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Objective: To explore general practitioners' experiences and reflections on how the current Norwegian guideline for screening for gestational diabetes affects their clinical practice. Design: A qualitive study in which data were collected through semi-structured focus group interviews and analyzed thematically. Setting and subjects: Five focus groups conducted in 2020 among GPs in Norway; three interviews took place face-to-face and two were held digitally. The total number of participants was 31. Results: GPs acknowledged the potential benefits of more extensive screening, but had concerns about the medicalization of pregnancy, stating that some women experienced considerable anxiety. The GPs expressed doubts about the guideline's evidence base but differed in how they interpreted what the guideline was asking them to do. Some offered eligible women the opportunity to be screened, while other set up a screening appointment without consulting the women first. For some, fear of incrimination made them recommend screening without being convinced that it was the right thing for the patient. Conclusions: It is unclear whether the guideline for gestational diabetes requires GPs to recommend screening to pregnant women or if they should provide neutral information about the availability of screening. This ambiguity should be addressed, and the guideline evaluated against the core principles of general practice. KEY POINTS: The Norwegian guideline for gestational diabetes (2017) increased the proportion of pregnant women eligible for screening and spurred considerable debate. The GPs in this study expressed concerns about the lack of evidence and the consequences of screening more women for gestational diabetes. It is unclear to GPs whether they are required to recommend screening to pregnant women or just inform them of its availability. The guideline should be evaluated to better account for the benefits, burdens and costs of screening and any subsequent treatment. [ABSTRACT FROM AUTHOR]

Objective: Private health insurance is becoming more common in Norway. The aim of this study was to investigate GPs' opinions on private health insurance, and their experiences from consultations where health insurance can affect decisions about referring. Design: A web based cross-sectional survey. Setting: Norwegian general practice. Subjects: All GPs in Norway were in 2019 invited to participate in an online survey. Main outcome measures: The GPs' opinions and experiences regarding health insurance were reported as proportions. Multiple logistic regression was used to test associations between how frequently GPs refer patients without further considerations and variables concerning their characteristics, opinions, and experiences. Results: Of 1,309 GPs (response rate 27%), 93% stated that private health insurance raises the risk of overtreatment and 90% considered such insurance to contribute to inequality in health. Frequently being pressured to refer in the absence of a medical indication was reported by 42%. Moreover, 28% often or always chose to refer patients without further consideration, and this was associated with perceptions of pressure with an adjusted odds ratio (AOR) of 3.80, 95% confidence interval (CI) 2.73–5.29, and unpleasant reactions from patients following refusals (AOR 1.63, 95% CI 1.14–2.33). Conclusion: Although most participating GPs associated private health insurance with overtreatment and inequality in health, more than one in four choose to refer without further consideration. GPs' experience of pressure to refer and negative reactions from patients when they consider referrals not to be medically indicated, raises the risk of medical overuse for patients holding private health insurance. KEY POINTS: Although most GPs had negative opinions regarding private health insurance, more than one quarter frequently referred insurance holders without further considerations. Perceived pressure and negative reactions from patients were associated with accommodating requests rather than acting as a gatekeeper. Private health insurance challenges the gatekeeping role of GPs in Norway and raises the risk of medical overuse. [ABSTRACT FROM AUTHOR]

To explore how stakeholders in depression care view intersectoral collaboration and work participation for workers with depression. Focus group study applying reflexive thematic analysis using a salutogenic perspective. We conducted seven focus group interviews in six different regions in Norway with 39 participants (28 women); three groups consisted of general practitioners (GPs), two of psychologists and psychiatrists and two of social welfare workers and employers (of which one group also included GPs). Stakeholders considered work participation salutary for most workers with depression, given the right conditions (e.g. manageable work accommodations and accepting and inclusive workplaces). They also highlighted work as an integral source of meaningfulness to many workers with depression. Early collaborative efforts and encouraging sick-listed workers to stay connected to the workplace were considered important to avoid long and passive sickness absences. Furthermore, stakeholders' views illuminated why intersectoral collaboration matters in depression care; individual stakeholders have limited information about a worker's situation, but through collaboration and shared insight, especially in in-person collaborative meetings, they (and the worker) can gain a shared understanding of the situation, thereby enabling more optimal support. Ensuring adequate information flow for optimal and timely follow-up of workers was also emphasized. Stakeholders highlighted the salutary properties of work participation for workers with depression under the right conditions. Intersectoral collaboration could support these conditions by sharing insight and knowledge, building a shared understanding of the worker's situation, assuring proper information flow, and ensuring early and timely follow-up of the worker. [ABSTRACT FROM AUTHOR]

Introduction: Little is known about the indications general practitioners (GPs) perceive as relevant for performing gynaecological examinations (GEs), how GPs master the GE and associated procedures, and how they handle the sensitive nature of GEs. Methods: In 2015, 70 medical students at the University of Bergen distributed a questionnaire to all 175 GPs in the practices they visited. The questions covered practical routines related to GEs, insertion of intrauterine device, frequency of GEs in different clinical settings and use of assisting personnel. Statistical analyses included chi-square tests and multiple logistic regressions adjusting for age, gender, specialization and localization. Results: Ninety male and 61 female GPs (87% of invited GPs) responded to the questionnaire. A minority (8%) usually had other staff present during GEs. Compared with female colleagues, male GPs performed bimanual palpation significantly less often in connection with routine Pap smear (AOR 0.3 (95% CI 0.1-0.6)). Twenty-eight percent of the GPs stated that they often/always omitted the GE if the patient was anxious about GE and 35% when the patient asked for referral to a gynaecologist. Omission was more frequent among male GPs. When the GP decided to refer to a gynaecologist based on the patient's symptoms, more male than female GPs omitted GE (AOR 2.5 (95% CI 1.1-5.4)). Conclusion: Male gender of the GP may be associated with barriers to medical evaluation of pelvic symptoms in women, potentially leading to substandard care. Possibly, however, male GPs' reluctance to perform the GE may also limit unnecessary bimanual palpation in asymptomatic women. [ABSTRACT FROM AUTHOR]

The attraction of human genetics is rooted in optimistic projections of possible futures, where present-day problems are to be solved by technologies-to-come. But hyperbolic optimism with its consequent cycles of expectations, investment and disappointment is a threat to users, investors, and the ethical reputation of the biotechnology field. We report a study of the entire news coverage of genetics in Icelandic mass media in 2000 and 2004. All media promoted optimistic industry-based information largely without critical questions concerning scientific uncertainty, health benefits, or ethical challenges. Criticism and deliberation were thematically narrowed down, in 2000 to the issue of “presumed consent” for nationwide participation in a database proposed by the company Decode genetics, and in 2004 to topics concerning Decode's finances. In a discourse of monetary gain and loss, sustained exploration of scientific, moral and cultural issues has little appeal. [ABSTRACT FROM AUTHOR]

Background: Traditional preclinical curricula based on memorization of scientific facts constitute learning environments which may negatively influence both factual understanding and professional identity development in medical students. Little is known of how students themselves experience and interpret such educational milieus.Objective: To investigate first-year medical students' view of the physician role, and their perception of the relevance and quality of teaching in a science-based preclinical curriculum. Design: Focus group interviews with thematic text analysis. Results: Students portrayed the good physician as communicative, humble, and open, combining biomedical knowledge and moral strength. When asked how medical school supported the development of such characteristics, two partly contradictory discourses emerged. The critical discourse identified decontextualized knowledge, poor pedagogy, lack of critical thinking, and contact with faculty. Students who voiced critical comments also articulated trust that the system would provide the competence they needed, that basic biological knowledge is needed before clinical practice, and that being on your own conveys freedom and responsibility, and helps you grow up. Conclusion: Trust in the educational system, within a substandard learning environment, created cognitive dissonance that students resolved through rationalization, whereby they negated that factual overload and lack of relevance, reflection, and personal feedback was problematic. The cost of this mechanism is possibly that inferior teaching is perceived as normal, necessary, and good enough. If so, these future physicians' ability to critically evaluate and create quality in medical education and practice, may be weakened. [ABSTRACT FROM AUTHOR]