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

The Doctor,

the Task and the Group

Balint Groups as a Means of Developing New Understanding in the Physician-Patient Relationship

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

But -

It keeps you going

and

it wears you out

Problems:

Overworked and tired GPs, who are frustrated and confused about their role

This may lead to burn-out

Many consider early retirement

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

More problemsThe 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?

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

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)

49 VAS-questions, 3 examples:49 VAS-questions, 3 examples:

• 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

• Can you take your coffee break every day? _______________________________________________________________________

0 1 2 3 4 5 6 7 8 9 10No, never Yes, always

• Do you find patients with psychosomatic problems a time-consuming burden?

______________________________________________0 1 2 3 4 5 6 7 8 9 10Yes No

* **

* **

***

Results

Experienced Balint doctors compared to reference group

02468

10Workload

Health*

Satisfaction***

Control***

Training***

Co-operation**

Quality*

Psychosomatic***

Balint > 1.5 years n=12

Reference group n=21

Validity of the reference group

0

2

4

6

8

10Workload

Health

Satisfaction

ControlTraining

Co-operation

Quality

Working environment study

Referencegroup

Validity

Results 0

2

4

6

8

10

Reference group, n=21

Balint < 1.5 years, n=5 Balint > 1.5 years, n=12

Mean of all questions,change by time in Balintgroup

***

Informants and method study 29 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)

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

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?

Could this alsobe a member of a Balint group?

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

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)

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