/psychology , Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Somatoform Disorders/psychologyABSTRACT
Functional abdominal complaints (IBS) are widespread in the general population, especially among women. Non-organic dimensions of the complaint such as complaint-related cognitions and behaviour appear to be related to the prognosis. The prognosis could possibly be improved by changing these factors during medical consultations. Therefore, doctors have to perceive patients' cognitions and behaviour. But, do they perceive them correctly? One hundred and twenty patients with functional abdominal complaints referred to an out-patient clinic for internal medicine completed a questionnaire about their complaints and their complaint-related cognitions, behaviour, and anxiety prior to the first consultation. After the first consultation, doctors completed a similar questionnaire indicating their perceptions of patients' cognitions, anxiety, behaviour, and complaints. Complaints were perceived better than cognitions, anxiety, and behaviour. Doctors underestimated patients' expectations and secondary complaints and overestimated patients' pain-related attributions, and their catastrophizing and self-efficacy cognitions.
Subject(s)
Attitude of Health Personnel , Cognition , Colonic Diseases, Functional/psychology , Physician-Patient Relations , Adult , Ambulatory Care , Family Practice , Female , Humans , Individuality , Male , Middle Aged , Personality Assessment , Sick RoleABSTRACT
Five non-ophthalmologists (four general practitioners and a hospital physician) assessed the retinal status of 62 patients with diabetes mellitus, using fundus photos. They had no particular interest in diabetic retinopathy, nor did they receive special training. Their diagnoses were compared with the diagnostic opinion of two ophthalmologists, whose diagnoses served as the standard. The use of reference charts (photos of normal retinas and retinas with diabetic retinopathy) reduced the number of false negative assessments. The sensitivity of the non-ophthalmologists varied between 100 per cent and 88 per cent, depending on the standard (diagnosis of one ophthalmologist or consensus between two ophthalmologists). The specificity was 55 percent, indicating the potentially high rate of inappropriate referral. The coefficient of agreement of diagnosis between the non-ophthalmologists and the ophthalmologists was kappa 0.54. All but one patient put on treatment by the ophthalmologists had been identified by the non-ophthalmologists. The possibility of fundus photography in patient management (consultation on photo reading instead of a referral of the patient) is discussed. It is concluded that the assessment of fundus photos to detect diabetic retinopathy by general physicians seems to be a promising strategy in the surveillance of patients with diabetes mellitus.
