The Identity Crisis of Osteoarthritis in General Practice: A Qualitative Study Using Video-Stimulated Recall

Zoe Paskins; Tom Sanders; Peter R. Croft; Andrew B. Hassell

doi:10.1370/afm.1866

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Author's response to comments
Zoe Paskins

Published on: 11 April 2016
Clarifying Dx and Shared Decision Making
Rebecca Hayes

Published on: 19 January 2016
OA as a primary complaint
Brian Bentele

Published on: 13 January 2016

Published on: (11 April 2016)
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Author's response to comments
Zoe Paskins, Senior Lecturer and Consultant Rheumatologist
Thanks very much to the authors of the previous TRACK comments. Rebecca Hays et al make a good point about the age of the included GPs; however, I would anticipate all the GPs in the study would be well versed in the concept of shared decision making (SDM): 7 were GP 'trainers' (term in the UK for GPs who are specifically trained to mentor and supervise trainee GPs) who would therefore be aware of the curriculum for train...
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Thanks very much to the authors of the previous TRACK comments. Rebecca Hays et al make a good point about the age of the included GPs; however, I would anticipate all the GPs in the study would be well versed in the concept of shared decision making (SDM): 7 were GP 'trainers' (term in the UK for GPs who are specifically trained to mentor and supervise trainee GPs) who would therefore be aware of the curriculum for trainee GPs which addresses SDM. Furthermore, the non-trainer GPs all taught medical students; in the undergraduate curriculum, some of the teaching on consultation skills and theory takes place in the context of primary care. Further work on a wider sample of consultations (including younger GPs) has found Elwyn's model of SDM was rarely observed in primary care consultations discussing analgesia for MSK pain (C Hyde, C Chew Graham, K Dunn, Z Paskins - unpublished). With reference to Brian Bentele's comment, I agree that it would be interesting to correlate satisfaction with duration of time spent discussing OA as a primary complaint. I also agree that it is entirely not surprising that OA only received a short amount of attention in the context of other, potentially life threatening, problems. However of interest to us, as expressed in the paper, were the assumptions that were made by both parties as a result of these brief encounters e.g. the belief by GPs that symptoms raised late in the consultation were unlikely to be troublesome. In fact, there were very varied reasons for raising a symptom late on - such as fear of being referred for surgery. Patients reported the reaction (or lack of reaction) to raising OA as a complaint late in the consultation, an important deterrent to consulting again with the same complaint.
Competing interests: None declared
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Competing Interests: None declared.
Published on: (19 January 2016)
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Clarifying Dx and Shared Decision Making
Rebecca Hayes, Resident
Other Contributors:
From reading this article, we saw clearly the importance of clarifying diagnosis, even for what appear to us as less prioritized conditions. We noted that the sample tended to have older GPs and that it is possible that the framework of shared decision making was not part of medical culture through much of their career. It would be interesting to see how younger doctors more inclined to using shared decision making would negotia...
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From reading this article, we saw clearly the importance of clarifying diagnosis, even for what appear to us as less prioritized conditions. We noted that the sample tended to have older GPs and that it is possible that the framework of shared decision making was not part of medical culture through much of their career. It would be interesting to see how younger doctors more inclined to using shared decision making would negotiate OA diagnosis and discussion with patients. All in all, it is clear that validation of symptoms and prioritizing OA is vitally needed.
Competing interests: None declared
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Competing Interests: None declared.
Published on: (13 January 2016)
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OA as a primary complaint
Brian Bentele, Resident
Other Contributors:
Looking at Table 2, we found it interesting that when OA was seen as a primary complaint GPs spent a significant amount of time discussing OA. However, when OA was not the primary complaint and addressed along with several other conditions, OA discussion time was very short. With one patient with 5 total conditions, time spent on OA was only 25 seconds out a 22 minute appointment. Nevertheless, this is inevitable - the...
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Looking at Table 2, we found it interesting that when OA was seen as a primary complaint GPs spent a significant amount of time discussing OA. However, when OA was not the primary complaint and addressed along with several other conditions, OA discussion time was very short. With one patient with 5 total conditions, time spent on OA was only 25 seconds out a 22 minute appointment. Nevertheless, this is inevitable - there are so many incentives to concentrate on conditions more likely to kill patients, like high blood pressure and diabetes, which reduces the likelihood of discussion. An interesting follow-up study would be to focus on the association between patient level of satisfaction and discussion time of OA, particularly when it is addressed as the primary complaint.
Competing interests: None declared
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Competing Interests: None declared.