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Dorte Kjeldmand, GP, PhD

The future role of general practice - continuing professional development and the wellbeing of the GP. Dorte Kjeldmand, GP, PhD University of Uppsala, Sweden Department of Public Health and Caring Sciences Section for Health Services Research Eksjö Primary Care Centre, Sweden.

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Dorte Kjeldmand, GP, PhD

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  1. The future role of general practice - continuing professional development and the wellbeing of the GP • Dorte Kjeldmand, GP, PhD • University of Uppsala, Sweden Department of Public Health and Caring Sciences Section for Health Services Research • Eksjö Primary Care Centre, Sweden

  2. The Doctor,the Task and the Group • Balint Groups as a Means of Developing New Understanding in the Physician-Patient Relationship

  3. The task, - the core of the medical profession • The encounter with the patient • To make contact and understand what the patient needs and what kind of help s/he wants • To contribute to increasing the patient’s understanding and competence in his/her situation • To be able to use ones professional competence for the benefit of the patient without being consumed oneself

  4. But - • It keeps you going • and • it wears you out

  5. Problems: • Overworked and tired GPs, who are frustrated and confused about their role • This may lead to burn-out • Many consider early retirement

  6. This might be the GP – caught between a rock and a hard place

  7. More problems • The public’s trust in the health care system has declined • Patients are dissatisfied • Physicians’ role and authority is questioned • In a modern, secularized society people seek health care for existential frustration and discontent • Demands and guidelines. Evidence-based medicine versus patient-centeredness? Or both?

  8. Can Balint groups contribute to the solution of these problems?The main aim of the thesis: • To study Balint groups and their effect on GPs

  9. Participants in study 1 • GPs in south-east Sweden • 4 Balint groups • 26 Balint participants, 20 (77%) answered • 26 reference physicians, 21 (81%) answered • 12 in Balint group for more than 1,5 years • 5 for less than 1,5 years (3 no answer)

  10. 49 VAS-questions, 3 examples: • Can you take your coffee break every day? • _______________________________________________________________________ • 0 1 2 3 4 5 6 7 8 9 10 • No, never Yes, always * * * • Do you sometimes refer patients or take ”unnecessary” tests in order to end the consultation? • ___________________________________________________ • 0 1 2 3 4 5 6 7 8 9 10 • Yes, often No, never • Do you find patients with psychosomatic problems a time-consuming burden? • ______________________________________________ • 0 1 2 3 4 5 6 7 8 9 10 • YesNo * * * * * *

  11. Results

  12. Validity

  13. Results

  14. Informants and method study 2 • 9 GPs: 4 women and 5 men (age: 42-60) • Duration of Balint group participation: 2-14 years • From 6 different groups with 6 different leaders in southern Sweden • Audio-taped, transcribed verbatim • Analysis: Gunnar Karlsson’s EPP-method (Empirical Phenomenological Psychological)

  15. Findings:(interrelating themes): • In the Balint group the physician’s • Professional identity • Competence • Sense of security • are developed through • Parallel processes: physician-patient • physician-Balint group • leading to increased • Satisfaction and endurance in work

  16. And so what? • If the method is so fantastic • Why are Balint groups so rare? • Why is it difficult to recruit members to start new groups? • Why do some members drop out? • Could Balint groups possibly have drawbacks?

  17. Could this alsobe a member of a Balint group?

  18. Informants and methods study 3 • Questionnaire: • Balint group leaders at the 14. International Balint congress 2005 (51 answers) • Interviews: • 8 Balint group leaders • From Sweden, Israel, USA, Denmark and England • Age 50-77 years, 2-33 years experience • 4 GPs, 2 psychiatrists, 2 psychologists • Analysis: Systematic text condensation inspired by Malterud

  19. Findings: • 10 % drop-outs from Balint groups, connected to these themes: • The individual: needs, sensitivity, practicalities • The group: group processes, conscious or unconscious wishes and motivations (obligatory groups), scapegoats, rivalry, hidden agendas, leader interventions • The environment:the health care paradigm, acceptance, time, money, attitudes to patients and other human beings (e.g. physicians)

  20. Balint group activity • Strengthens and develops professional identity • Promotes patient-centeredness • Strengthens relations between colleagues • Increases feeling of control in work • Increases understanding of what happens in human relations • Should be conducted professionally • Should be voluntary

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