Medical errors and uncertainty in primary healthcare: a comparative study of coping strategies among young and experienced GPs.

OBJECTIVE: To study coping differences between young and experienced GPs in primary care who experience medical errors and uncertainty. DESIGN: Questionnaire-based survey (self-assessment) conducted in 2011. SETTING: Finnish primary practice offices in Southern Finland. SUBJECTS: Finnish GPs engaged in primary health care from two different respondent groups: young (working experience ≤ 5 years, n = 85) and experienced (working experience > 5 years, n = 80). MAIN OUTCOME MEASURES: Outcome measures included experiences and attitudes expressed by the included participants towards medical errors and tolerance of uncertainty, their coping strategies, and factors that may influence (positively or negatively) sources of errors. RESULTS: In total, 165/244 GPs responded (response rate: 68%). Young GPs expressed significantly more often fear of committing a medical error (70.2% vs. 48.1%, p = 0.004) and admitted more often than experienced GPs that they had committed a medical error during the past year (83.5% vs. 68.8%, p = 0.026). Young GPs were less prone to apologize to a patient for an error (44.7% vs. 65.0%, p = 0.009) and found, more often than their more experienced colleagues, on-site consultations and electronic databases useful for avoiding mistakes. CONCLUSION: Experienced GPs seem to better tolerate uncertainty and also seem to fear medical errors less than their young colleagues. Young and more experienced GPs use different coping strategies for dealing with medical errors. IMPLICATIONS: When GPs become more experienced, they seem to get better at coping with medical errors. Means to support these skills should be studied in future research.

Family physician experiences with and needs for clinical supervision: Associations between work experiences, professional issues and social support at work.

OBJECTIVE: To explore how work experiences, professional issues and social support at work are associated with a need for clinical supervision (CS) among family physicians (FP). METHODS: Web-based survey to FPs in Finland 2011 (response rate 68%; n=165). RESULTS: Among FPs, 36% needed CS, 35% had experience with CS, and 29% did not need CS. Feeling emotionally drained from work was associated with both needing and experience with CS. FPs needing CS felt callous and had committed a medical error in the recent past more often than those with CS experience. FPs expressing a need for CS felt greater uncertainty regarding their professional knowledge and more alone at work than FPs not needing CS. Rewarding work experiences were common. CONCLUSIONS: A large proportion of FPs expressed a need for CS. Need for CS is associated with feeling alone at work, experiences of callousness and uncertainty regarding medical knowledge. Experience of emotional drainage was associated with experience of and need for CS. PRACTICE IMPLICATIONS: Emotional drainage may signal a need for CS among FPs. CS might enhance FPs' emotional well-being at work. It should be more widely available to FPs and could be integrated into continuing professional development.

Tolerance of uncertainty and fears of making mistakes among fifth-year medical students.

BACKGROUND AND OBJECTIVES: Tolerance of uncertainty is an important skill among general practitioners (GPs). Our aim was to study fifth-year medical students' feelings related to facing uncertainty and fears of making mistakes in medical decisions. Further, we studied the associations of intolerance of uncertainty with demographic factors, the students' fears of making mistakes, and their views of a GP's work prior to their ultimate course in general practice. METHODS: A questionnaire-based survey was carried out among the fifth-year medical students prior to their main course in general practice at the University of Helsinki. The questionnaire included demographic variables and inquired about their views of their own tolerance of uncertainty, fear of making mistakes, and of a GP's work overall. RESULTS: During the years 2008--2010, 307/359 medical students (mean age 25.7 years, 64% females) responded. Of the respondents, 22% felt they had difficulty tolerating uncertainty when making medical decisions. Females reported that they tolerated uncertainty poorly more often (27%) than did males (11%). Those tolerating uncertainty more poorly were more often afraid of making mistakes (100% versus 86%). This group more often considered a GP's work too difficult and challenging than did others. CONCLUSIONS: Poor self-reported tolerance of uncertainty among medical students is associated with considering a GP's work too challenging.

Inflammation markers and malnutrition as risk factors for infections and impaired health-related quality of life among older nursing home residents.

OBJECTIVES: To explore malnutrition and inflammation markers as risk factors for poor outcome such as infections and impaired health-related quality-of-life (HRQoL) among nursing home residents. DESIGN: Prospective study lasting 8 months. SETTING: Three nursing homes in Helsinki, Finland, in 2003. PARTICIPANTS: Sample 1 included 199 residents whose Mini Nutritional Assessment (MNA) scores and complete follow-up records concerning infections and mortality were available, and Sample 2 included 55 patients (subsample) whose data concerning laboratory values, HRQoL, and infections during the 8 months follow-up period were available. MEASUREMENTS: At baseline all residents were interviewed with a structured questionnaire consisting of demographic characteristics, activities of daily living (ADL), MNA, and 15D HRQoL instrument. Blood samples were drawn at baseline (hsCRP, IL-10, TNF-alfa,TGF-beta 1,WBC) and during follow-up if infections arose (CRP). Data concerning infections and mortality during the 8-month follow-up were collected. RESULTS: In the whole study group (N=199), malnutrition according to the MNA (<17, n=79) was associated with poor outcome (a serious infection and/or death) during 8 months follow-up compared with those not malnourished according to the MNA (>17, n=120) (30.4% versus 14.2%, P=.006). However, MNA score below 17 did not predict infections in the subsample (n=55). The mean age of residents in subsample was 83 years, 44 (80%) were women. Those with MNA below 17 (n=18) did not differ from others (MNA>17, n=37) with respect to age, gender, ADL-functioning, cognition, or inflammatory markers. The group with MNA below 17 had significantly lower HRQoL according to the 15D both at baseline and at 8 months. During the 8-month follow-up, subsample residents in the highest quartile of hsCRP at baseline (>4.38 mg/L, n=13) had more infections than residents in lower quartiles (<4.38 mg/L, n=42). None of the other inflammation markers were associated with the number of infections or with HRQoL. CONCLUSION: Malnutrition according to the MNA and hsCRP may be used as markers to flag nursing home residents at risk for poor outcome.