Managing an Unhappy Patient

A clinical study has noted that one out of six patients is perceived as “difficult” by clinicians. Not surprisingly, patient dissatisfaction has to do with multiple factors, both within and outside the control of the surgeon. In the present times of electronic information and ratings, managing difficult patients is a critical skill—a patient's dissatisfactory review could adversely affect a practitioner's reputation built over years of meticulous practice. Patient expectations are often more pronounced in case of elective medical procedures such as hair transplants. The subject of managing an unhappy patient in the context of hair transplantation is, therefore, one that requires due enquiry and is the subject that this article seeks to explore.

Person-Centered Care Practice, Patient Safety Competence, and Patient Safety Nursing Activities of Nurses Working in Geriatric Hospitals

Geriatric nursing activities are closely related to patient safety; therefore, nurses’ efforts to improve patient safety in geriatric hospitals are important. In the present study, we investigated the relationships between person-centered care practice, patient safety competence, and patient safety during nursing activities in geriatric hospitals. We used the following tools to investigate the factors affecting patient safety during nursing activities: (a) the Korean version of the Person-Centered Care Assessment Tool (P-CAT), (b) the Patient Safety Competence Assessment Tool for Nurses, and (c) the Patient Safety Nursing Activities Assessment Tool for geriatric nurses. The questionnaire survey was completed by 186 geriatric nurses in 12 geriatric hospitals from 1 August to 31 August 2018. We analyzed the survey data using a t-test, one-way ANOVA, Pearson’s correlation coefficient, and multiple regression. We identified patient safety skills (β = 0.417, p < 0.001) and age (β = 0.209, p = 0.035) as key factors that influence patient safety during nursing activities. Therefore, to improve the quality of patient safety during nursing activities conducted by geriatric nurses, it is necessary to develop strategies to improve patient safety skills and expand the pool of competent nurses with clinical experience.

PHYSIATRY DURING COVID-19: A SURVEY BASED ANALYSIS

Introduction: The declaration of COVID 19 pandemic by WHO on 11th March 2020, is the dening global health crisis of the past 100 years. The following Nationwide survey was conducted to ascertain the sea changes this pandemic has brought in the physiatrist practice, patient management and preparing oneself to the challenges of rehabilitation in the POST COVID world. The survey covers the role and importance of social media in medical education and consultation in a POST COVID world. It also sheds light on the nancial implications and personal lifestyle changes that physiatrists are witnessing. A Google form comprising of 74 questions, divided in 3 se Material &Methods: ctions, was used to gather the requisite data on :- A) PRECOVID practice, management and lifestyle; B) Life during COVID pandemic; and C) Anticipated changes in POST COVID era. The survey was circulated to 400 physiatrist via various interactive groups who have been practicing either independently or in govt setups and associated hospitals nationwide. They were requested to submit their responses in a period of 30 days. In PRECOVID era an average Result: physiatrist was nely balancing his profession, personal lifestyle, learning and recreation. The LOCKDOWN clamped their practice which lead to nancial drought but hardly made a dent in productivity by engaging in webinars, reading and researching. The POST COVID time demands implementation of newer safety protocols like changes in setup, regulating the patient trafc, limiting daily procedures, engaging in distance learning through virtual conferences, maintaining a healthy lifestyle and constructing proper protocols for pulmonary, neurological and musculoskeletal rehabilitation programs for patients post recovery from COVID19, especially the patients weaning from ventilators. Conclusion: The effect of COVID19 demands major change in physiatrist professional practice like limiting consultation, following safety protocols, COVID testing, preparing consolidated program for POSTCOVID sequel. Social media is rightly poised to be a major tool for education, consultation, marketing and awareness. The role of teleconsultation needs to be reprised, recognised and regularised. Webinars and virtual conferences will nd more takers in future.

P012 Raynaud's phenomenon: a primary care problem?

Background/Aims Despite an established awareness of Raynaud’s phenomenon (RP), defined as an episodic vasospasm of the arteries in the extremities, no studies have yet described the way in which the phenomenon is assessed and managed within a primary care setting. The primary aim of this study is to evaluate the way in which Raynaud’s Phenomenon commonly presents, is investigated, and managed within a UK general practice (GP); auditing concordance with the National Institute for Health and Care Excellence (NICE) Clinical Knowledge Summary (CKS) 2020 guidance. Methods An audit of 79 patients with a coded diagnosis of RP was completed at Green Lane Medical Centre, a Merseyside General Practice. Patient care was audited against standards within the NICE CKS. Results The patient group was comprised of 53 females (67.1%) and 26 males (32.9%). 89.9% (71/79) of patients have a working diagnosis of primary RP. Patient age at the time of audit: 4% aged 0-18; 29% aged 19-45; 30% aged 46-60; 37% aged 60+. 59.5% (47/79) of patients had 2 or more troubling symptoms of RP documented by their GP, with 12.7% (10/79) describing a classic triphasic colour change. Examination findings were documented for 55.7% (44/79) of patients and 27.9% (22/79) received an autoantibody screen. 26.6% (21/79) of patients were referred to secondary care, with 42.9% (9/21) of these referrals specifying an intention to rule out Secondary RP. Documentation available regarding patient management indicated that conservative advice was provided to 62.5% (40/64) of patients, the most common being a patient information sheet (26/64). Medical management was offered to 39.1% (25/64) of patients but was declined by 24.0% (6/25) of those to whom it was offered, with most (16/19) patients who were commenced on medical therapy discontinuing by the time of audit. In secondary care, 81.0% (17/21) of referred patients had further investigations, 57.1% (12/21) received reassurance before or after the investigations and conservative advice was the most common management. Conclusion This study suggests that GPs play a major role in the assessment and management of patients with RP; 73.4% (58/79) of patients were not referred to secondary care. Of those that were referred, the majority were due to worsening or severe symptoms, or suspected secondary RP, in line with the CKS guidance. Most patients present with 2 or more of the symptoms described in the NICE CKS guidance and the use of examination and screening blood tests in primary care appears to be the mainstay of assessment. In accordance with the CKS guidance, most patients are provided with information and lifestyle advice. High rates of medical therapy discontinuation suggest that assessment of severity of symptoms and improved patient education of medication side effects may play a role in determining the most appropriate candidates for medical therapy. Disclosure K.E. Winstone: None. M.E. Anderson: None. A.E. Stickland: None.

Sociodemographic inequalities in patients’ experiences of primary care: an analysis of the General Practice Patient Survey in England between 2011 and 2017

Objective Younger people, minority ethnic groups, sexual minorities and people of lower socioeconomic status report poorer experiences of primary care. In light of NHS ambitions to reduce unwarranted variations in care, we aimed to investigate whether inequalities in patient experience of primary care changed between 2011 and 2017, using data from the General Practice Patient Survey in England. Methods We considered inequalities in relation to age, sex, deprivation, ethnicity, sexual orientation and geographical region across five dimensions of patient experience: overall experience, doctor communication, nurse communication, access and continuity of care. We used linear regression to explore whether the magnitude of inequalities changed between 2011 and 2017, using mixed models to assess changes within practices and models without accounting for practice to assess national trends. Results We included 5,241,408 responses over 11 survey waves from 2011–2017. There was evidence that inequalities changed over time (p < 0.05 for 27/30 models), but the direction and magnitude of changes varied. Changes in gaps in experience ranged from a 1.6 percentage point increase for experience of access among sexual minorities, to a 5.6 percentage point decrease for continuity, where experience worsened for older ages. Inequalities in access in relation to socio-economic status remained reasonably stable for individuals attending the same GP practice; nationally inequalities in access increased 2.1 percentage points (p < 0.0001) between respondents living in more/less deprived areas, suggesting access is declining fastest in practices in more deprived areas. Conclusions There have been few substantial changes in inequalities in patient experience of primary care between 2011 and 2017.