Una experiencia de grupo de reflexión para el manejo de entrevistas clínicas difíciles / A reflection group’s experience in handling hard clinical encounters

Fundamento. Se presenta la experiencia de un grupo de reflexión para valorar si la metodología llevada a cabo, ayuda a los profesionales sanitarios a entenderlos encuentros difíciles (ED), a mejorar su satisfacción profesional y la comunicación con el paciente. Material y método. Se siguió una metodología de reestructuración cognitiva con registro escrito para analizar, primero individualmente, los ED con los pacientes y comentarlos luego en el grupo de reflexión. Resultados. Los ED se referían principalmente a: solicitudes vividas como inapropiadas, cuestionamiento de competencia profesional, y cambio inesperado de médico. Las emociones surgidas, antes y después de “volver a pensar”, cambiaron de intensidad de forma significativa (p<0,001). Los pensamientos irracionales se agruparon en 9 tipos de distorsiones cognitivas, siendo las más frecuentes “razonamiento emocional” y “falacias de control”. Las pautas explicativas constructivas que surgieron después de “volver a pensar”, en su mayoría estaban relacionados con la necesidad de mejorar la comunicación. El grupo reconoció muchas aportaciones positivas. Ni las encuestas utilizadas para valorar el desgaste profesional (MBI), ni la encuesta diseñada para la evaluación, presentaron diferencias significativas, comparando al inicio y final del trabajo. Conclusiones. El empleo conjunto de una metodología cognitivo-conductual en el marco de un grupo de reflexión, se complementan mutuamente, y posibilitan el trabajo engrupo sin precisar un conductor profesional. La reflexión escrita y el trabajo con los pensamientos irracionales y “volver a pensar” con la perspectiva de comentarlo en el grupo, es una experiencia aplicable en el contexto de Atención Primaria y ayuda al manejo de los encuentros difíciles (AU)

Background. We present the experience of a reflection group to evaluate whether the methodology carried out helps health professionals to understand difficult encounters and improve their professional satisfaction and communication with the patient. Method. We followed a cognitive restructuring methodology with a written record in order to analyze difficult encounters with patients, first individually and then followed by comments in the reflection group. Results. Difficult encounters mainly involved: requests felt to be inappropriate, questioning of professional competence, and unexpected change of doctor. The emotions arising, before and after “rethinking”, changed in intensity in a significant way (p<0.001). Irrational thoughts were grouped in 9 types of cognitive distortions, with the most frequent being “emotional reasoning” and “control fallacies”. The majority of constructive explanatory patterns that emerged after “rethinking” were related to the need for improving communication. The group recognized many positive contributions. Neither the surveys used to evaluate occupational burnout, nor the survey designed for the evaluation showed significant differences, comparing the beginning and end of the work. Conclusions. The joint use of a cognitive-behavioral methodology in the framework of a reflection group is mutually complementary, and enables group work without the need for professional direction. Written reflection and work with irrational thoughts and “rethinking” with the perspective of group comment is an experience that is applicable in the context of Primary Care and helps in handling difficult encounters (AU)

[A reflection group's experience in handling difficult clinical encounters]. / Una experiencia de grupo de reflexión para el manejo de entrevistas clínicas difíciles.

BACKGROUND: We present the experience of a reflection group to evaluate whether the methodology carried out helps health professionals to understand difficult encounters and improve their professional satisfaction and communication with the patient. METHOD: We followed a cognitive restructuring methodology with a written record in order to analyze difficult encounters with patients, first individually and then followed by comments in the reflection group. RESULTS: Difficult encounters mainly involved: requests felt to be inappropriate, questioning of professional competence, and unexpected change of doctor. The emotions arising, before and after "rethinking", changed in intensity in a significant way (p<0.001). Irrational thoughts were grouped in 9 types of cognitive distortions, with the most frequent being "emotional reasoning" and "control fallacies". The majority of constructive explanatory patterns that emerged after "rethinking" were related to the need for improving communication. The group recognized many positive contributions. Neither the surveys used to evaluate occupational burnout, nor the survey designed for the evaluation showed significant differences, comparing the beginning and end of the work. CONCLUSIONS: The joint use of a cognitive-behavioral methodology in the framework of a reflection group is mutually complementary, and enables group work without the need for professional direction. Written reflection and work with irrational thoughts and "rethinking" with the perspective of group comment is an experience that is applicable in the context of Primary Care and helps in handling difficult encounters.