Physician-Patient Relations

Despite increasing calls for shared decision making (SDM), the precise mechanisms for its attainment are unclear. Sharing decisions in mental health care may be especially complex. Fluctuations in service user capacity and significant power differences are particular barriers. We trialled a form of facilitated SDM that aimed to generate patients' treatment preferences in advance of a possible relapse. The 'Joint Crisis Plan' (JCP) intervention was trialled in four mental health trusts in England between 2008 and 2011. This qualitative study used grounded theory methods to analyse focus group and interview data to understand how stakeholders perceived the intervention and the barriers to SDM in the form of a JCP. Fifty service users with psychotic disorders and 45 clinicians participated in focus groups or interviews between February 2010 and November 2011. Results suggested four barriers to clinician engagement in the JCP: (i) ambivalence about care planning; (ii) percep...

Objectives: This study evaluates what type of patient prepares a birth plan, identifies common requests made, and determines how closely these are followed during labor. Methods: Patients who were admitted in labor with birth plans during a 3.5-year period ...

Medical Schools are challenged to improve palliative care education and to find ways to introduce and nurture attitudes and behaviours such as empathy, patient-centred care and wholistic care. This paper describes the curriculum and evaluation results of a unique course centred on palliative care decision-making but aimed at introducing these other important competencies as well. The 20 h-long optional course, presented in an art museum, combined different learning methods, including reflections on art, case studies, didactic sessions, personal experiences of faculty, reflective trigger videos and group discussions. A mixed methods approach was used to evaluate the course, including a) a post-course reflective exercise; b) a standardized evaluation form used by the University for all courses; and c) a focus group. Twenty students (2nd to 6th years) participated. The course was rated highly by the students. Their understanding of palliative care changed and misconceptions were dispel...

Respect for autonomy is well known as a core element of normative views on good care. Most often it is interpreted in a liberal way, with a focus on independence and self-determination. In this article we argue that this interpretation is too narrow in the context of care in nursing homes. With the aim of developing an alternative view on respect for autonomy in this setting we described four interpretations and investigated the moral intuitions (i.e. moral judgements) of caregivers regarding these approaches. We found that these caregivers seemed to value different notions relating to respect for autonomy under different circumstances. There was no significant difference in moral judgements between men and women or between doctors and nurses. We conclude that a multidimensional understanding of this principle would best fit this context. We end this article with a description of a modest theory of respect for autonomy in nursing homes.

DIABETES CARE, VOLUME 21, NUMBER 9, SEPTEMBER 1998 ... gests that provider beliefs and attitudes, not knowledge deficits, are the major bar-riers to preventive screening practices in diabetes, and that medical training and CME must address these to be eff ective (9,10). ...

Job stress is common in health care professionals in the west. Less is known about its prevalence in Middle Eastern countries. To determine job stress, its sources and its effect on health care professionals in northern Jordan. A simple random sample of 101 physician specialists, 126 dentists, 52 general practitioners and 123 pharmacists in northern Jordan completed a socio-demographic questionnaire, the General Health Questionnaire, and addressed structured questions about job stress. Descriptive statistics and multivariate analyses were used to describe and compare participants, and a binary logistic regression was used to identify factors associated with stress and reported health problems. Of the 402 health care professionals, 27% reported high levels of stress. Prevalence was highest among general practitioners (33%), then dentists (30%) and pharmacists (25%). The lowest stress was among physician specialists (12%). Factors associated with the highest stress were being a genera...

Informed consent in medical practice is essential and a global standard that should be sought at all the times doctors interact with patients. Its intensity would vary depending on the invasiveness and risks associated with the anticipated treatment. To our knowledge there has not been any systematic review of consent practices to document best practices and identify areas that need improvement in our setting. The objective of the study was to evaluate the informed consent practices of surgeons at University teaching Hospitals in a low resource setting. A cross-sectional study conducted at three university teaching hospitals in Uganda. Self-guided questionnaires were left at a central location in each of the surgical departments after verbally communicating to the surgeons of the intention of the study. Filled questionnaires were returned at the same location by the respondents for collection by the research team. In addition, 20 in-depth interviews were held with surgeons and a rev...

Plastic, reconstructive, and cosmetic surgery refers to a variety of operations performed in order to repair or restore body parts to look normal or to enhance a certain structure or anatomy that is already normal. Several ethical considerations such as a patient’s right for autonomy, informed consent, beneficence, and nonmalfeasance need to be given careful consideration. The principal objective of

To explore the feelings and experiences of TB patients, and to highlight how TB stigma may affect case finding and compliance with treatment. Qualitative research approach using focus groups and individual interviews. Sekondi-Takoradi Metropolitan district, Ghana. Purposeful selection of TB patients receiving TB at four government hospitals in the district. None. Because of TB stigma, majority of the patients failed to recognise their symptoms as due to TB, and attributed it to malaria and ordinary cough. They reported to the hospital only after prolonged period of self-medication in the community, with some indicating multiple visits before a diagnosis was made. When diagnosed, some were worried and cried, questioned how they got the disease, contemplated committing suicide, and others doubted it was TB. Most of them hid the diagnosis from others, and were isolated within the family and community. Most TB patients failed to recognize their symptoms as due to TB, because of the stig...

The assessment of communication competence has become a major priority of medical educational, policy, and licensing organizations in the United States and Canada. Multiple tools are available to assess communication competence, but there are few studies that compare the tools. A consensus panel of six family medicine educators evaluated 15 instruments measuring the physician-patient interview. The primary evaluation criteria came from the Kalamazoo Consensus Statement (KCS), which derived from a multidisciplinary panel of experts that defined seven essential elements of physician-patient communication. We evaluated psychometric properties of the instruments and other assessment criteria felt to be important to family physicians (exploring family issues, interview efficiency, and usability/practicality). Instruments that received the highest ratings on KCS elements were designed for faculty raters and varied in their practicality/usability ratings and psychometric properties. Few in...

Purpose/Aims: The purpose of the study was to examine the reliability and validity of the Jefferson Scale of Physician Empathy: Health Provider – Student Version (JSE-HPS) when used with nursing students. In examining the psychometric properties of the scale, the present study expands upon past research by establishing the scale’s suitability for use with several new populations. Specifically, the demographically diverse student body of California State University, Fullerton and recent implementation of a Doctor of Nursing Practice program allows for the scale to be validated for use across a broader spectrum of student characteristics and program levels. Rationale: Nurses’ empathy levels are central to the provision of health care, with medical practitioners’ empathy reported to impact outcomes ranging from patient satisfaction to medical error rates. Despite the critical role of empathy for medical practitioners, research has shown that students’ empathy levels decrease over the c...

The stress of migration as well as social factors and changes related to the receiving society may lead to the manifestation of psychiatric disorders in vulnerable individuals after migration. The diversity of cultures, ethnicities, races and reasons for migration poses a challenge for those seeking to understand how illness is experienced by immigrants whose backgrounds differ significantly from their clinicians. Cultural competence represents good clinical practice and can be defined as such that a clinician regards each patient in the context of the patient's own culture as well as from the perspective of the clinician's cultural values and prejudices. The EPA Guidance on cultural competence training outlines some of the key issues related to cultural competence and how to deal with these. It points out that cultural competence represents a comprehensive response to the mental health care needs of immigrant patients and requires knowledge, skills and attitudes which can i...

Medical interviewing is the foundation of medical care and is the clinician's most important activity. A growing body of evidence suggests that clinicians use distinctive, describable behaviors to conduct medical interviews. This article describes four patterns of behavior that we term Habits and reviews the research evidence that links each Habit with both biomedical and functional outcomes of care. The Four Habits are: Invest in the Beginning, Elicit the Patient's Perspective, Demonstrate Empathy, and Invest in the End. Each Habit refers to a family of skills. In addition, the Habits bear a sequential relationship to one another and are thus interdependent. The Four Habits approach offers an efficient and practical framework for organizing the flow of medical visits. It is unique because it concentrates on families of interviewing skills and on their inter-relationships.

As part of our family medicine clerkship seminar on the patient-physician relationship, third-year students write about an illness episode within their own families. Using a grounded research approach, we examined 260 student narratives to extract the most significant meanings. Significant themes that emerged include the role of family members in illness episodes, specific influences resulting from the family's ethnicity or religion, experiences with socially unacceptable illnesses, experiences with death, appreciation of the moral trajectory of illness, and situations that display the fallibility and limitations of medicine. Writing exercises can help students recognize the centrality of narrative and of cultural values in medicine so they are better able to understand their patients and provide more patient-centered medical care.

W hile the patient's right to give informed consent to medical treat-ment is now well-established both in US law and in biomedical ethics, evidence continues to suggest that the concept has been poorly integrated into American medical practice, and that in many instances the ...

In a formal needs assessment, conducted prior to the Canadian Headache Society's recent national continuing education workshop, participants expressed particular enthusiasm for enhancing their own communication skills or their teaching of those skills. Responding to both interests, this paper offers a practical conceptual framework for thinking systematically about how to improve physician-patient communication to a professional level of competence. The three-part, evidence-based framework first defines communication in medicine in terms of five underlying assumptions about communication and the learning of communication skills. It then discusses three categories of communication skills (content, process, and perceptual skills) and six goals that physicians and patients work to achieve through their communication with each other. The second part of the framework explores "first principles" of effective communication and includes a brief look at the historical context t...

It is well known that nonwhite minority participation in clinical research is lower than their representation in the community. The goal of this study was to assess satisfaction of minority community members in Omaha with the care received and cultural competency of healthcare providers. We sought input from Omaha minority communities on how to improve the care they received and asked why they did not participate in healthcare research. Seventy-two minority members representing African Americans, Hispanic Americans, Native Americans, Sudanese, and Vietnamese; and eight whites were surveyed. The results of this study indicated that the majority of our respondents were satisfied with the care they received, but for a small percentage, language, communication and/or culture contributed to dissatisfaction. In addition, some respondents did not think the provider was culturally competent, i.e., not sufficiently knowledgeable about their racial, ethnic and/or cultural background. Some par...

Introduction Cancer care involves addressing patient emotion. When patients express negative emotions, empathic opportunities emerge. When oncologists respond with a continuer statement, which is one that offers empathy and allows patients to continue expressing emotions, rather than with a terminator statement, which is one that discourages disclosure, patients have less anxiety and depression and report greater satisfaction and adherence to therapy. We studied whether oncologist traits were associated with empathic opportunities and empathic responses. Patients and Methods We audio-recorded 398 clinic conversations between 51 oncologists and 270 patients with advanced cancer; oncologists also completed surveys. Conversations were coded for the presence of empathic opportunities and oncologist responses. Analyses examined the relationship with oncologists' demographics, self-reported confidence, outcome expectancies, and comfort to address social versus technical aspects of car...

Ethical problems routinely arise in the hospital and outpatient practice settings and times of dilemma do occur such that practitioners and patients are at cross-roads where choice and decision making become difficult in terms of ethics. This paper attempts a synopsis of the basic principles of medical ethics, identifies some ethical dilemmas that doctors often encounter and discusses some strategies to address them as well as emphasizes the need for enhanced ethics education both for physicians and patients particularly in Nigeria. Literature and computer programmes (Medline and PsychoInfo databases) were searched for relevant information. The search showed that the fundamental principles suggested by ethicists to assist doctors to evaluate the ethics of a situation while making a decision include respect for autonomy, beneficence, non-maleficence and justice. Although the above principles do not give answers as to how to handle a particular situation, they serve as a guide to doct...

Objectives To revise an existing three-talk model for learning how to achieve shared decision making, and to consult with relevant stakeholders to update and obtain wider engagement.Design Multistage consultation process.Setting Key informant group, communities of interest, and survey of clinical specialties.Participants 19 key informants, 153 member responses from multiple communities of interest, and 316 responses to an online survey from medically qualified clinicians from six specialties.Results After extended consultation over three iterations, we revised the three-talk model by making changes to one talk category, adding the need to elicit patient goals, providing a clear set of tasks for each talk category, and adding suggested scripts to illustrate each step. A new three-talk model of shared decision making is proposed, based on "team talk," "option talk," and "decision talk," to depict a process of collaboration and deliberation. Team talk plac...

This investigation offers a comprehensive analysis of the relative social prestige of various medical specialties. The specialties were evaluated in terms of ascribed esteem by a lay sample of 400 respondents. Several attributes were then tested in order to measure their contribution to ...

Consultation skills are essential for general practice. Tools for measuring consultation skills in everyday practice are not well developed To examine and develop the content validity of the MAAS History-taking and Advice Checklist GP (MAAS-GP) tool which is used in The Netherlands for testing consultation skills, with simulated patients in United Kingdom general practice from the perspectives of both general practitioners and patients. Qualitative research using semi-structured interviews. Alternate patients attending seven general practices in the north west of England. Thematic analysis of the contents of patient and GP interviews, and of focus groups, mapping key themes to the MAAS-GP. There was strong agreement between patients and GPs on issues mapping to 46 out of 68 items of the MAAS-GP. Eight further MAAS-GP items were linked to issues only raised by patients and four to issues raised only by GPs. The remaining 10 items could not be related to issues raised by either. All o...