Identifying existential concerns as an analytical tool: an eye-opener for the doctor.

Existential concerns manifest themselves emotionally in patients. Emotions tend to be transferred between patient and doctor but the underlying existential concerns may remain hidden and obscure for both. If doctors understand that there are always existential concerns behind patients' inquiries it becomes easier to relate to the patient's feelings in an interested and curious way. Ultimately this benefits both doctors and patients. We have observed five existential human concerns leads to strong emotions (1. death, 2. thrown-ness, 3. aloneness, 4. choosing (the imperative of choice) and 5. meaninglessness (the absence of objective meaning).

Helping doctors to improve the 'Patient's Part' of consultation using the 'Macro-Micro Supervision' teaching method.

A doctor-patient consultation can be viewed as consisting of three parts: Patient's Part, Doctor's Part and Shared Part. Macro-Micro Supervision is a teaching method developed to train doctors in consultation techniques for the initial Patient's Part and to become more patient-centred. Doctors find the Patient's Part of our consultation method the most difficult. Macro-Micro Supervision is used when groups review video-recorded role-plays of real consultations or of simulated consultations, where participants alternate between playing doctor and patient. It can also be used in one-to-one supervision.

Developing communication skills for the general practice consultation process.

Medical curriculum revisions all over the world in the last 20 years have increased the number of teaching hours in communication skills. This article describes a concrete communication skills teaching programme focused on general practice. Since the spring of 1992, more than 2,000 physicians from Denmark, Sweden and Finland have attended courses within this programme in Kalymnos, Greece. The training mainly takes place in groups of 8 doctors and 1 supervisor. The skills training is based on video feedback using the Window Supervision Method described here. We have identified several classical pitfalls for the doctor which this training programme seeks to address. We have also defined the 9 steps in an effective consultation process, which are given the acronym PRACTICAL. The major issue is to discriminate between the patient's, the doctor's and the shared part of the communication process. In our experience, this model shortens the consultation time to c. 15 minutes as doctors collaborate with their patients and build up an agreed agenda in order to deal effectively with the main problems of the patients.

[Supervision--why?]. / Supervision--hvorfor?

In their work, doctors are exposed to strong emotions on the part of their patients. They need to learn to listen and not interrupt them; in general, after each consultation they focus on whatever was not accomplished. Therefore doctors need a secure environment in which they can examine common work conditions, as well as their own strengths and weaknesses, with colleagures in order to discover new ways of doing things. Based on this observation, it is a very positive development that supervision has become a part of the new specialist training for general practice.