Abstract
Objetivos
Describir las conductas empleadas por los residentes en los momentos iniciales (recibimiento, primeros segundos de la obtención de información) y finales de las consultas y valorar en qué medida interrupciones muy precoces de estos a los pacientes afectan a algunos resultados intraconsultas como la duración de los cierres o la aparición de nuevas demandas en esta fase.
Diseño
Estudio observacional, descriptivo.
Emplazamiento
Consultas de atención primaria.
Participantes
Treinta y siete residentes de medicina de familia de tercer año y 307 pacientes con problemas incidentes.
Material y método
Todas las consultas fueron videograbadas y analizadas por dos observadores entrenados que usaron protocolos establecidos ad hoc previamente validados.
Resultados
Los residentes realizaron recibimientos y cierres de consulta muy breves y comunicativamente muy pobres ya que emplearon muy pocas habilidades relacionales. La mitad de los médicos redirigen muy precozmente el discurso inicial del paciente (en 16 s) y esto se asoció significativamente (p = 0,03) a nuevas demandas del paciente en el momento del cierre y con despedidas más prolongadas (p = 0,001).
Conclusiones
La conducta de los residentes en los instantes estudiados seguramente limita su capacidad para establecer y mantener la relación clínica, obtener información y aclarar la que dan a los pacientes. Los cierres disfuncionales son más probables cuando el médico tiene conductas dominantes muy precozmente; estas conductas no acortan las entrevistas.
Palabras clave: Formación médica, Relación médico-paciente, Entrevista clínica
Abstract
Objectives
To describe the communicative behaviour by residents at the beginning (reception and first seconds after obtaining information) and closing of the consultation and to evaluate in what way very early interruptions in the patient monologue affect within-consultation results, such as the duration of their closing and the appearance of new concerns in this phase.
Design
Descriptive observational study.
Location
Primary care clinics.
Participants
Thirty seven third year residents of family medicine and 307 patients with incidental problems.
Material and method
All the consultations were videotaped and analysed by 2 trained observers who used previously validated established ad hoc procedures.
Results
The reception and closing of the consultations by the residents were very short and very poorly communicated since they used very few relational abilities. Half of the doctors redirected the initial discourse of the patient very early on (in 16 sec) and this was significantly associated (P=.03) with new concerns by the patient at the time of closing and with longer goodbyes (P=.001).
Conclusions
The conduct of the residents in the moments studied surely limits their ability to establish and maintain a clinical relationship, to obtain information and explain what they are giving to the patients. The dysfunctional closures are most probable when the doctor assumes a dominant role very early: this behaviour does not shorten the consultations.
Key words: Physician-patient relationship, Primary care, Trainees, Consultation closure
Footnotes
Este trabajo ha sido financiado gracias a una ayuda de investigación de la Consejería de Salud de la Junta de Andalucía (Expte. 278/03) y otra de la SAMFYC (Andaluza) 2003.
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