Why do clinics not follow the same code of practice?

1. Why do clinics not follow the same code of practice? Loni Ledderer Research Unit of General Practice, Institute of Public Health, University of Southern Denmark lledderer@health.sdu.dk. Loni Ledderer

2. Existing Interventions focus on • Medical treatment • New technology • Clinical procedures Existing Interventions neglect • Cultural rules • Collective meaning Loni Ledderer

3. Rules and interaction about • Receptionist’s duties • The consultation routine • Blood tests Give collective meaning to medical practice Loni Ledderer

4. Preventive Health Project 2005-2006 10 general practices Voluntary participation Motivational Interviewing (MI) Organizing MI into patient care

5. The resources in the clinic. • Consultation room • Appointment system • Trained staff Loni Ledderer

6. Medical assessment We have to be physicians; we form an estimate of biochemical profile from patients’ blood test….. We shall devote our time to the sick people. (clinic 4, GP) Talk I ask patients about their motives, what is valuable to them, try to figure out, what they think is most important. I also inquire about the reason for the decision they have made to visit the clinic, what kind of behavior change they expect to obtain... (Clinic 10, nurse) Loni Ledderer

7. Producing variation in medical practices Biomedical approach Psychological approach Loni Ledderer

8. Conclusion Variation in clinics’ understanding of new interventions produces substantial variation in the form of health service offered to patients. Loni Ledderer

9. Implication Change in medical practice depends on healthcare organizations’ ability to put forward a new collective meaning to what is considered an appropriate health service. • No intervention fits equally into every clinic • Purely technical, instrumental and practical issues are inadequate Loni Ledderer