Objectives To investigate the circumstances, manner and extent of physical examination of the lungs in adults by general medical practitioners (GPs) in the United Kingdom. Methods National Health Service research ethics committee approval was obtained. Three phases of research were undertaken. The first phase was exploratory, in which GPs responded to a series of questions using electronic voting handsets. There followed a sequence of qualitative interviews in which GP opinion was sought in greater depth. The interview transcripts were analysed thematically, with the aid of Atlas software. Finally an online Delphi study was undertaken, in which the themes that had developed in the previous phases were developed and discussed, with the aim of achievinq consensus. Results A total of 66 GPs took part in the study. GPs conducted physical examination principally to reassure patients: the diagnostic value of examination was secondary. History and first impressions were more important diagnostic tools. There was an unquestioned assumption that patients visited GPs because they wanted to be examined. The extent of the examination depended largely on whether the patient appeared ill, but was influenced by a wide range of other factors. Most GPs would usually examine the patient's chest if there was a cough, but there was a range of responses. The chance of this examination increased with the duration of symptoms, and if there was fever, dyspnoea or any adverse history. Conclusions The principal reasons that GPs examine the lungs are to reassure patients, assist in detecting pneumonia, avoid complaints and confrontation, and justify not prescribing antibiotics. The untested assertion, that patients attend to be examined, could be explored as a modification of clinical method, that includes a discussion with patients about their expectations and reassurance needs, prior to commencing physical examination. There are potential implications for undergraduate and postgraduate education.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:579528 |
| Date | January 2011 |
| Creators | Lord, John Robert |
| Publisher | University of Leeds |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
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