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Sample records for doctors missing patients

  1. Adequate doctor - patient communication

    Directory of Open Access Journals (Sweden)

    Janković Slobodan

    2013-01-01

    Full Text Available Communication process gives to physician necessary information for establishing diagnosis and prescribing therapy, and helps to a patient to gain confidence in his doctor and the prescribed treatment. The communication between doctor and his patient is enhanced by the following: openness and conscientiousness of the physician, serious approach to the patient, participation of the patient in decision-making, advanced age and higher education of the patient. On the other hand, communication is less efficient if the doctor has longer employment status, if he/her avoids disclosure of all relevant information to the patient, if he/her is emotionally separated from the patient, if the time for an encounter is limited, if the patient is passive and with unrealistic expectations, and if the doctor is expressing himself/herself unclearly. In order to improve communication with patients, doctors should follow these recommendations: keeping eye contact with a patient, releasing tension from his/her body language, taking detailed patient history with active listening and without interrupting of a patient, speaking clearly and slowly, using language understandable to a patient, treating patients with equality, disclosing all relevant information to the patient and sharing decisionmaking with the patient. Adequate communication between doctor and patient always brings better treatment outcomes.

  2. [Patients, doctors and the internet].

    Science.gov (United States)

    Jeannot, Jean Gabriel; Bischoff, Thomas

    2015-05-13

    The majority of the Swiss population uses the internet to seek information about health. The objective is to be better informed, before or after the consultation. Doctors can advise their information-seeking patients about high quality websites, be it medical portals or websites dedicated to a specific pathology. Doctors should not see the internet as a threat but rather as an opportunity to strengthen the doctor-patient relationship.

  3. [Patients' rights--doctors' duties].

    Science.gov (United States)

    Jaeger, L; Bertram, E; Grate, S; Mischkowsky, T; Paul, D; Probst, J; Scala, E; Wbllenweber, H D

    2015-06-01

    On 26 February 2013 the new "Law on Patients' Rights" (hereinafter also the "Law") became effective. This Law strengthens patients' rights vis-à-vis the insurdnce company and also regulates patients' rights regarding their relation to the doctor. This has consequences for the laws on medical liability all doctors must consider. The doctor's performance is and remains a service and such service does not hold any guarantee of success. Nevertheless, this Law primarily reads as a "law on the duties of physicians". To duly take into account these duties and to avoid mistakes and misinterpretation of the Law, the Ethics Committee of the Consortium of Osteosynthesis Trauma Germany (AOTRAUMA-D) has drafted comments on the Law. Brief summaries of its effects are to be found at the end of the respective comment under the heading "Consequences for Practice". The text of the law was influenced particularly by case law, as continuously developed by the German Federal Court of Justice ("BGH"). The implementation of the Law on Patients' Rights was effected by the newly inserted sections 630a to 630h of the German Civil Code (the "BGB"), which are analysed below. The following comments are addressed to physicians only and do not deal with the specific requirements and particularities of the other medical professions such as physiotherapy, midwifery and others so on. Special attention should be paid to the comments on the newly inserted Duty to inform, which has to be fullfilled prior to any diagnostic or therapeutic procedure (sec. 630c para 2 sentence 1 BGB). Under certain conditions the doctor also has to inform the patient about the circumstances that lead to the presumed occurance of a therapeutic or diagnostic malpractice (sec. 630c para. 2 sentence 2 BGB), based on the manifestation of an undesired event or an undesired outcome. As before, the patient's valid consent to any procedure (sec. 630d BGB) is directly linked to the comprehensive and timely provision of information

  4. Masculinity in the doctor's office: Masculinity, gendered doctor preference and doctor-patient communication.

    Science.gov (United States)

    Himmelstein, Mary S; Sanchez, Diana T

    2016-03-01

    Mortality and morbidity data suggest that men have shorter life expectancies than women and outrank women on several leading causes of death. These gendered disparities may be influenced by psychosocial factors like masculinity. Three studies (Total N=546) examined the role of masculinity in men's doctor choices and doctor-patient interactions. In Studies 1 and 2, men completed measures of masculinity, gender bias, and doctor preference. Using structural equation modeling, we tested the direct relationship between masculinity and male doctor preference and the indirect relationship of masculinity on male doctor preference through an association with gendered competence stereotypes. Participants in Study 3 disclosed symptoms in private followed by disclosure to a male or female interviewer in a clinical setting. Using repeated measures analysis of variance (ANOVA), we examined the interaction among symptom reporting, masculinity and doctor gender, controlling for participant comfort. In Study 1, results suggested that masculinity encouraged choice of a male doctor directly and indirectly via beliefs that men make more competent doctors than women; Study 2 directly replicated the results of Study 1. In Study 3, independent of participant comfort, an interaction between interviewer gender and masculinity emerged such that men scoring higher on masculinity reported symptoms less consistently to male interviewers (relative to higher scoring men reporting to female interviewers); the reverse was found for men scoring low on masculinity. Taken together these studies suggest that masculinity may affect men's health by encouraging choice of a male doctor with whom doctor-patient communication may be impaired. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. Open notes: doctors and patients signing on.

    Science.gov (United States)

    Delbanco, Tom; Walker, Jan; Darer, Jonathan D; Elmore, Joann G; Feldman, Henry J; Leveille, Suzanne G; Ralston, James D; Ross, Stephen E; Vodicka, Elisabeth; Weber, Valerie D

    2010-07-20

    Few patients read their doctors' notes, despite having the legal right to do so. As information technology makes medical records more accessible and society calls for greater transparency, patients' interest in reading their doctors' notes may increase. Inviting patients to review these notes could improve understanding of their health, foster productive communication, stimulate shared decision making, and ultimately lead to better outcomes. Yet, easy access to doctors' notes could have negative consequences, such as confusing or worrying patients and complicating rather than improving patient-doctor communication. To gain evidence about the feasibility, benefits, and harms of providing patients ready access to electronic doctors' notes, a team of physicians and nurses have embarked on a demonstration and evaluation of a project called OpenNotes. The authors describe the intervention and share what they learned from conversations with doctors and patients during the planning stages. The team anticipates that "open notes" will spread and suggests that over time, if drafted collaboratively and signed by both doctors and patients, they might evolve to become contracts for care.

  6. Patient perception of smartphone usage by doctors

    Directory of Open Access Journals (Sweden)

    Kerry G

    2017-03-01

    Full Text Available Georgina Kerry,1 Shyam Gokani,2 Dara Rasasingam,2 Alexander Zargaran,3 Javier Ash,2 Aaina Mittal2 1College of Medical and Dental Sciences, University of Birmingham, Birmingham, 2Faculty of Medicine, Imperial College London, London, 3Faculty of Medicine, St George’s University of London, London, UK Abstract: Technological advancements have revolutionized modern medicine and smartphones are now ubiquitous among health care professionals. The ability to look up information promptly is invaluable to doctors and medical students alike, but there is an additional contiguous benefit to patients. Queries can be answered more accurately through fingertip access to evidence-based medicine, and physicians have instant access to emergency care protocols. However, is consideration always extended to the patient’s perception of the use of smartphones by doctors? Do patients know why we use smartphones to assist us in their care? What do they think when they see a doctor using a smartphone?An independent question, conducted within a wider service evaluation (ethical approval not required, full verbal and written electronic consent provided by all patients at St. Mary’s Hospital, London, indicated that although the majority (91.0% of patients owned a smartphone, many (61.6% did not agree that the use of smartphones at work by doctors is professional. This highlights the potential for damage to the doctor–patient relationship. There is a risk that these patients will disconnect with care services with possible detriment to their health. Additionally, it is notable that a larger proportion of those patients aged >70 years found the use of smartphones by doctors at work unprofessional, compared with patients aged <70 years.Adequate communication between the doctor and patient is critical in ensuring that doctors can make use of modern technology to provide the best possible care and that patients are comfortable with this and do not feel isolated or

  7. Interpersonal perception in the context of doctor-patient relationships: a dyadic analysis of doctor-patient communication.

    Science.gov (United States)

    Kenny, David A; Veldhuijzen, Wemke; Weijden, Trudy van der; Leblanc, Annie; Lockyer, Jocelyn; Légaré, France; Campbell, Craig

    2010-03-01

    Doctor-patient communication is an interpersonal process and essential to relationship-centered care. However, in many studies, doctors and patients are studied as if living in separate worlds. This study assessed whether: 1) doctors' perception of their communication skills is congruent with their patients' perception; and 2) patients of a specific doctor agree with each other about their doctor's communication skills. A cross-sectional study was conducted in three provinces in Canada with 91 doctors and their 1749 patients. Doctors and patients independently completed questions on the doctor's communication skills (content and process) after a consultation. Multilevel modeling provided an estimate of the patient and doctor variance components at both the dyad-level and the doctor-level. We computed correlations between patients' and doctors' perceptions at both levels to assess how congruent they were. Consensus among patients of a specific doctor was assessed using intraclass correlation coefficient (ICC). The mean score of the rating of doctor's skills according to patients was 4.58, and according to doctors was 4.37. The dyad-level variance for the patient was .38 and for the doctor was .06. The doctor-level variance for the patient ratings was .01 and for the doctor ratings, .18. The correlation between both the patients' and the doctors' skills' ratings scores at the dyad-level was weak. At the doctor-level, the correlation was not statistically significant. The ICC for patients' ratings was .03 and for the doctors' ratings .76. Overall, this study suggests that doctors and their patients have a very different perspective of the doctors' communication skills occurring during routine clinical encounters. 2009 Elsevier Ltd. All rights reserved.

  8. Cancer patients' coping styles and doctor-patient communication

    NARCIS (Netherlands)

    Ong, L. M.; Visser, M. R.; van Zuuren, F. J.; Rietbroek, R. C.; Lammes, F. B.; de Haes, J. C.

    1999-01-01

    Monitoring and blunting styles have become relevant concepts regarding their potential impact on patients' and doctors' behaviors. The present study aimed at investigating the relation between cancer patients' coping styles and doctor-patient communication and global affect. Coping styles were

  9. The Language of the Medical Profession: Doctor-Patient Discourse ...

    African Journals Online (AJOL)

    This paper examines language use in a doctor-patient context (situation) with specific focus on the doctors' use of language to achieve a wide range of purposes, from empathy, egotism, to concealing the true state of their patient's health status and many others. In any doctor-patient situation, the context leading to the ...

  10. Difficult Doctors, Difficult Patients: Building Empathy.

    Science.gov (United States)

    Anderson, Patricia F; Wescom, Elise; Carlos, Ruth C

    2016-12-01

    Effective doctor-patient communication facilitates the therapeutic relationship, promotes patient physical and mental health, and improves physician satisfaction. Methods of teaching effective communication use a range of techniques, typically combining didactic instruction with simulated communication encounters and reflective discussion. Rarely are patients and physicians exposed to these instructions as colearners. The evidence for the utility of graphic stories, comics, and cartoons to improve patient comprehension and self-regulation is small but encouraging. The authors describe the use of graphic medicine as a teaching tool for engendering empathy from both the physician and the patient for the other during a shared clinical encounter. This use of educational comics in a colearning experience represents a new use of the medium as a teaching tool. Copyright © 2016. Published by Elsevier Inc.

  11. Bladder injuries frequently missed in polytrauma patients

    Directory of Open Access Journals (Sweden)

    Tanweer Karim

    2010-05-01

    Full Text Available Tanweer Karim, Margaret Topno, Vinod Sharma, Raymond Picardo, Ankur HastirSurgery, MGM Medical College, Kamothe, Navi Mumbai, IndiaAbstract: Bladder injuries are very common in patients who have had road traffic accidents. The method of diagnosis and management of such injuries is well established and accepted. However, trauma to the bladder can be associated with other life-threatening injuries which are frequently missed, and often diagnosed during laparotomy for other reasons. The aim of this study was to diagnose bladder injury in polytrauma patients as early as possible, taking into consideration the fact that these patients are hemodynamically unstable and require rapid evaluation and management. In order to achieve our objective, we used bedside sonography with retrograde instillation of normal saline to diagnose bladder injury in addition to use of the conventional retrograde cystogram.Keywords: bladder injury, bladder rupture, retrograde cystogram

  12. How doctors' communication style and race concordance influence African-Caribbean patients when disclosing depression.

    Science.gov (United States)

    Adams, A; Realpe, A; Vail, L; Buckingham, C D; Erby, L H; Roter, D

    2015-10-01

    To determine the impact of doctors' communication style and doctor-patient race concordance on UK African-Caribbeans' comfort in disclosing depression. 160 African-Caribbean and 160 white British subjects, stratified by gender and history of depression, participated in simulated depression consultations with video-recorded doctors. Doctors were stratified by black or white race, gender and a high (HPC) or low patient-centred (LPC) communication style, giving a full 2×2×2 factorial design. Afterwards, participants rated aspects of doctors' communication style, their comfort in disclosing depression and treatment preferences Race concordance had no impact on African-Caribbeans' comfort in disclosing depression. However a HPC versus LPC communication style made them significantly more positive about their interactions with doctors (p=0.000), their overall comfort (p=0.003), their comfort in disclosing their emotional state (p=0.001), and about considering talking therapy (p=0.01); but less positive about considering antidepressant medication (p=0.01). Doctors' communication style was shown to be more important than patient race or race concordance in influencing African Caribbeans' depression consultation experiences. Changing doctors' communication style may help reduce disparities in depression care. Practitioners should cultivate a HPC style to make African-Caribbeans more comfortable when disclosing depression, so that it is less likely to be missed. Copyright © 2015 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

  13. The perception of patients of doctor-patient relationship in ...

    African Journals Online (AJOL)

    Background: The doctor-patient relationship is central to the practice of medicine and is essential for the delivery of high quality healthcare in the diagnosis and treatment of diseases. Recently, patient participation has gained increasing prominence in healthcare delivery. Aim: To explore the perceptions of Nigerian adult ...

  14. When doctors share visit notes with patients: a study of patient and doctor perceptions of documentation errors, safety opportunities and the patient-doctor relationship.

    Science.gov (United States)

    Bell, Sigall K; Mejilla, Roanne; Anselmo, Melissa; Darer, Jonathan D; Elmore, Joann G; Leveille, Suzanne; Ngo, Long; Ralston, James D; Delbanco, Tom; Walker, Jan

    2017-04-01

    Patient advocates and safety experts encourage adoption of transparent health records, but sceptics worry that shared notes may offend patients, erode trust or promote defensive medicine. As electronic health records disseminate, such disparate views fuel policy debates about risks and benefits of sharing visit notes with patients through portals. Presurveys and postsurveys from 99 volunteer doctors at three US sites who participated in OpenNotes and postsurveys from 4592 patients who read at least one note and submitted a survey. Patients read notes to be better informed and because they were curious; about a third read them to check accuracy. In total, 7% (331) of patients reported contacting their doctor's office about their note. Of these, 29% perceived an error, and 85% were satisfied with its resolution. Nearly all patients reported feeling better (37%) or the same (62%) about their doctor. Patients who were older (>63), male, non-white, had fair/poor self-reported health or had less formal education were more likely to report feeling better about their doctor. Among doctors, 26% anticipated documentation errors, and 44% thought patients would disagree with notes. After a year, 53% believed patient satisfaction increased, and 51% thought patients trusted them more. None reported ordering more tests or referrals. Despite concerns about errors, offending language or defensive practice, transparent notes overall did not harm the patient-doctor relationship. Rather, doctors and patients perceived relational benefits. Traditionally more vulnerable populations-non-white, those with poorer self-reported health and those with fewer years of formal education-may be particularly likely to feel better about their doctor after reading their notes. Further informing debate about OpenNotes, the findings suggest transparent records may improve patient satisfaction, trust and safety. Published by the BMJ Publishing Group Limited. For permission to use (where not already

  15. Should doctors provide futile medical treatment if patients or their ...

    African Journals Online (AJOL)

    Is it ethical and legal for doctors to provide futile medical treatment if patients ... exercise patient autonomy when they demand to be treated if their prognosis is ... a placebo effect.[3]. When deciding to terminate or refuse treatment against a patient's or their proxy's wishes because of futility, doctors must discuss this with them ...

  16. Patients preference for doctors' gender in North Western, Nigeria ...

    African Journals Online (AJOL)

    Background: Cultural and religious beliefs affect the way people perceive illness and therapeutic interventions. These also affect the ability of patients and doctors to communicate freely, Objectives: To determine patients' preference for doctors' gender among patients attending the antenatal and gynaceology clinics in ...

  17. Should doctors provide futile medical treatment if patients or their ...

    African Journals Online (AJOL)

    Ethically and legally doctors are not obliged to provide futile treatment to patients, even if the patient or their proxies are prepared to pay for it. However, it may be justified where such treatment is harmless and has a placebo effect. In deciding about a request for futile treatment, doctors should be guided by the ethical ...

  18. Doctor-Patient Communication in Southeast Asia: A Different Culture?

    Science.gov (United States)

    Claramita, Mora; Nugraheni, Mubarika D. F.; van Dalen, Jan; van der Vleuten, Cees

    2013-01-01

    Studies of doctor-patient communication generally advocate a partnership communication style. However, in Southeast Asian settings, we often see a more one-way style with little input from the patient. We investigated factors underlying the use of a one-way consultation style by doctors in a Southeast Asian setting. We conducted a qualitative…

  19. Doctor-Shopping Behavior among Patients with Eye Floaters

    Directory of Open Access Journals (Sweden)

    Gow-Lieng Tseng

    2015-07-01

    Full Text Available Patients suffering from eye floaters often resort to consulting more than one ophthalmologist. The purpose of this study, using the Health Belief Model (HBM, was to identify the factors that influence doctor-shopping behavior among patients with eye floaters. In this cross-sectional survey, 175 outpatients who presented floaters symptoms were enrolled. Data from 143 patients (77 first time visitors and 66 doctor-shoppers who completed the questionnaire were analyzed. Descriptive and logistic regression analyses were performed. We found that women and non-myopia patients were significantly related with frequent attendance and doctor switching. Though the HBM has performed well in a number of health behaviors studies, but most of the conceptual constructors of HBM did not show significant differences between the first time visitors and true doctor-shoppers in this study. Motivation was the only significant category affecting doctor-shopping behavior of patients with eye floaters.

  20. Why Patients Miss Follow-Up Appointments: A Prospective Control ...

    African Journals Online (AJOL)

    Reasons include: transport (19 responses), ill-health (6) and financial constraints (5). State transport was unavailable to almost twothirds of the responders who cited transport as a problem. Conclusions: The 17% missed appointment rate is largely due to transport constraints. The commonest time for patients to miss ...

  1. Differential growth in doctor-patient communications skills

    NARCIS (Netherlands)

    M van Es, Judith; Wieringa-de Waard, Margreet; Visser, Mechteld R. M.

    2013-01-01

    Although doctor-patient communication is considered a core competency for medical doctors, the effect of training has not been unequivocally established. Moreover, knowledge about the variance in the growth of different skills and whether certain patterns in growth can be detected could help us to

  2. [Corruption risks in relations between doctor and patient ].

    Science.gov (United States)

    Kolwitz, Marcin; Gąsiorowski, Jakub

    2014-01-01

    The article describes the problem of corruption occurring in the relationship between doctor and patient. The doctor-patient relationship, including the provision of health services, is one of several potential areas of corruption in the health care system. Among the reasons for the existence of corruption in these relationships are the need to obtain better healthcare for the patient, and higher earnings in the case of a doctor. Indications of corruption are utilitarian (action for personal advantage without ethical aspects), but may also be (actually or in the patient's opinion) the only way to obtain services and save health and even life. Corruption between the doctor and the patient can be limited by better organization of the health care system, including the financing of benefits and education of medical personnel and patients, as well as traditional legal measures, such as prevention or the application of criminal sanctions.

  3. Survey of Doctors' Experience of Patients Using the Internet

    OpenAIRE

    Potts, Henry W. W; Wyatt, Jeremy C

    2002-01-01

    Background There have been many studies showing the variable quality of Internet health information and it has often been assumed that patients will blindly follow this and frequently come to harm. There have also been reports of problems for doctors and health services following patient Internet use, but their frequency has not been quantified. However, there have been no large, rigorous surveys of the perceptions of Internet-aware doctors about the actual benefits and harms to their patient...

  4. Effect of breaking bad news on patients' perceptions of doctors

    Science.gov (United States)

    Barnett, Mandy M

    2002-01-01

    The breaking of bad news is a routine but difficult task for many health professionals. There are numerous anecdotes of insensitive practice but the subject has attracted little systematic research. We therefore interviewed 106 patients with advanced cancer (from an original sample of 195) to assess their perceptions of the doctors involved in their care. Aspects of the ‘breaking bad news’ event were recorded during discussion of the illness history and were subsequently rated. Participants were also asked to nominate doctors under the headings ‘most helpful’ and ‘less helpful’, and completed standardized psychological screening questionnaires. In 94 of the 106 cases the bad news had been given by a doctor, usually a surgeon. Of the 13 doctors categorized as ‘most helpful’ when breaking bad news, 8 were general practitioners; of the 7 categorized as ‘less helpful’ all were surgeons. 69% of patients were neutral or positive about the bad-news consultation, but 20% were negative and 6% very negative. Doctors in surgical specialties were significantly more likely to be rated poorly than non-surgical specialists or general practitioners. Surgeons were the group of doctors most likely to break bad news, but non-surgical doctors were rated more positively in performance of the task. This finding has implications for training. PMID:12091508

  5. Doctors' trustworthiness, practice orientation, performance and patient satisfaction.

    Science.gov (United States)

    Van Den Assem, Barend; Dulewicz, Victor

    2015-01-01

    The purpose of this paper is to provide a greater understanding of the general practitioner (GP)-patient relationship for academics and practitioners. A new model for dyadic professional relationships specifically designed for research into the doctor-patient relationship was developed and tested. Various conceptual models of trust and related constructs in the literature were considered and assessed for their relevance as were various related scales. The model was designed and tested using purposefully designed scales measuring doctors' trustworthiness, practice orientation performance and patient satisfaction. A quantitative survey used closed-ended questions and 372 patients responded from seven GP practices. The sample closely reflected the profile of the patients who responded to the DoH/NHS GP Patient Survey for England, 2010. Hierarchical regression and partial least squares both accounted for 74 per cent of the variance in "overall patient satisfaction", the dependent variable. Trust accounted for 39 per cent of the variance explained, with the other independent variables accounting for the other 35 per cent. ANOVA showed good model fit. The findings on the factors which affect patient satisfaction and the doctor-patient relationship have direct implications for GPs and other health professionals. They are of particular relevance at a time of health reform and change. The paper provides: a new model of the doctor-patient relationship and specifically designed scales to test it; a greater understanding of the effects of doctors' trustworthiness, practice orientation and performance on patient satisfaction; and a new framework for examining the breadth and meaning of the doctor-patient relationship and the management of care from the patient's viewpoint.

  6. Survey of doctors' experience of patients using the Internet.

    Science.gov (United States)

    Potts, Henry W W; Wyatt, Jeremy C

    2002-01-01

    There have been many studies showing the variable quality of Internet health information and it has often been assumed that patients will blindly follow this and frequently come to harm. There have also been reports of problems for doctors and health services following patient Internet use, but their frequency has not been quantified. However, there have been no large, rigorous surveys of the perceptions of Internet-aware doctors about the actual benefits and harms to their patients of using the Internet. To describe Internet-literate doctors' experiences of their patients' use of the Internet and resulting benefits and problems. Online survey to a group of 800 Web-using doctors (members of a UK medical Internet service provider, Medix) in September and October 2001. Responses were received from 748 (94%) doctors, including 375 general practitioners (50%). Respondents estimated that 1%-2% of their patients used the Internet for health information in the past month with no regional variation. Over two thirds of the doctors considered Internet health information to be usually (20%) or sometimes (48%) reliable; this was higher in those recently qualified. Twice as many reported patients experiencing benefits (85%; 95% confidence interval, 80%-90%) than problems (44%; 95% confidence interval, 37%-50%) from the Internet. Patients gaining actual physical benefits from Internet use were reported by 40% of respondents, while 8% reported physical harm. Patients' overall experiences with the Internet were judged excellent 1%, good 29%, neutral 62%, poor 9%, or bad Internet use on the doctors themselves, 13% reported no problems, 38% 1 problem, and 49% 2 or more problems. Conversely, 20% reported no benefits for themselves, 49% 1 benefit, and 21% 2 or more benefits. These doctors reported patient benefits from Internet use much more often than harms, but there were more problems than benefits for the doctors themselves. Reported estimates of patient Internet usage rates were

  7. knowledge of consequences of missing teeth in patients attending

    African Journals Online (AJOL)

    teeth and sex or on level of education (p 0.05). Dentists constituted the largest source of information to these patients (25.6%) while the media constituted the least (0.5%). Conclusion: The result of this study showed poor knowledge of the consequences of missing teeth among partially edentulous patients and the media ...

  8. Doctor-patient dialogue--basic aspect of medical consultation.

    Science.gov (United States)

    Murariu-Brujbu, Isabella Cristina; Macovei, Luana Andreea

    2013-01-01

    Family medicine is the specialty that provides ongoing primary medical care and improves the health status of the individual, of the family and of the community through preventive, educational, therapeutic and rehabilitation measures. The family doctor often makes the interdisciplinary synthesis, in a flexible manner, either alone or in most cases with interdisciplinary consultation. In the latter case, the family doctor initiates the team work and makes the final evaluation by using the longitudinal follow-up of the disease. The doctor-patient encounter represents the "confrontation" with the greatest moral weight, due to the complexity of the values involved, the status of the doctor in a society, and patient's involvement in decision making. The patient is a person who should be treated with respect, honesty, professionalism and loyalty, whatever the clinical status, severity of illness, mental competence or incompetence. A focus, on an international scale, is represented by the characteristics of a good doctor, family physician included, as the latter is the first link in the network of health services. Each model of consultation varies in a more or less subtle way in priorities assignment, and suggests slight differences regarding the role played by doctor and patient in their collaboration. The qualities of a good family physician include not only the strictly professional competences, that also apply to other medical specialties, but also duties, such as, clearly explaining to patients issues concerning their health, informing them about all the possible preventive measures of diseases, making a diagnosis, initiating and supervising a therapy. Medical responsibility lies at the crossroads between medical science and the conscience of the doctor.

  9. Doctor-shopping behavior among diabetic patients in urban Puducherry

    Directory of Open Access Journals (Sweden)

    Sonia Agrawal

    2016-01-01

    Full Text Available Background: Seeking assistance from multiple physicians for an illness is a major obstacle in providing efficient care by the health care systems. It not only alters the disease condition but also adds to excess health care costs. This study aimed at exploring healthcare-seeking behavior in adult patients with diabetes and also to identify the factors associated with doctor-shopping behavior. Methods: This questionnaire-based cross-sectional study was conducted in an urban ward of Puducherry. A total of 100 patients aged more than 18 years with diabetes were included in the study. Results: Around 80% of the study subjects were availing treatment from government facilities. Prevalence of doctor-shopping behavior was found to be 14%. Reasons for change in their treatment facility were mainly due to patient-related factors like unaffordability of medicines and consultant fees, or illness-related factors like no improvement in symptoms. Physician/facility-related factors were due to prolonged waiting hours and poor interpersonal communication by the doctor. Various factors associated with doctor-shopping behavior in diabetics such as chronicity of illness (P< 0.005, past treatment facility being private (P< 0.001, and upper socioeconomic status (P = 0.045 were statistically found to be significant. Conclusion: The present study shows the prevalence of doctor shopping among diabetic patients to be 14% in urban Puducherry and this change in consultation was mainly due to the patient, illness, physician, or facility-related factors. Patient education, good interpersonal communication skills, and health system strengthening measures can increase responsiveness of the community toward the health systems and thereby reduce doctor shopping behavior among diabetic patients.

  10. DO PATIENTS VIEW MALE AND FEMALE DOCTORS DIFFERENTLY?

    African Journals Online (AJOL)

    2007-04-04

    Apr 4, 2007 ... ABSTRACT. Background: This study was a patient survey of attitudes towards the gender of their physicians generally and in medical specialties at the University of Benin Teaching Hospital. Objective: To determine if patients view male and female doctors differently and the factors that govern these views.

  11. [Teaching doctor-patient communication - a proposal in practice].

    Science.gov (United States)

    Carvalho, Irene P; Ribeiro-Silva, Raquel; Pais, Vanessa G; Figueiredo-Braga, Margarida; Castro-Vale, Ivone; Teles, Ana; Almeida, Susana S; Mota-Cardoso, Rui

    2010-01-01

    Traditionally, doctor-patient communication was considered a matter of and , and a topic for informal learning. Recently, studies have shown the importance of communication skills in medical practice. Doctor-patient communication skills, such as knowing how to listen, how to observe, and how to inform are today considered important components of Medical Education, although they are often difficult to integrate in Medical Curricula. In the current work, the authors describe the program of Communication in the Doctor-Patient Relationship, initiated in 2001 in the Medical School of the University of Porto, part of its undergraduate program. Future studies will allow us to assess the effectiveness of the learning and application of these skills in clinical practice.

  12. Breaking bad news: doctors' skills in communicating with patients.

    Science.gov (United States)

    Ferreira da Silveira, Francisco José; Botelho, Camila Carvalho; Valadão, Carolina Cirino

    2017-01-01

    Breaking bad news is one of doctors' duties and it requires them to have some skills, given that this situation is difficult and distressful for patients and their families. Moreover, it is also an uncomfortable condition for doctors. The aim of this study was to evaluate doctors' capacity to break bad news, ascertain which specialties are best prepared for doing this and assess the importance of including this topic within undergraduate courses. Observational cross-sectional quantitative study conducted at a university hospital in Belo Horizonte (MG), Brazil. This study used a questionnaire based on the SPIKES protocol, which was answered by 121 doctors at this university hospital. This questionnaire investigated their attitudes, posture, behavior and fears relating to breaking bad news. The majority of the doctors did not have problems regarding the concept of bad news. Nevertheless, their abilities diverged depending on the stage of the protocol and on their specialty and length of time since graduation. Generally, doctors who had graduated more than ten years before this survey felt more comfortable and confident, and thus transmitted the bad news in a better conducted manner. Much needs to be improved regarding this technique. Therefore, inclusion of this topic in undergraduate courses is necessary and proposals should be put forward and verified.

  13. Improving doctor-patient communication: content validity examination of a novel urinary system-simulating physical model.

    Science.gov (United States)

    Hu, WenGang; Song, YaJun; Zhong, Xiao; Feng, JiaYu; Wang, PingXian; Huang, ChiBing

    2016-01-01

    Effective doctor-patient communication is essential for establishing a successful doctor-patient relationship and implementing high-quality health care. In this study, a novel urinary system-simulating physical model was designed and fabricated, and its content validity for improving doctor-patient communication was examined by conducting a randomized controlled trial in which this system was compared with photographs. A total of 240 inpatients were randomly selected and assigned to six doctors for treatment. After primary diagnosis and treatment had been determined, these patients were randomly divided into the experimental group and the control group. Patients in the experimental group participated in model-based doctor-patient communication, whereas control group patients received picture-based communication. Within 30 min after this communication, a Demographic Information Survey Scale and a Medical Interview Satisfaction Scale (MISS) were distributed to investigate patients' demographic characteristics and their assessments of total satisfaction, distress relief, communication comfort, rapport, and compliance intent. The study results demonstrated that the individual groups were comparable with respect to demographic variables but that relative to patients in the picture-based communication group, patients in the model-based communication group had significantly higher total satisfaction scores and higher ratings for distress relief, communication comfort, rapport, and compliance intent. These results indicate that the physical model is more effective than the pictures at improving doctor-patient communication and patient outcomes. The application of the physical model in doctor-patient communication is helpful and valuable and therefore merits widespread clinical popularization.

  14. [The doctor-patient relationship in the novel Thibault].

    Science.gov (United States)

    Radu, Ancuta

    2008-12-01

    A masterpiece of the realistic novel, Les Thibault is a document of political and social life before and during the First World War. At the same time, it is a document of the status of medicine at the beginning of the 20th century. Roger Martin du Gard collected information on the diseases of the time, on medical deontology and on the doctor-patient relationship which is established during the medical encounter. The novel reflects the author's ability to transform a document into literary fiction. Antoine Thibault, who represents the ideal doctor, is able to create a perfect relationship with his patients, basing this on confidence. He also provides one of the literary models of a doctor practicing medicine from a sense of vocation.

  15. Knowledge of Consequences of missing teeth in patients attending ...

    African Journals Online (AJOL)

    There was no significant difference between the knowledge of the consequences of missing teeth and sex or on level of education (p 0.05). Dentists constituted the largest source of information to these patients (25.6%) while the media constituted the least (0.5%). Conclusion: The result of this study showed poor knowledge ...

  16. How To Talk to Your Doctor (and Get Your Doctor To Talk to You!). An Educational Workshop on Doctor Patient Communication = Como Hablarle a su Doctor (iY que su doctor le hable a usted!). Un seminario educativo sobre la comunicacion entre el doctor y el paciente.

    Science.gov (United States)

    Baylor Coll. of Medicine, Houston, TX.

    This workshop, written in both English and Spanish, focuses on improving communication between physician and patient. In the workshop, the trainers will talk about "building bridges" between patient and doctor by understanding the doctor's role and his/her duty to the patient. According to the workshop, a person's doctor should…

  17. Doctor-patient communication and cancer patients' quality of life and satisfaction

    NARCIS (Netherlands)

    Ong, L. M.; Visser, M. R.; Lammes, F. B.; de Haes, J. C.

    2000-01-01

    In this study, the relationship between (a) doctor's and patients' communication and (b) doctors' patient-centredness during the oncological consultation and patients' quality of life and satisfaction was examined. Consultations of 96 consecutive cancer patients were recorded and content analysed by

  18. Importance of doctor-patient relationship for patient adherence with medication regimes

    DEFF Research Database (Denmark)

    Sokolowski, Ineta; Vedsted, Peter

    Aim: It has been supposed that the relation between the doctor and the patient has implications for the adherence to medication. This study explores the effect of patient reported doctor-patient relationship on patient adherence with medication regiments. Methods: Design: Prospective cohort study...

  19. The patient-doctor relationship: a synthesis of the qualitative literature on patients' perspectives.

    Science.gov (United States)

    Ridd, Matthew; Shaw, Alison; Lewis, Glyn; Salisbury, Chris

    2009-04-01

    The patient-doctor relationship is an important but poorly defined topic. In order to comprehensively assess its significance for patient care, a clearer understanding of the concept is required. To derive a conceptual framework of the factors that define patient-doctor relationships from the perspective of patients. Systematic review and thematic synthesis of qualitative studies. Medline, EMBASE, PsychINFO and Web of Science databases were searched. Studies were screened for relevance and appraised for quality. The findings were synthesised using a thematic approach. From 1985 abstracts, 11 studies from four countries were included in the final synthesis. They examined the patient-doctor relationship generally (n = 3), or in terms of loyalty (n = 3), personal care (n = 2), trust (n = 2), and continuity (n = 1). Longitudinal care (seeing the same doctor) and consultation experiences (patients' encounters with the doctor) were found to be the main processes by which patient-doctor relationships are promoted. The resulting depth of patient-doctor relationship comprises four main elements: knowledge, trust, loyalty, and regard. These elements have doctor and patient aspects to them, which may be reciprocally related. A framework is proposed that distinguishes between dynamic factors that develop or maintain the relationship, and characteristics that constitute an ongoing depth of relationship. Having identified the different elements involved, future research should examine for associations between longitudinal care, consultation experiences, and depth of patient-doctor relationship, and, in turn, their significance for patient care.

  20. Doctor-patient communication and the quality of care.

    NARCIS (Netherlands)

    Bensing, J.M.

    1991-01-01

    This large scale study clearly shows that 'the spoken language is a most important tool in medicine'. The study unravels which elements in the doctor-patient communication provide for the quality of care. A thorough analysis of over 3000 videotaped general practice consultations reveales that the

  1. Harm to patients and others caused by impaired junior doctors ...

    African Journals Online (AJOL)

    hour policy continues to be implemented in all provinces, except recently in the Western Cape. Public health officials may be held directly liable for the harm caused to patients, third parties or the junior doctors themselves, if it can be shown that ...

  2. How do patients define "good" and "bad" doctors? - Qualitative approach to the representations of hospital patients

    NARCIS (Netherlands)

    Luthy, C; Cedraschi, C; Perrin, E; Allaz, AF

    2005-01-01

    Questions under study: Knowledge of hospital patients' perceptions of doctors' qualities is limited. The purpose of this study was to explore hospital patients' definitions of "good" and "bad" doctors. Methods: Semi-structured interviews conducted with 68 consecutive hospital patients. The questions

  3. The Relationships Between Doctor-Patient Affectionate Communication and Patient Perceptions and Outcomes.

    Science.gov (United States)

    Hesse, Colin; Rauscher, Emily A

    2018-02-20

    The current article combines the literature on doctor-patient communication and affectionate communication. Using Affection Exchange Theory (AET), the study predicts that the need for affection and the benefits of affectionate communication translate to the doctor-patient setting, proposing a series of relationships from both perceived doctor affectionate communication and affection deprivation to several patient outcome variables (patient perception of the doctor, patient communication with the doctor, and patient satisfaction/adherence). The results strongly supported the predictions for both affectionate communication and affection deprivation, with affectionate communication positively relating to most outcome measures and affection deprivation negatively relating to most outcome measures. Affection deprivation served as a moderator for the relationship between provider competence and patient satisfaction, although affectionate communication moderated the relationship between provider competence and patient adherence. Implications and possible directions for future research are discussed.

  4. Challenges and changes in spirituality among doctors who become patients.

    Science.gov (United States)

    Klitzman, Robert L; Daya, Shaira

    2005-12-01

    Though spirituality can help patients cope with illness, several studies have suggested that physicians view spirituality differently than do patients. These issues have not been systematically investigated among doctors who become patients, and who may be able to shed critical light on this area. We interviewed fifty doctors from major urban US centers who had become patients due to serious illnesses about their experiences and views relating to religion and spirituality before and after diagnosis, and we explore the range of issues that emerged. These physician-patients revealed continua of forms and contents of spirituality. The forms ranged from being spiritual to start with; to being spiritual, but not thinking of themselves as such; to wanting but being unable to believe. Some continued to doubt and, perhaps relatedly, appeared depressed. The contents of beliefs ranged from established religious traditions, to mixing beliefs, or having non-specific beliefs (e.g., concerning the power of nature). One group of doctors felt wary of organized religion, which could prove an obstacle to belief. Others felt that symptoms could be reduced through prayer. At times, self-assessments of spirituality were difficult to make or inaccurate. Questions surfaced concerning whether and how medical education could best address these issues, and how spirituality may affect clinical work. This study is the first that we know of to examine spirituality among physicians when they become patients. Obstacles to physicians' attentiveness to the potential role of spirituality arose that need to be further explored in medical education and future research. Increased awareness of these areas could potentially have clinical relevance, strengthening doctor-patient relationships and communication, and patient satisfaction.

  5. Interpretation in doctor-patient interviews: a sociolinguistic analysis.

    Science.gov (United States)

    Marshall, R S

    1988-06-01

    This paper discusses interpretation in doctor-patient interviews from a sociolinguistic perspective. A meaning-centered orientation to clinical practice calls for practitioners to create a clinical picture of the illness that is compatible with the patient's experience. This requires that appropriate interpretation of symptoms take place. Using transcripts of doctor-patient interviews, this paper demonstrates that another interpretive process, necessary to understanding illness, occurs at the level of conversation. Contrasting examples illustrate that without an adequate degree of "conversational cooperation," interpretation cannot take place. The results of poor conversational interpretation are the creation of an inaccurate clinical picture and the loss of clinically relevant information. The anthropological and sociolinguistic paradigms are linked by showing how differing perspectives on the illness affect conversational interpretation.

  6. Doctor's perception of doctor-patient relationships in emergency departments: What roles do gender and ethnicity play?

    Science.gov (United States)

    Babitsch, Birgit; Braun, Tanja; Borde, Theda; David, Matthias

    2008-04-11

    Emergency departments continuously provide medical treatment on a walk-in basis. Several studies investigated the patient's perception of the doctor-patient relationship, but few have asked doctors about their views. Furthermore, the influence of the patient's ethnicity and gender on the doctor's perception remains largely unanswered. Based on data collated in three gynaecology (GYN)/internal medicine (INT) emergency departments in Berlin, Germany, we evaluated the impact of the patient's gender and ethnicity on the doctors' satisfaction with the course of the treatment they provided. Information was gathered from 2.429 short questionnaires completed by doctors and the medical records of the corresponding patients. The patient's ethnicity had a significant impact on the doctors' satisfaction with the doctor-patient relationship. Logistic regression analysis showed that the odds ratio (OR) for physician satisfaction was significantly lower for patients of Turkish origin (OR = 2.6 INT and 5.5 GYN) than for those of German origin. The main reasons stated were problems with communication and a perceived lack of urgency for emergency treatment. The odds ratios for dissatisfaction due to a lack of language skills were 4.48 (INT) and 6.22 (GYN), and those due to perceived lack of urgency for emergency treatment were 0.75 (INT) and 0.63 (GYN). Sex differences caused minor variation. The results show that good communication despite language barriers is crucial in providing medical care that is satisfactory to both patient and doctors, especially in emergency situations. Therefore the use of professional interpreters for improved communication and the training of medical staff for improved intercultural competence are essential for the provision of adequate health care in a multicultural setting.

  7. Doctor's perception of doctor-patient relationships in emergency departments: What roles do gender and ethnicity play?

    Directory of Open Access Journals (Sweden)

    Borde Theda

    2008-04-01

    Full Text Available Abstract Background Emergency departments continuously provide medical treatment on a walk-in basis. Several studies investigated the patient's perception of the doctor-patient relationship, but few have asked doctors about their views. Furthermore, the influence of the patient's ethnicity and gender on the doctor's perception remains largely unanswered. Methods Based on data collated in three gynaecology (GYN/internal medicine (INT emergency departments in Berlin, Germany, we evaluated the impact of the patient's gender and ethnicity on the doctors' satisfaction with the course of the treatment they provided. Information was gathered from 2.429 short questionnaires completed by doctors and the medical records of the corresponding patients. Results The patient's ethnicity had a significant impact on the doctors' satisfaction with the doctor-patient relationship. Logistic regression analysis showed that the odds ratio (OR for physician satisfaction was significantly lower for patients of Turkish origin (OR = 2.6 INT and 5.5 GYN than for those of German origin. The main reasons stated were problems with communication and a perceived lack of urgency for emergency treatment. The odds ratios for dissatisfaction due to a lack of language skills were 4.48 (INT and 6.22 (GYN, and those due to perceived lack of urgency for emergency treatment were 0.75 (INT and 0.63 (GYN. Sex differences caused minor variation. Conclusion The results show that good communication despite language barriers is crucial in providing medical care that is satisfactory to both patient and doctors, especially in emergency situations. Therefore the use of professional interpreters for improved communication and the training of medical staff for improved intercultural competence are essential for the provision of adequate health care in a multicultural setting.

  8. Abortion Bans, Doctors, and the Criminalization of Patients.

    Science.gov (United States)

    Oberman, Michelle

    2018-03-01

    January 2018, the American College of Obstetrics and Gynecology issued a position statement opposing the punishment of women for self-induced abortion. To those unfamiliar with emerging trends in abortion in the United States and worldwide, the need for the declaration might not be apparent. Several studies suggest that self-induced abortion is on the rise in the United States. Simultaneously, prosecutions of pregnant women for behavior thought to harm the fetus are increasing. The ACOG statement responds to both trends by urging doctors to honor the integrity and confidentiality inherent in the doctor-patient relationship. Seen in the context of the larger battle over legal abortion, the statement has far broader implications. By acknowledging the role doctors play in enforcing pregnancy-related crimes, the ACOG position statement wisely anticipates the ways in which doctors will be implicated should access to legal abortion be further restricted. To understand the need for the ACOG directive, you must first understand that the story of what will happen if abortion becomes a crime in the United States is not to be found in history books; it is staring at us across our southern border. © 2018 The Hastings Center.

  9. [Pitfalls within the cancer-related doctor-patient communication].

    Science.gov (United States)

    Muszbek, Katalin; Gaal, Ilona

    2016-04-24

    There is a "confusion of tongues" in the communication between patient and physician that hinders mutual understanding. Cancer - because of its malignant and often chronic nature - accentuates the communication problems and emphasizes the importance of human relationship. The confusion of tongues can only be resolved through understanding of the situation and motivations of the other person. Thus our aim is to help medical doctors to recognize and understand the most important communication characteristics of the doctor-patient interactions that are strained by the burden of cancer. Interviews with directly concerned professionals and non-professionals were recorded in order to reveal the most common communication disturbances. The majority of the "communication vacuum" arose when bad news should be disclosed for the patient, as bad news is bad for the physician as well. It is emotionally burdening to perceive bad news, and a big challenge for the physician to break it gently, to be tactful, while he/she has no possibility to pay attention with regard to his/her own emotional stability. Medical doctors can cope with this challenge if they are acquainted with the psychological difficulties of the patients that block the effective medical communication.

  10. Missing Clinical Information in NHS hospital outpatient clinics: prevalence, causes and effects on patient care

    Directory of Open Access Journals (Sweden)

    Moorthy Krishna

    2011-05-01

    to their care and 20% had a risk of harm. In over half of cases the doctor relied on the patient for the information, making a clinical decision despite the information being missing in 20% of cases. Hospital mergers, temporary staff and non-integrated IT systems were contributing factors. Conclusions If these findings are replicated across the NHS then almost 10 million outpatients are seen each year without key clinical information, creating over a million unnecessary appointments, and putting nearly 2 million patients at risk of harm. There is a need for a systematic, regular audit of the prevalence of missing clinical information. Only then will we know the impact on clinical decision making and patient care of new technology, service reorganisations and, crucially given the present financial climate, temporary or reduced staffing levels. Further research is needed to assess the relationship between missing clinical information and diagnostic errors; to examine the issue in primary care; and to consider the patients perspective.

  11. Factors influencing intercultural doctor-patient communication: a realist review.

    Science.gov (United States)

    Paternotte, Emma; van Dulmen, Sandra; van der Lee, Nadine; Scherpbier, Albert J J A; Scheele, Fedde

    2015-04-01

    Due to migration, doctors see patients from different ethnic backgrounds. This causes challenges for the communication. To develop training programs for doctors in intercultural communication (ICC), it is important to know which barriers and facilitators determine the quality of ICC. This study aimed to provide an overview of the literature and to explore how ICC works. A systematic search was performed to find literature published before October 2012. The search terms used were cultural, communication, healthcare worker. A realist synthesis allowed us to use an explanatory focus to understand the interplay of communication. In total, 145 articles met the inclusion criteria. We found ICC challenges due to language, cultural and social differences, and doctors' assumptions. The mechanisms were described as factors influencing the process of ICC and divided into objectives, core skills and specific skills. The results were synthesized in a framework for the development of training. The quality of ICC is influenced by the context and by the mechanisms. These mechanisms translate into practical points for training, which seem to have similarities with patient-centered communication. Training for improving ICC can be developed as an extension of the existing training for patient-centered communication. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  12. Two is a perfect number: Patient-doctor relationship and patient attachment style in palliative care.

    Science.gov (United States)

    Zaporowska-Stachowiak, Iwona; Stachowiak, Katarzyna; Stachnik, Katarzyna

    2017-08-01

    We tested the association between the palliative patient's attachment style and the patient-doctor relationship, by means of Revised Adult Attachment Scale and a self-designed, patient-doctor relationship questionnaire. The study included 110 (52 M, 58 F) cancer, hospice patients, aged 36-80 years. We observed 54 percent of secure, 18 percent of dismissive, 9 percent of preoccupied, and 19 percent of fearful styles. Securely attached patients developed significantly ( p < .05) better relationships with doctors than insecure patients. There was no difference in the quality of the patient-doctor relationship among dismissive versus preoccupied versus fearful patients. We argue that attachment theory should be applied in palliative care to improve patients' quality of life and dying.

  13. The impact of email as a communicative medium on the doctor-patient relationship

    DEFF Research Database (Denmark)

    Jensen, Matilde Nisbeth; Fage-Butler, Antoinette Mary

    Background and objective: Although theoretical perspectives on the doctor-patient relationship have characteristically assumed the temporal and physical co-presence of doctor and patient, the advent of email in doctor-patient communication has brought with it a different communicative reality. Ne...

  14. Missed connections: A case study of the social networks of physics doctoral students in a single department

    Science.gov (United States)

    Knaub, Alexis Victoria

    , with students having more connections for the more social purposes. Students are isolated when working on their research, even in their early years. Research discussion does not occur, unless one is providing casual updates to a peer. Findings for student-faculty networks indicate that these relationships are important but complicated. Advisor selection is often done casually, even when one is switching advisors. Faculty have a lot of influence on the doctoral students such as motivating research collaborations among students or aiding in the job search. Most doctoral students feel as though there is a power dynamic that hinders them from socializing with faculty and thus, are not close to the faculty. Opportunities to develop stronger relationships and for professional development are often missed. The total number of peer and faculty ties has significant relationships to whether a student considers leaving the program. Analyzing the qualitative and quantitative data through demographic variables showed how complex these experiences are. All demographic variables indicated there are statistically significant differences in social experience among the groups, though the extent varies. The year in program variable showed the most differences among cohort years, primarily with those in the fifth year. While gender showed few differences, women tended to have more homophilous peer networks than men and women tended to have more connections to higher prestige faculty. The race/ethnicity, student type, undergraduate institute, subfield, and relationship status variables produced few statistically significant results. Peer networks have statistically significant differences in homophily when examining research type. The regression model suggests that being female, having a higher year in the program, and/or completing undergraduate studies from a liberal arts college increases the time to degree. Being in a relationship (dating or married) and/or working on experimental

  15. Quality of Doctor-Patient Communication through the Eyes of the Patient: Variation According to the Patient's Educational Level

    Science.gov (United States)

    Aelbrecht, Karolien; Rimondini, Michela; Bensing, Jozien; Moretti, Francesca; Willems, Sara; Mazzi, Mariangela; Fletcher, Ian; Deveugele, Myriam

    2015-01-01

    Good doctor-patient communication may lead to better compliance, higher patient satisfaction, and finally, better health. Although the social variance in how physicians and patients communicate is clearly demonstrated, little is known about what patients with different educational attainments actually prefer in doctor-patient communication. In…

  16. Doctor-patient communication in the e-health era.

    Science.gov (United States)

    Weiner, Jonathan P

    2012-08-28

    The digital revolution will have a profound impact on how physicians and health care delivery organizations interact with patients and the community at-large. Over the coming decades, face-to-face patient/doctor contacts will become less common and exchanges between consumers and providers will increasingly be mediated by electronic devices.In highly developed health care systems like those in Israel, the United States, and Europe, most aspects of the health care and consumer health experience are becoming supported by a wide array of technology such as electronic and personal health records (EHRs and PHRs), biometric & telemedicine devices, and consumer-focused wireless and wired Internet applications.In an article in this issue, Peleg and Nazarenko report on a survey they fielded within Israel's largest integrated delivery system regarding patient views on the use of electronic communication with their doctors via direct-access mobile phones and e-mail. A previous complementary paper describes the parallel perspectives of the physician staff at the same organization. These two surveys offer useful insights to clinicians, managers, researchers, and policymakers on how best to integrate e-mail and direct-to-doctor mobile phones into their practice settings. These papers, along with several other recent Israeli studies on e-health, also provide an opportunity to step back and take stock of the dramatic impact that information & communication technology (ICT) and health information technology (HIT) will have on clinician/patient communication moving forward.The main goals of this commentary are to describe the scope of this issue and to offer a framework for understanding the potential impact that e-health tools will have on provider/patient communication. It will be essential that clinicians, managers, policymakers, and researchers gain an increased understanding of this trend so that health care systems around the globe can adapt, adopt, and embrace these rapidly

  17. Doctor-patient communication in the e-health era

    Directory of Open Access Journals (Sweden)

    Weiner Jonathan P

    2012-08-01

    Full Text Available Abstract The digital revolution will have a profound impact on how physicians and health care delivery organizations interact with patients and the community at-large. Over the coming decades, face-to-face patient/doctor contacts will become less common and exchanges between consumers and providers will increasingly be mediated by electronic devices. In highly developed health care systems like those in Israel, the United States, and Europe, most aspects of the health care and consumer health experience are becoming supported by a wide array of technology such as electronic and personal health records (EHRs and PHRs, biometric & telemedicine devices, and consumer-focused wireless and wired Internet applications. In an article in this issue, Peleg and Nazarenko report on a survey they fielded within Israel's largest integrated delivery system regarding patient views on the use of electronic communication with their doctors via direct-access mobile phones and e-mail. A previous complementary paper describes the parallel perspectives of the physician staff at the same organization. These two surveys offer useful insights to clinicians, managers, researchers, and policymakers on how best to integrate e-mail and direct-to-doctor mobile phones into their practice settings. These papers, along with several other recent Israeli studies on e-health, also provide an opportunity to step back and take stock of the dramatic impact that information & communication technology (ICT and health information technology (HIT will have on clinician/patient communication moving forward. The main goals of this commentary are to describe the scope of this issue and to offer a framework for understanding the potential impact that e-health tools will have on provider/patient communication. It will be essential that clinicians, managers, policymakers, and researchers gain an increased understanding of this trend so that health care systems around the globe can adapt, adopt

  18. Doctor-patient-child communication: a (re)view of the literature.

    NARCIS (Netherlands)

    Tates, K.; Meeuwesen, L.

    2001-01-01

    Studies on doctor-patient communication focus predominantly on dyadic interactions between adults; even when the patient is a child, the research focus is usually on doctor-parent interaction. The aim of this review study is to evaluate the state of the art of research into doctor-parent-child

  19. Children and their parents assessing the doctor-patient interaction: a rating system for doctors' communication skills.

    Science.gov (United States)

    Crossley, Jim; Eiser, Christine; Davies, Helena A

    2005-08-01

    Only a patient and his or her family can judge many of the most important aspects of the doctor-patient interaction. This study evaluates the feasibility and reliability of children and their families assessing the quality of paediatricians' interactions using a rating instrument developed specifically for this purpose. A reliability analysis using generalisability theory on the ratings from 352 doctor-patient interactions across different speciality clinics. Ratings were normally distributed. They were highest for 'overall' performance, and lowest for giving time to discuss the families' agenda. An appropriate sample of adults' ratings provided a reliable score (G = 0.7 with 15 raters), but children's ratings were too idiosyncratic to be reproducible (G = 0.36 with 15 raters). CONCLUSIONS AND FURTHER WORK: Accompanying adults can provide reliable ratings of doctors' interactions with children. Because an adult is usually present at the consultation their ratings provide a highly feasible and authentic approach. Sampling doctors' interactions from different clinics and with patients of both genders provides a universal picture of performance. The method is ideal to measure performance for in-training assessment or revalidation. Further work is in progress to evaluate the educational impact of feeding ratings back to the doctors being assessed, and their use in a range of clinical contexts.

  20. Equipping tomorrow's doctors for the patients of today.

    Science.gov (United States)

    Oakley, Rachel; Pattinson, Joanne; Goldberg, Sarah; Daunt, Laura; Samra, Rajvinder; Masud, Tahir; Gladman, John R F; Blundell, Adrian G; Gordon, Adam L

    2014-07-01

    As the proportion of older patients with frailty presenting to health services increases, so does the need for doctors to be adequately trained to meet their needs. The presentations seen in such patients, the evidence-based models of care and skillsets required to deliver them are different than for younger patient groups-so specific training is required. Several research programmes have used detailed and explicit methods to establish evidence-based expert-validated curricula outlining learning outcomes for undergraduates in geriatric medicine-there is now broad-consensus on what newly qualified doctors need to know. There are, despite this, shortcomings in the teaching of undergraduates about geriatric medicine. National and international surveys from the UK, EU, USA, Canada, Austria and the Netherlands have all shown shortcomings in the content and amount of undergraduate teaching. Mechanisms to improve this situation, aside from specifying curricula, include developing academic departments and professorships in geriatric medicine, providing grants to develop teaching in geriatric medicine and developing novel teaching interventions to make the best of existing resources. Under the last of these headings, innovations have been shown to improve outcomes by: using technology to ensure the most effective allocation of teaching time and resources; using inter-professional education as a means of improving attitudes towards care of older patients; focusing teaching specifically on attitudes towards older patients and those who work with them; and trying to engage patients in teaching. Research areas going forward include how to incentivise medical schools to deliver specified curricula, how to choose from an ever-expanding array of teaching technologies, how to implement interprofessional education in a sustainable way and how to design teaching interventions using a qualitative understanding of attitudes towards older patients and the teams that care for them.

  1. Improving patient care. The cognitive psychology of missed diagnoses.

    Science.gov (United States)

    Redelmeier, Donald A

    2005-01-18

    Cognitive psychology is the science that examines how people reason, formulate judgments, and make decisions. This case involves a patient given a diagnosis of pharyngitis, whose ultimate diagnosis of osteomyelitis was missed through a series of cognitive shortcuts. These errors include the availability heuristic (in which people judge likelihood by how easily examples spring to mind), the anchoring heuristic (in which people stick with initial impressions), framing effects (in which people make different decisions depending on how information is presented), blind obedience (in which people stop thinking when confronted with authority), and premature closure (in which several alternatives are not pursued). Rather than trying to completely eliminate cognitive shortcuts (which often serve clinicians well), becoming aware of common errors might lead to sustained improvement in patient care.

  2. Patients' communication with doctors: a randomized control study of a brief patient communication intervention.

    Science.gov (United States)

    Talen, Mary R; Muller-Held, Christine F; Eshleman, Kate Grampp; Stephens, Lorraine

    2011-09-01

    In research on doctor-patient communication, the patient role in the communication process has received little attention. The dynamic interactions of shared decision making and partnership styles which involve active patient communication are becoming a growing area of focus in doctor-patient communication. However, patients rarely know what makes "good communication" with medical providers and even fewer have received coaching in this type of communication. In this study, 180 patients were randomly assigned to either an intervention group using a written communication tool to facilitate doctor-patient communication or to standard care. The goal of this intervention was to assist patients in becoming more effective communicators with their physicians. The physicians and patients both rated the quality of the communication after the office visit based on the patients' knowledge of their health concerns, organizational skills and questions, and attitudes of ownership and partnership. The results supported that patients in the intervention group had significantly better communication with their doctors than patients in the standard care condition. Physicians also rated patients who were in the intervention group as having better overall communication and organizational skills, and a more positive attitude during the office visit. This study supports that helping patients structure their communication using a written format can facilitate doctor-patient communication. Patients can become more adept at describing their health concerns, organizing their needs and questions, and being proactive, which can have a positive effect on the quality of the doctor-patient communication during outpatient office visits. (PsycINFO Database Record (c) 2011 APA, all rights reserved).

  3. Helping Doctors and Patients Make Sense of Health Statistics.

    Science.gov (United States)

    Gigerenzer, Gerd; Gaissmaier, Wolfgang; Kurz-Milcke, Elke; Schwartz, Lisa M; Woloshin, Steven

    2007-11-01

    Many doctors, patients, journalists, and politicians alike do not understand what health statistics mean or draw wrong conclusions without noticing. Collective statistical illiteracy refers to the widespread inability to understand the meaning of numbers. For instance, many citizens are unaware that higher survival rates with cancer screening do not imply longer life, or that the statement that mammography screening reduces the risk of dying from breast cancer by 25% in fact means that 1 less woman out of 1,000 will die of the disease. We provide evidence that statistical illiteracy (a) is common to patients, journalists, and physicians; (b) is created by nontransparent framing of information that is sometimes an unintentional result of lack of understanding but can also be a result of intentional efforts to manipulate or persuade people; and (c) can have serious consequences for health. The causes of statistical illiteracy should not be attributed to cognitive biases alone, but to the emotional nature of the doctor-patient relationship and conflicts of interest in the healthcare system. The classic doctor-patient relation is based on (the physician's) paternalism and (the patient's) trust in authority, which make statistical literacy seem unnecessary; so does the traditional combination of determinism (physicians who seek causes, not chances) and the illusion of certainty (patients who seek certainty when there is none). We show that information pamphlets, Web sites, leaflets distributed to doctors by the pharmaceutical industry, and even medical journals often report evidence in nontransparent forms that suggest big benefits of featured interventions and small harms. Without understanding the numbers involved, the public is susceptible to political and commercial manipulation of their anxieties and hopes, which undermines the goals of informed consent and shared decision making. What can be done? We discuss the importance of teaching statistical thinking and

  4. The persuasive role of ethos in doctor-patient interactions.

    Science.gov (United States)

    Bigi, Sarah

    2011-01-01

    In 'expert-to-non-expert' interactions, one of the distinguishing features is that there is no or very little shared knowledge between the subjects. This situation may become particularly challenging when the unshared knowledge is of a very technical kind, as the likeliness of misunderstandings or unsuccessful communication becomes very high. This is particularly true of interactions between patients and physicians. In the course of such interactions, physicians are expected to inform, advise and persuade patients regarding their health problems. It is especially when differences of opinion emerge that physicians need to be persuasive, but it is also then that this may become very difficult, as the patient does not share the medical expertise of the physician. At these moments, one of the most powerful means of persuasion in the hands of physicians is their professional ethos, or authority. The paper presents partial results of an ongoing research project aimed at describing the ways in which physicians construct their professional ethos in interactions with their patients, and how they use it to reconcile patients' diverging opinions with their own. The analysis is carried out on a corpus of video recordings of doctor-patient interactions and it is aimed at identifying different persuasive strategies based on the professional ethos.

  5. SPECIFICITY OF COMMUNICATION DOCTORPATIENT, ONLINE, THROUGH SOCIAL NETWORKS

    Directory of Open Access Journals (Sweden)

    Florin-Alexandru LUCA

    2014-12-01

    Full Text Available A survey in 2013 of Division Market Research Group Rentrop Straton Romanian-German - "state services and private clinics. Comparative Analysis ", highlights the fact that into urban population in Romania, the internet is the most popular source of information on health services. According to the survey, 81.9% of respondents use the Internet to find out about the best doctors available to them. Preferences of respondents to the online environment as the main source of information translates into ease of access and the possibility of interaction, but also trust recommendations based on personal experiences, recommendations can be found through discussion forums, mostly or comments left on pages on social networking sites. In the present study we try to emphasize the specificity of communication physician - patient online through social networks.

  6. Doctor-Patient Communication in a Southeast Asian Setting: The Conflict between Ideal and Reality

    Science.gov (United States)

    Claramita, Mora; Utarini, Adi; Soebono, Hardyanto; Van Dalen, Jan; Van der Vleuten, Cees

    2011-01-01

    Doctor-patient communication has been extensively studied in non-Western contexts and in relation to patients' cultural and education backgrounds. This study explores the perceived ideal communication style for doctor-patient consultations and the reality of actual practice in a Southeast Asian context. We conducted the study in a teaching…

  7. Doctor-patient communication in a Southeast Asian setting: the conflict between ideal and reality.

    NARCIS (Netherlands)

    Claramita, M.; Utarini, A.; Soebono, H.; Dalen, J. Van; Vleuten, C.P.M. van der

    2011-01-01

    Doctor-patient communication has been extensively studied in non-Western contexts and in relation to patients' cultural and education backgrounds. This study explores the perceived ideal communication style for doctor-patient consultations and the reality of actual practice in a Southeast Asian

  8. Doctors' recognition and management of melanoma patients' risk: An Australian population-based study.

    Science.gov (United States)

    Madronio, C M; Armstrong, B K; Watts, C G; Goumas, C; Morton, R L; Curtin, A; Menzies, S W; Mann, G J; Thompson, J F; Cust, A E

    2016-12-01

    Guidelines recommend that health professionals identify and manage individuals at high risk of developing melanoma, but there is limited population-based evidence demonstrating real-world practices. A population-based, observational study was conducted in the state of New South Wales, Australia to determine doctors' knowledge of melanoma patients' risk and to identify factors associated with better identification and clinical management. Data were analysed for 1889 patients with invasive, localised melanoma in the Melanoma Patterns of Care study. This study collected data on all melanoma diagnoses notified to the state's cancer registry during a 12-month period from 2006 to 2007, as well as questionnaire data from the doctors involved in their care. Three-quarters (74%) of patients had doctors who were aware of their risk factor status with respect to personal and family history of melanoma and the presence of many moles. Doctors working in general practice, skin cancer clinics and dermatology settings had better knowledge of patients' risk factors than plastic surgeons. Doctors were 15% more likely to know the family history of younger melanoma patients (risk status, by doctors practising in plastic surgery, dermatology and skin cancer clinic settings, and by female doctors. Both patient-related and doctor-related factors were associated with doctors' recognition and management of melanoma patients' risk and could be the focus of strategies for improving care. Copyright © 2016 Elsevier Ltd. All rights reserved.

  9. [Walking among doctors and patients. Stories and reflections.

    Science.gov (United States)

    Pagliaro, Luigi; Colli, Agostino

    2016-09-01

    The clinician - the doctor who treats sick people - should be able to establish a good human relationship with his or her patients and their family; should be able to reach a diagnosis even in patients with rare diseases, or atypical presentations - or should refer the patient to a senior colleague; and should be able to recommend the best treatment (or no treatment at all). And he - or she - should be able to draw these abilities from the "deliberate practice" according to Ericsson, i.e. from the combination of experience with reflection - not, or with much lesser strength, from the medical literature as suggested by Evidence-Based Medicine. The diagnosis is often an easy task, i.e. by pattern recognition or recognizing a frequent illness script - "fast thinking" in the vocabulary of Kahneman; or a difficult task, sometimes very difficult for rare diseases or atypical presentations - "slow thinking" of Kahneman. The decisions about the use of therapeutic interventions, whether for individuals or entire healthcare systems, should be based on the totality of the available evidence. The idea that evidence can be reliably or usefully placed in "hierarchies" is illusory, and the pedestal deserved to the RCT is inappropriate.

  10. Spiritual support of cancer patients and the role of the doctor.

    Science.gov (United States)

    Best, Megan; Butow, Phyllis; Olver, Ian

    2014-05-01

    Spiritual care is reported as important for cancer patients, but the role of the doctor in its provision is unclear. We undertook to understand the nature of spiritual support for Australian cancer patients and their preferences regarding spiritual care from doctors. Using grounded theory, semistructured interviews were conducted with 15 cancer patients with advanced disease in a variety of care settings. Patients were asked about the source of their spiritual support and how they would like their doctors to engage with them on spiritual issues. Three themes were identified as follows: (1) sources of spiritual support which helped patients cope with illness and meet spiritual needs, (2) facilitators of spiritual support, and (3) role of the doctor in spiritual support. Regardless of religious background, the majority of patients wanted their doctor to ask about their source of spiritual support and facilitate access to it. Patients did not want spiritual guidance from their doctors, but wanted to be treated holistically and to have a good relationship, which allowed them to discuss their fears. Doctors' understanding of the spiritual dimension of the patient was part of this. Spirituality is a universal phenomenon. Patients in a secular society want their doctor to take an interest in their spiritual support and facilitate access to it during illness.

  11. Missed posterior dislocation of the hip in a head-injured patient with ...

    African Journals Online (AJOL)

    Background: Head injury increases the risk of missed diagnosis by making patient-derived history impossible. The risk of missing a posterior dislocation of the hip in a head-injured patient is aggravated when an ipsilateral femoral shaft fracture co-exists. Adequate radiological evaluation of bone and joints is therefore of ...

  12. Instrumental and socioemotional communications in doctor-patient interactions in urban and rural clinics.

    Science.gov (United States)

    Desjarlais-deKlerk, Kristen; Wallace, Jean E

    2013-07-08

    Location of practice, such as working in a rural or urban clinic, may influence how physicians communicate with their patients. This exploratory pilot study examines the communication styles used during doctor-patient interactions in urban and rural family practice settings in Western Canada. We analyzed observation and interview data from four physicians practicing in these different locations. Using a grounded theory approach, communications were categorized as either instrumental or socioemotional. Instrumental communication refers to "cure-oriented interactions" and tends to be more task-oriented focusing on the patient's health concerns and reason for the appointment. In contrast, socioemotional communication refers to more "care-oriented interactions" that may make the patient feel comfortable, relieve patient anxiety and build a trusting relationship. The physicians in small, rural towns appear to know their patients and their families on a more personal level and outside of their office, and engage in more socioemotional communications compared to those practicing in suburban clinics in a large urban centre. Knowing patients outside the clinic seems to change the nature of the doctor-patient interaction, and, in turn, the doctor-patient relationship itself. Interactions between urban doctors and their patients had a mixture of instrumental and socioemotional communications, while interactions between rural doctors and their patients tended to be highly interpersonal, often involving considerable socioemotional communication and relationship-building. Despite the different ways that doctors and patients communicate with each other in the two settings, rural and urban doctors spend approximately the same amount of time with their patients. Thus, greater use of socioemotional communication by rural doctors, which may ease patient anxiety and increase patient trust, did not appear to add extra time to the patient visit. Research suggests that socioemotional

  13. Improving the doctor-patient relationship in China: the role of balint groups.

    Science.gov (United States)

    Jing, Wei; Otten, Heide; Sullivan, Leonie; Lovell-Simons, Laurie; Granek-Catarivas, Martine; Fritzsche, Kurt

    2013-01-01

    Doctor-patient relationships in China have been deteriorating for the past 10 years. Many Chinese doctors are involved in tense and conflictual doctor-patient relationships. Most patients do not trust doctors or other medical staff and physical attacks on these professionals have become a common event. The Balint group offers a better understanding of the doctor-patient relationship in a safe environment and relieves the doctors from the daily stress. This article (1) describes the specifics of Balint work in China, (2) reports experiences from the first International Balint Conference in China, and (3) compares these experiences with the doctor-patient relationship described by Michael and Enid Balint in the 1950s. Chinese doctors have a great need to communicate, to share their own feelings of powerlessness, helplessness, frustration, and anger. The Balint method is highly appreciated in China. All participants experienced the 2 1/2-day meeting as very helpful. Also, in China, Balint work as relationship work in the analytical group process fosters the ability for introspection alongside openness, unconscious processes, "thinking outside the box," "courage of one's own stupidity," and "beginner's spirit," thus promoting the individuation, the "small but significant change in the personality of the doctor." Perhaps Balint work in China is a contribution to the integration of traditional Chinese virtues: benevolence, tolerance, magnanimity, and prudence with modern medicine. Balint work could be an alternative to the outcome-oriented pressure to perform and to the machine paradigm of biomedicine.

  14. Socio-cultural difference in doctor-patient communication in the European countries.

    NARCIS (Netherlands)

    Brink-Muinen, A. van den; Meeuwesen, L.

    2003-01-01

    Aims: In medical encounters, good doctor-patient communication is of utmost importance in the health care process. The influence of doctor, patients and organizational charactersitics has been showed in many studies. Scarce studies have indicated the importance of cultural characteristics on

  15. Physicians' professionalism at primary care facilities from patients' perspective: The importance of doctors' communication skills.

    Science.gov (United States)

    Sari, Merry Indah; Prabandari, Yayi Suryo; Claramita, Mora

    2016-01-01

    Professionalism is the core duty of a doctor to be responsible to the society. Doctors' professionalism depicts an internalization of values and mastery of professionals' standards as an important part in shaping the trust between doctors and patients. Professionalism consists of various attributes in which current literature focused more on the perspective of the health professionals. Doctors' professionalism may influence patients' satisfaction, and therefore, it is important to know from the patients' perspectives what was expected of medical doctors' professionalism. This study was conducted to determine the attributes of physician professionalism from the patient's perspective. This was a qualitative research using a phenomenology study design. In-depth interviews were conducted with 18 patients with hypertension and diabetes who had been treated for at least 1 year in primary care facilities in the city of Yogyakarta, Indonesia. The results of the interview were transcribed, encoded, and then classified into categories. Communication skills were considered as the top priority of medical doctors' attributes of professionalism in the perspectives of the patients. This study revealed that communication skill is the most important aspects of professionalism which greatly affected in the process of health care provided by the primary care doctors. Doctor-patient communication skills should be intensively trained during both basic and postgraduate medical education.

  16. Doctors' tacit knowledge on coping processes of oral cancer patients: A qualitative study.

    Science.gov (United States)

    Rana, Madiha; Czens, Franziska; Wingartz, Franziska; Gellrich, Nils-Claudius; Rana, Majeed

    2016-12-01

    The implicit knowledge of doctors about coping, quality of life and factors which have an influence on these aspects were investigated. In addition, they were asked about the need for psychological support in clinical practice. Doctors (n = 40) working in the field of oral and maxillofacial surgery, otorhinolaryngology and oncology were interviewed about coping and quality of life of patients, the course of therapy and experiences in the doctor-patient interaction based on a semi-structured interview. The data were analyzed using qualitative content analysis. Hundred percent of the doctors pointed out that patients with oral cancer are a special clientele which definitely needs to have psycho-oncological support. Eighty seven percent of the doctors divide their patients based on their style of coping into two groups: the one who are depressive and do not cope well and active patients who are able to stand their diagnosis. Ninety five percent of the doctors cite personality and social support as key factors affecting the quality of life and style of coping. Lack of time and lack of support from psychologists were given as the main obstacle for holistic treatment. Doctors have very specific ideas about the coping mechanisms and problems of their patients. These theories may have an impact on the doctor-patient relationship and should be considered in more detail. Copyright © 2016 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  17. Patient satisfaction with doctor-patient interaction in a radiotherapy centre during the severe acute respiratory syndrome outbreak.

    Science.gov (United States)

    Tang, J I; Shakespeare, T P; Zhang, X J; Lu, J J; Liang, S; Wynne, C J; Mukherjee, R K; Back, M F

    2005-08-01

    An outpatient radiotherapy department assessed how precautions implemented during the severe acute respiratory syndrome (SARS) outbreak affected patient satisfaction with doctor-patient interaction and explored variables potentially influencing satisfaction. The information obtained would help prepare us for future infectious disease outbreaks. Outpatients seen during the outbreak completed a validated questionnaire assessing satisfaction with doctor-patient interaction. Additional items assessed included patients' perception of SARS measures and patient demographics. Of 149 patients, 97% had heard of SARS, 92% believed SARS precautions necessary, and 54% believed contracting SARS was possible despite the precautions. Patients were satisfied with doctors wearing masks (97%), temperature checks (97%), and patients wearing masks (96%). Despite the high satisfaction levels with SARS precautions, 24% believed it had adversely affected doctor-patient interaction. With regards to doctor-patient interaction, 94% of patients were satisfied. Patients were most satisfied with the 'information exchange' domain (mean score 3.23 out of 4) compared to other domains (P plan (100%), doctor being honest (97%) and being understood (96%). Patients were least satisfied with information about caring for their illness (61%), that the visit could be better (59%), and the doctor showing more interest (58%). On multivariate analysis, patients who were less satisfied with SARS measures were significantly less satisfied with doctor-patient interaction (P = 0.0001). Dissatisfaction with SARS measures was associated with significant dissatisfaction for questions in all domains. Older age and non-breast cancer patients were also less satisfied with doctor-patient interaction. Most (94%) of patients were satisfied with doctor-patient interaction, despite implementation of infectious disease prevention measures. However, patients who were dissatisfied with the SARS precautions had poorer

  18. Medication adherence in patients with hypertension: Does satisfaction with doctor-patient relationship work?

    Directory of Open Access Journals (Sweden)

    Ahmad Mahmoudian

    2017-01-01

    Full Text Available Background: It is assumed that doctor-patient relationship plays an effective role in patients' satisfaction, medication adherence, and health outcomes since exploring different aspects of this relationship, such as addressing medication adherence, has rarely been investigated. Therefore, the main aim of the present study was to assess the impact of patients' satisfaction derived from communicating with doctors on medication adherence in hypertensive patients. Materials and Methods: This cross-sectional survey was conducted on three hundred patients with hypertension, using multistage sampling technique in health care centers in Isfahan, Iran. Data were collected by two questionnaires comprised (1 patients' satisfaction derived from the relationship with doctors and (2 medication adherence named “Morisky Medication Adherence Scale” with 8 items. Multivariate logistic regression model was applied to test the odds ratio (OR of patients' satisfaction resulting from the relationship with physicians in numerous aspects in two groups: appropriate and inappropriate medication adherence. Results: A lower level of satisfaction derived from building the relationship (confidence interval [CI] =0.95, 0.06–0.71 and OR = 0.20 and empathy subscales (CI = 0.95, 13–0.80 and OR = 0.33 was associated with nonadherence to treatment after controlling the physicians' gender and patients' age, gender, education, and duration of disease. Conclusion: Patients' satisfaction resulting from building the relationship and empathy with physicians appeared to be associated with medication adherence among hypertensive patients.

  19. Transforming doctor-patient relationships to promote patient-centered care: lessons from palliative care.

    Science.gov (United States)

    Yedidia, Michael J

    2007-01-01

    Palliative care was studied for its potential to yield lessons for transforming doctor-patient relationships to promote patient-centered care. Examination of patient and provider experiences of the transition from curative to palliative care promises valuable insights about establishing and maintaining trust as the goals of care shift and about addressing a broad spectrum of patient needs. The study was guided by a conceptual framework grounded in existing models to address five dimensions of doctor-patient relationships: range of needs addressed, source of authority, maintenance of trust, emotional involvement, and expression of authenticity. Data collection included observation of the care of 40 patients in the inpatient hospice unit and at home, interviews with patients and family members, and in-depth interviews with 22 physicians and two nurses providing end-of-life care. Standard qualitative procedures were used to analyze the data, incorporating techniques for maximizing the validity of the results and broadening their relevance to other contexts. Findings provide evidence for challenging prominent assumptions about possibilities for doctor-patient relationships: questioning the merits of the prohibition on emotional involvement, dependence on protocols for handling difficult communication issues, unqualified reliance on consumer empowerment to assure that care is responsive to patients' needs, and adoption of narrowly defined boundaries between medical and social service systems in caring for patients. Medical education can play a role in preparing doctors to assume new roles by openly addressing management of emotions in routine clinical work, incorporating personal awareness training, facilitating reflection on interactions with patients through use of standardized patients and videotapes, and expanding capacity to effectively address a broad range of needs through teamwork training.

  20. The Adequacy of Doctor Patient the Relationship to the Requirements of Validity of the legal Transaction: the Doctor Patient Relationship as legal Phenomenon

    Directory of Open Access Journals (Sweden)

    Silvio Romero Beltrão

    2015-04-01

    Full Text Available This work is interdisciplinary and aims to examine the adequacy of the patient-physician relationship to the requirements of validity of legal business. The doctor-patient relationship needs a complete overview on the elements and requirements that constitute its validity in law. As a starting point analyzes the doctor-patient relationship as a legal fact, to then verify the validity requirements of the patient medical legal business, capable agent, object and lawful manner prescribed by law. Investigating the manifestation of the will as the main element of the legal transaction to define the end of the study the importance of the doctor-patient relationship by law, based on the General Theory of Civil Law.

  1. Missed Injuries in Polytrauma Patients after Trauma Tertiary Survey in Trauma Intensive Care Unit.

    Science.gov (United States)

    Tammelin, E; Handolin, L; Söderlund, T

    2016-02-29

    Injuries are often missed during the primary and secondary surveys in trauma patients. Studies have suggested that a formal tertiary survey protocol lowers the number of missed injuries. Our aim was to determine the number, severity, and consequences of injuries missed by a non-formalized trauma tertiary survey, but detected within 3 months from the date of injury in trauma patients admitted to a trauma intensive care unit. We conducted a cohort study of trauma patients admitted to a trauma intensive care unit between 1 January and 17 October 2013. We reviewed the electronic medical records of patients admitted to the trauma intensive care unit in order to register any missed injuries, their delay, and possible consequences. We classified injuries into four types: Type 0, injury detected prior to trauma tertiary survey; Type I, injury detected by trauma tertiary survey; Type II, injury missed by trauma tertiary survey but detected prior to discharge; and Type III, injury missed by trauma tertiary survey and detected after discharge. During the study period, we identified a total of 841 injuries in 115 patients. Of these injuries, 93% were Type 0 injuries, 3.9% were Type I injuries, 2.6% were Type II injuries, and 0,1% were Type III injuries. Although most of the missed injuries in trauma tertiary survey (Type II) were fractures (50%), only 2 of the 22 Type II injuries required surgical intervention. Type II injuries presumably did not cause extended length of stay in the intensive care unit or in hospital and/or morbidity. In conclusion, the missed injury rate in trauma patients admitted to trauma intensive care unit after trauma tertiary survey was very low in our system without formal trauma tertiary survey protocol. These missed injuries did not lead to prolonged hospital or trauma intensive care unit stay and did not contribute to mortality. Most of the missed injuries received non-surgical treatment. © The Finnish Surgical Society 2016.

  2. Predictors of missed appointments in patients referred for congenital or pediatric cardiac magnetic resonance

    Energy Technology Data Exchange (ETDEWEB)

    Lu, Jimmy C.; Dorfman, Adam L. [C.S. Mott Children' s Hospital, Department of Pediatrics and Communicable Diseases, Division of Pediatric Cardiology, University of Michigan Health System, University of Michigan Congenital Heart Center, Ann Arbor, MI (United States); C.S. Mott Children' s Hospital, Department of Radiology, University of Michigan Health System, Section of Pediatric Radiology, Ann Arbor, MI (United States); Lowery, Ray; Yu, Sunkyung [C.S. Mott Children' s Hospital, Department of Pediatrics and Communicable Diseases, Division of Pediatric Cardiology, University of Michigan Health System, University of Michigan Congenital Heart Center, Ann Arbor, MI (United States); Ghadimi Mahani, Maryam [C.S. Mott Children' s Hospital, Department of Radiology, University of Michigan Health System, Section of Pediatric Radiology, Ann Arbor, MI (United States); Agarwal, Prachi P. [University of Michigan Health System, Department of Radiology, Division of Cardiothoracic Radiology, Ann Arbor, MI (United States)

    2017-07-15

    Congenital cardiac magnetic resonance is a limited resource because of scanner and physician availability. Missed appointments decrease scheduling efficiency, have financial implications and represent missed care opportunities. To characterize the rate of missed appointments and identify modifiable predictors. This single-center retrospective study included all patients with outpatient congenital or pediatric cardiac MR appointments from Jan. 1, 2014, through Dec. 31, 2015. We identified missed appointments (no-shows or same-day cancellations) from the electronic medical record. We obtained demographic and clinical factors from the medical record and assessed socioeconomic factors by U.S. Census block data by patient ZIP code. Statistically significant variables (P<0.05) were included into a multivariable analysis. Of 795 outpatients (median age 18.5 years, interquartile range 13.4-27.1 years) referred for congenital cardiac MR, a total of 91 patients (11.4%) missed appointments; 28 (3.5%) missed multiple appointments. Reason for missed appointment could be identified in only 38 patients (42%), but of these, 28 (74%) were preventable or could have been identified prior to the appointment. In multivariable analysis, independent predictors of missed appointments were referral by a non-cardiologist (adjusted odds ratio [AOR] 5.8, P=0.0002), referral for research (AOR 3.6, P=0.01), having public insurance (AOR 2.1, P=0.004), and having scheduled cardiac MR from November to April (AOR 1.8, P=0.01). Demographic factors can identify patients at higher risk for missing appointments. These data may inform initiatives to limit missed appointments, such as targeted education of referring providers and patients. Further data are needed to evaluate the efficacy of potential interventions. (orig.)

  3. How do doctors learn the spoken language of their patients? | Pfaff ...

    African Journals Online (AJOL)

    Methods. Qualitative individual interviews were conducted with seven doctors who had successfully learned the language of their patients, to determine their experiences and how they had succeeded. Results. All seven doctors used a combination of methods to learn the language. Listening was found to be very important, ...

  4. Prescription drug overdose: between patients and their doctors

    Directory of Open Access Journals (Sweden)

    Ling W

    2013-01-01

    Full Text Available Walter Ling,1 Li-Tzy Wu21Department of Psychiatry and Biobehavioral Science, Integrated Substance Abuse Programs, University of California, Los Angeles, CA, USA; 2Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USAPrescription drug overdoses, mainly involving prescription opioids, have reached epidemic proportions in the United States over the past 20 years.1,2 Since 2003, prescription opioids have been involved in more drug-related overdose deaths than heroin and cocaine combined. Among patients who were prescribed opioids, an estimated 20% were prescribed high doses of opioids by either single or multiple physicians, and these patients appeared to account for the majority of prescription opioid-related overdoses.1,3,4 The increase in prescription overdose deaths has coincided with a major increase in prescription opioid sales.2 The prescribing practices of some physicians are often believed to have contributed in part to the increase in these overdose deaths. In a recently published perspective, Anna Lembke speculated on why doctors prescribe opioids to known prescription opioid abusers.5 Her article raises a timely and troubling issue for all of us interested in this area of medicine. Lembke identifies the root of the problem to lie in the changing societal attitude towards pain and suffering, the ever-growing availability of opioid medications, the regulatory requirements promulgated, and the perceived shift in the role of the medical professional in this context. Central to her argument is that physicians must now practice according to a set of externally imposed expectations of patients, payers, and regulators, putting the prescriber in the position of being "damned if you do and damned if you don’t". If Lembke is right, the physician now prescribes not according to what he or she wants to do, but according to what he or she must do. The result, at one extreme, is the patient acting as their

  5. Quality of doctor-patient communication through the eyes of the patient: variation according to the patient's educational level.

    Science.gov (United States)

    Aelbrecht, Karolien; Rimondini, Michela; Bensing, Jozien; Moretti, Francesca; Willems, Sara; Mazzi, Mariangela; Fletcher, Ian; Deveugele, Myriam

    2015-10-01

    Good doctor-patient communication may lead to better compliance, higher patient satisfaction, and finally, better health. Although the social variance in how physicians and patients communicate is clearly demonstrated, little is known about what patients with different educational attainments actually prefer in doctor-patient communication. In this study we describe patients' perspective in doctor-patient communication according to their educational level, and to what extent these perspectives lean towards the expert opinion on doctor-patient communication. In a multi-center study (Belgium, The Netherlands, UK and Italy), focus group discussions were organised using videotaped medical consultations. A mixed methods approach was used to analyse the data. Firstly, a difference in perspective in communication style was found between the lower educated participants versus the middle and higher educated participants. Secondly, lower educated participants referred positively most to aspects related to the affective/emotional area of the medical consultation, followed by the task-oriented/problem-focused area. Middle and higher educated participants positively referred most to the task-oriented/problem-focused area. The competency of the physician was an important category of communication for all participants, independent of social background. The results indicate that the preferences of lower educated participants lean more towards the expert opinion in doctor-patient communication than the middle and higher educated participants. Patients' educational level seems to influence their perspective on communication style and should be taken into account by physicians. Further quantitative research is needed to confirm these results.

  6. [WHO AFFECTS THE PATIENT, DR. GOOGLE OR THE DOCTOR?].

    Science.gov (United States)

    Mishali, Moshe; Avrech, Tova

    2015-09-01

    In the last decade the World Wide Web has become one of the prime sources for medical data searches. The abundance of information and emphasis on consumer communication, which are the main characteristics of the new generation of the web named "Web 2.0", enable users to engage and educate others by sharing and collaborating knowledge. It also enables them to receive medical information based on the experience of other patients, while the duration of the traditional physician's visit has shortened. However, using Web 2.0 for health collaboration has drawbacks as well: When alternative ways of "knowing" replace objective medical facts, there is danger of misinformation and truth "flattening". This article examines the distribution of medical misinformation online: Its characteristics, the nature of the messages presented online and the means that might help protect users and patients from it. The authors hold positions in the Israeli Dairy Board (IDB): Dr. Averch manages the health field on the IDB, and the findings in this article are based on research that she is leading as part of this position, and Dr. Mishali is a trained psychologist, and acts as a strategic consultant for IDB in the field of coping with the opposition to milk and its products. In this article it is initially shown how the characteristics of information distribution in general help spreading medical misinformation online: The decline of doctors' authority as sole providers of medical information, disillusionment and suspicion towards science and the notion of expertise, and the emergence of new ways to evaluate information, based on community ties. The nature of this pseudo-medical information will then be discussed, including the range of the phenomenon and the probability of users to be affected by it. Furthermore, we will raise specific tactics in which anti-establishment messages are portrayed; examples will be given of the use of emotion evoking content in the anti-establishment messages

  7. Doctor-patient communication: a comparison between telemedicine consultation and face-to-face consultation.

    Science.gov (United States)

    Liu, Xiao; Sawada, Yoshie; Takizawa, Takako; Sato, Hiroko; Sato, Mahito; Sakamoto, Hironosuke; Utsugi, Toshihiro; Sato, Kunio; Sumino, Hiroyuki; Okamura, Shinichi; Sakamaki, Tetsuo

    2007-01-01

    The objective of this study was to compare doctor-patient communications in clinical consultations via telemedicine technology to doctor-patient communications in face-to-face clinical consultations. Five doctors who had been practicing internal medicine for 8 to 18 years, and twenty patients were enrolled in this study; neither doctors nor patients had previous experience of telemedicine. The patients received both a telemedicine consultation and a face-to-face consultation. Three measures--video observation, medical record volume, and participants' satisfaction--were used for the assessment. It was found that the time spent on the telemedicine consultation was substantially longer than the time spent on the face-to-face consultation. No statistically significant differences were found in the number of either closed or open-ended questions asked by doctors between both types of consultation. Empathy-utterances, praise-utterances, and facilitation-utterances were, however, seen less in the telemedicine consultations than in the face-to-face consultations. The volume of the medical records was statistically smaller in the telemedicine consultations than in the face-to-face consultations. Patients were satisfied with the telemedicine consultation, but doctors were dissatisfied with it and felt hampered by the communication barriers. This study suggests that new training programs are needed for doctors to develop improved communication skills and the ability to express empathy in telemedicine consultations.

  8. [Doctor-patient relationship in situations of economic precarity: the patient's point of view].

    Science.gov (United States)

    Marron-Delabre, Alice; Rivollier, Elisabeth; Bois, Christophe

    2015-01-01

    Disparity in healthcare is widening in France. From the doctors' perspectives, their relationship with patients in a precarious economic situation raises a number of specific difficulties. The objective of this qualitative study of people in a precarious economic position, was to identify the specific challenges and aspects that can facilitate patient-doctor relationships. This qualitative study was based on a series of individual, semi-structured interviews between GPs and patients over the age of 18 years with a regular GP, and who were financially vulnerable (recipients of state benefits), and/or covered by universal complementary health care insurance, and/or who frequently attended charitable organisations for free food and clothes. A total of 19 people were interviewed. The participants highlighted the expected human dimension: respect, charisma and open-mindedness. A high quality of receptiveness and communication also facilitated the relationship. On the other hand, lack of availability, an authoritative tone and intrusion hindered the relationship. The patients did not appear to have any additional demands related to their economic vulnerability. In conversation with their GPs, the patients did not define themselves by their unstable financial position. The patients' experience and expectations in relation to interactions with their doctors appeared to be similar to those of the general population.

  9. Significance of gender in the attitude towards doctor-patient communication in medical students and physicians.

    Science.gov (United States)

    Löffler-Stastka, Henriette; Seitz, Tamara; Billeth, Sabrina; Pastner, Barbara; Preusche, Ingrid; Seidman, Charles

    2016-09-01

    Gender-specific differences in the attitudes towards doctor-patient communication among medical students and physicians were assessed. A total of 150 medical students and 51 physicians from different departments took part in the study. The association, attitude and experiences regarding doctor-patient communication were assessed with a series of tools and questionnaires. Female doctors and students tended to describe the doctor-patient communication with positive attributes, such as "helpful", "sentimental", "voluble", "sociable", "gentle", "yielding" and "peaceful". Male students and physicians, on the other hand, described doctor-patient communication as "overbearing", "robust" and "inhibited". The most frequent associations females had with the term doctor-patient communication were "empathy", "confidence", "openess", while the most frequent association of the male colleagues was "medical history". Female doctors reported speaking about the psychosocial situation of the patient significantly more often and believed in higher patient satisfaction by sharing more information. Furthermore, they reported having longer conversations with a more equal partnership than their male colleagues. Compared to male students, female students were willing to take part in training their communication skills more often and had more interest in research about doctor-patient communication. Male medical students reported self-doubt during conversations with female patients, while one third of the male physicians talked about "the power over the patient". This study indicates a gender-dependent communication style influenced by stereotypes. At the establishment of communication training these differences should be taken into account, especially to strengthen male communication skills and improve their attitudes.

  10. Intercultural doctor-patient communication in daily outpatient care: relevant communication skills

    NARCIS (Netherlands)

    Paternotte, E.; Scheele, F.; Seeleman, C.M.; Bank, L.; Scherpbier, A.J.; Dulmen, S. van

    2016-01-01

    INTRODUCTION: Intercultural communication (ICC) between doctors and patients is often associated with misunderstandings and dissatisfaction. To develop ICC-specific medical education, it is important to find out which ICC skills medical specialists currently apply in daily clinical consultations.

  11. The role of mobile devices in doctor-patient communication: A systematic review and meta-analysis.

    Science.gov (United States)

    Kashgary, Abdullah; Alsolaimani, Roaa; Mosli, Mahmoud; Faraj, Samer

    2017-09-01

    Introduction In the last few years, the use of telecommunication and mobile technology has grown significantly. This has led to a notable increase in the utilization of this telecommunication in healthcare, namely phone calls and text messaging (SMS). However, evaluating its global impact on improving healthcare processes and outcomes demands a more comprehensive assessment. In this study, we focused on the role of mobile devices via phone calls and SMS in patient-doctor communication, and aimed to assess its impact on various health outcomes. Methods Major databases, including MEDLINE, EMBASE, PsycINFO, Global Health, and Cochrane CENTRAL, were searched for clinical trials that investigated mobile-device technology in any facet of doctor-patient communication published between 1990 and April 2015. A meta-analysis was performed where appropriate. Results Sixty-two articles met our inclusion criteria. Of those, 23 articles investigated mobile appointment reminder technologies, 19 investigated medication adherence, 20 investigated disease-control interventions, and two investigated test-result reporting. Patients who received an appointment reminder were 10% less likely to miss an appointment (relative risk [RR] = 1.11, 95% confidence interval [CI] 1.08-1.15). Mobile interventions increased medication adherence by 22% (RR = 1.22, 95% CI 1.09-1.36). Ten of 20 studies examining disease control reported statistically significant reductions in clinically meaningful endpoints. The use of mobile-device interventions improved forced expiratory volume in one second and hemoglobin A1c percentage in meta-analyses. Conclusion The use of mobile-device technologies exerted modest improvements in communication and health outcomes. Further research is needed to determine the true effect of these technologies on doctor-patient communication.

  12. The doctor's role in helping dying patients with cancer achieve peace: a qualitative study.

    Science.gov (United States)

    Best, Megan; Butow, Phyllis; Olver, Ian

    2014-10-01

    Being at peace is important for the quality of life of dying cancer patients, but its features, and the role of the doctor in facilitating peace, are unclear. We sought to understand the features of a peaceful patient, and patients' preferences regarding the role of the doctor in facilitating a sense of peace. A grounded theory approach was used with semi-structured interviews. Patients were asked about the things that gave their life meaning and a sense of peace and how the doctor could support their spiritual well-being. Patients were also questioned about their concerns for their future. In total, 15 cancer patients with advanced disease were interviewed in a variety of care settings. Patients were observed to be along a spectrum between having peace and not having peace. Features of the two extreme positions are described. Doctors could facilitate peace by developing a good relationship with cancer patients and supplying clear and honest information about what patients could expect as they approached their death. Spiritual well-being in cancer patients can be promoted by communication from doctors regarding prognosis, which allows them time to prepare for death, and recognition of their fears. However, acceptance of death does not always lead to the patient experiencing peace. © The Author(s) 2014.

  13. Intercultural doctor-patient communication in daily outpatient care: relevant communication skills.

    Science.gov (United States)

    Paternotte, Emma; Scheele, Fedde; Seeleman, Conny M; Bank, Lindsay; Scherpbier, Albert J J A; van Dulmen, Sandra

    2016-10-01

    Intercultural communication (ICC) between doctors and patients is often associated with misunderstandings and dissatisfaction. To develop ICC-specific medical education, it is important to find out which ICC skills medical specialists currently apply in daily clinical consultations. Doctor-patient consultations of Dutch doctors with non-Dutch patients were videotaped in a multi-ethnic hospital in the Netherlands. The consultations were analyzed using the validated MAAS-Global assessment list in combination with factors influencing ICC, as described in the literature. In total, 39 videotaped consultations were analyzed. The doctors proved to be capable of practising many communication skills, such as listening and empathic communication behaviour. Other skills were not practised, such as being culturally aware and checking the patient's language ability. We showed that doctors did practice some but not all the relevant ICC skills and that the ICC style of the doctors was mainly biomedically centred. Furthermore, we discussed the possible overlap between intercultural and patient-centred communication. Implications for practice could be to implement the relevant ICC skills in the existing communication training or develop a communication training with a patient-centred approach including ICC skills.

  14. [Doctor-patient relationship in the context of a changing society].

    Science.gov (United States)

    Siebzehner, Miriam Ines; Balik, Chaya; Matalon, Andre

    2008-12-01

    During the 20th century doctors gained a special status in the medical system, which is about to change as a consequence of a change in the doctor-patient relationship and in the characteristics of the labor market in health care. Some changes correspond with the adoption of business terms within the medical system. The doctor is represented as a supplier of services, while the patient is a consumer. From patient-centered care, the doctor-patient relationship changed to a costumer-supplier of services, as is the case in other fields of the consumer society. This article analyzes the changes in the patterns of the doctor-patient interactions in the light of the changes in society over the last decades such as: the creation of regulations and laws on patients' rights; the establishment of organizations that represent the sick, the distribution of knowledge and information by means of mass communication, changes in the status of the doctors, the academization of other health professionals and changes in the management of health care to a more financially viable approach to the costs of health.

  15. The image ofan ideal psychiatrist inthe eyes of medical students, patients and doctors involved inpsychiatric care

    Directory of Open Access Journals (Sweden)

    Aleksandra Margulska

    2013-03-01

    Full Text Available Aim: The aim of the study was to determine differences in the image of ideal psychiatrist (IIP among patients, doctors involved in psychiatric care and medical students and also between individuals with different work experience (doctors vs. students. The psychiatrist’s personality seems an important factor in supporting therapeutic process; therefore it is worth searching for the patient’s needs. Materials and methods: Three groups participated in the study: patients of the psychiatric units, medical students of 6th year and psychiatrists. The Gough and Heilbrun ACL (Adjective Check List – based on Mur‑ ray’s theory of needs – was used to assess IIP. Results: Data analysis revealed statistically significant differences among patients, doctors and students involving five scales: Nurturance, Aggression, Change, Succorance and Deference. Patients had lower scores on Change scale than doctors and higher scores on the Nurturance, Succurance and Deference than stu‑ dents. Psychiatrists had higher scores on Nurturance and Deference scale and lower score on Aggression scale than students. Conclusions: The findings showed differences in the expectations of patients compared to those of students and doctors. The most significant difference that was observed involved the Change. It may indicate that patients prefer order, conventional approach and stability in psychiatrist’s personality traits more commonly than doctors. Study findings suggest that work experience has impact on IIP: with increasing work experience, opinion about IIP comes closer to patients’ expectations.

  16. Patient-Reported Attributions for Missed Colonoscopy Appointments in Two Large Healthcare Systems.

    Science.gov (United States)

    Bhise, Viraj; Modi, Varsha; Kalavar, Anisha; Espadas, Donna; Hanser, Loretta; Gould, Milena; El-Serag, Hashem B; Singh, Hardeep

    2016-07-01

    Missed colonoscopy appointments (no-shows) can lead to wasted resources and delays in colorectal cancer diagnosis, an area of special concern in public health systems that often provide care for vulnerable patients. Our objective was to identify reasons for missed colonoscopy appointments in patients seeking care at two large public health systems in Houston, TX. We conducted a telephone survey of patients who missed their colonoscopy appointments at two tertiary care health systems. Using a structured survey instrument, we collected information on patient-specific and health services barriers. Patient-specific barriers included perceived procedural-related factors (e.g., difficulty in preparation), cognitive-emotional factors (e.g., fear or concern about modesty), and changes in health status (e.g., improvement or worsening of health). Health services barriers included logistical factors (e.g., travel-related difficulties) and appointment scheduling problems (inconvenient date or time). We examined differences in attributions for missed appointments between the two study sites. Of 160 unique patients (102 Site A and 58 Site B) who missed their appointment during the study period, 153 (95.6 %) attributed their no-show to at least one of the listed barriers. Most respondents (125; 78.1 %) cited travel-related issues or scheduling problems as reasons for their missed appointment. Not having a ride or a travel companion was the most commonly reported travel-related issue. We also found significant differences for barriers between the two sites. Most missed colonoscopy appointments resulted from potentially preventable travel- and scheduling-related issues. Because barriers to keeping colonoscopy appointments are different across health systems, each health system might need to develop unique interventions to reduce missed colonoscopy appointments.

  17. Anaphylaxis: lack of hospital doctors' knowledge of adrenaline (epinephrine) administration in adults could endanger patients' safety.

    Science.gov (United States)

    Droste, J; Narayan, N

    2012-06-01

    Adrenaline (epinephrine) is the first line drug to be given in anaphylaxis and can save patients' lives. Conversely, incorrect administration of adrenaline in anaphylaxis has caused patients serious harm, including death. We compared the survey results of doctors' knowledge of adrenaline administration in adults of two District General Hospitals Trusts in England and found, that from 284 Hospital Doctors, 14.4% (n = 41) would administer adrenaline as recommended by published anaphylaxis guidelines. This survey comparison shows that a significant number of hospital doctors, regardless of seniority and specialty, have an educational deficit regarding correct administration of adrenaline (epinephrine) administration in adults with anaphylaxis. Multilevel strategies to educate doctors and prevent patient harm are needed. We propose a mnemonic for remembering the recommended treatment for anaphylaxis in the adult: "A Thigh 500" forAdrenaline into the antero-lateral thigh, 500 micrograms.

  18. Do doctors pay attention to the religious beliefs of their patients? A survey amongst Dutch GPs

    NARCIS (Netherlands)

    Kuyck, WGE; Kuyvenhoven, MM

    Background. Patients' religious beliefs can offer support at times of illness and disease. Therefore religious beliefs of patients are important in doctor-patient interaction, Objective. To assess to what extent GPs pay attention to religious beliefs of patients in their daily work. Methods. A

  19. Patient satisfaction with doctor-patient interactions: a mixed methods study among diabetes mellitus patients in Pakistan.

    Science.gov (United States)

    Jalil, Aisha; Zakar, Rubeena; Zakar, Muhammad Zakria; Fischer, Florian

    2017-02-21

    Patient satisfaction with doctor-patient interactions is an indicator of physicians' competence. The satisfaction of diabetes patients is rarely studied in public diabetes clinics of Pakistan. Thus, this study aims to analyse the association between patient satisfaction and five dimensions of medical interaction: technical expertise, interpersonal aspects, communication, consultation time, and access/availability. A cross-sectional mixed methods study was conducted during July and August 2015 in the largest public diabetes outpatient clinic in Punjab province. We used the criterion sampling method to identify 1164 patients who: (i) were adult (18 years and above), (ii) had diabetes mellitus, (iii) had made at least three previous visits to the same clinic. The data was collected through face-to-face interviews. The structured part of the questionnaire was based on demographic characteristics and the Patient Satisfaction Questionnaire (PSQ-III). We translated the questionnaire into Urdu and pretested it with 25 patients in a similar context. Data storage and analysis were carried out using SPSS (version 22.0). Bivariate analyses and multinomial logistic regression model were used to generate the quantitative findings. Out of the 1164 eligible patients approached for interviews, 1095 patients completed the structured questionnaire and 186 respondents provided qualitative information in comments section. We conducted a thematic content analysis of qualitative responses in order to explain the quantitative findings. Demographic characteristics such as gender, education and occupation were significantly associated with the levels of patient satisfaction. The dimensions of doctor-patient interaction were significantly associated with patient satisfaction: technical expertise (OR = .87; 95% CI = .84-.91), interpersonal aspects (OR = .82; 95% CI = .77-.87), communication (OR = .83; 95% CI = .78-.89), time dimension (OR = .90; 95% CI = .81

  20. Sexualization of the doctor-patient relationship: is it ever ethically permissible?

    Science.gov (United States)

    Hall, K H

    2001-10-01

    Whilst having sexual relationships with current patients is clearly unethical, the ethics of such a relationship between a doctor and former patient is more debatable. In this review of the current evidence, based on major articles listed in Medline and Bioethicsline in the past 15 years, the argument is made here that such relationships are almost always unethical due to the persistence of transference, the unequal power distribution in the original doctor-patient relationship and the ethical implications that arise from both these factors especially with respect to the patient's autonomy and ability to consent, even when a former patient. Only in very particular circumstances could such relationships be ethically permissible.

  1. Fears, Uncertainties, and Hopes: Patient-Initiated Actions and Doctors' Responses During Oncology Interviews.

    Science.gov (United States)

    Beach, Wayne A; Dozier, David M

    2015-01-01

    New cancer patients frequently raise concerns about fears, uncertainties, and hopes during oncology interviews. This study sought to understand when and how patients raise their concerns, how doctors responded to these patient-initiated actions, and implications for communication satisfaction. A subsampling of video recorded and transcribed encounters was investigated involving 44 new patients and 14 oncologists. Patients completed pre/post self-report measures about fears, uncertainties, and hopes as well as postevaluations of interview satisfaction. Conversation analysis was used to initially identify pairs of patient-initiated and doctor-responsive actions. A coding scheme was subsequently developed, and two independent coding teams, comprised of two coders each, reliably identified patient-initiated and doctor-responsive social actions. Interactional findings reveal that new cancer patients initiate actions much more frequently than previous research had identified, concerns are usually raised indirectly, and with minimal emotion. Doctors tend to respond to these concerns immediately, but with even less affect, and rarely partner with patients. From pre/post results, it was determined that the higher patients' reported fears, the higher their postvisit fears and lower their satisfaction. Patients with high uncertainty were highly proactive (e.g., asked more questions), yet reported even greater uncertainties after encounters. Hopeful patients also exited interviews with high hopes. Overall, new patients were very satisfied: oncology interviews significantly decreased patients' fears and uncertainties, while increasing hopes. Discussion raises key issues for improving communication and managing quality cancer care.

  2. Doctors' views about the importance of shared values in HIV positive patient care: a qualitative study.

    Science.gov (United States)

    Lawlor, A; Braunack-Mayer, A

    2004-12-01

    Robert Veatch has proposed a model of the doctor-patient relationship that has as its foundation the sharing of values between the doctor and the patient. This paper uses qualitative research conducted with six doctors involved in the long term, specialised care of HIV positive patients in South Australia to explore the practical application of Veatch's value sharing model in that setting. The research found that the doctors in this study linked "values" with sexual identity such that they defined value sharing, in part, as a shared set of values and beliefs about sexual identity and practices. They voluntarily identified themselves as either homosexual or heterosexual and they regarded the relation between their own sexual identity and that of their patients as important for the provision of quality care. None of the doctors thought that value sharing, in the way they defined it, was essential to the clinical relationship, but the homosexual doctors attributed a greater degree of importance to it than their heterosexual colleagues.

  3. Detection of patient psychological distress and longitudinal patient–doctor relationships: a cross-sectional study

    Science.gov (United States)

    Ridd, Matthew; Lewis, Glyn; Peters, Tim J; Salisbury, Chris

    2012-01-01

    Background Psychological distress in patients who attend their GP is thought to be under-recognised. However, it is likely that both disclosure and detection are influenced by how well the patient and doctor know each another. Aim To examine whether patient–doctor depth of relationship is associated with identification of psychological distress. Design and setting Cross-sectional study in general practices in and around Bristol, England. Method Patients (aged ≥16 years) were asked to complete a questionnaire and consent to their electronic medical records being reviewed. Study GPs independently assessed patient psychological distress. Multivariable logistic regression was used to look for associations between patient–doctor depth of relationship and GP detection of patient psychological distress (defined according to the 12-item General Health Questionnaire, GHQ-12). Results There were 643 eligible appointments with 31 GPs. In total, 541 (84.1%) patients returned questionnaires and 490 (76.2%) consented to their records being reviewed. Patient–doctor depth of relationship was not associated with GP detection of mild to severe patient psychological distress (adjusted odds ratio [OR] 0.94, 95% CI = 0.87 to 1.02) but, in secondary analyses, it was associated with the identification of moderate to severe distress (adjusted OR 1.13, 95% CI = 1.02 to 1.26). GPs reported more patient psychological distress in patients who reported a greater depth of relationship but this did not relate to patients' GHQ-12 scores. Conclusion Evidence to support an association between patient–doctor depth of relationship and improved GP detection of patients with psychological distress was weak, except in those patients who GPs thought were more distressed. GPs may overestimate emotional distress in patients who report deeper patient–doctor relationships. PMID:22429433

  4. Ulysses contracts for the doctor and for the patient.

    Science.gov (United States)

    Hansson, Mats G; Hakama, Matti

    2010-05-01

    Research subjects participating in randomised clinical trials have a right to drop out of a study without specifying any reason for this. However, leaving a trial may be contradictory to their own general interests in medical research since drop outs may lead to biased conclusions and loss of valuable medical information. We suggest in this paper that self-binding "Ulysses contracts" that are non-exploitative and based on autonomous decisions by research subjects as well as by investigating doctors should be implemented with stopping rules adjusted to the needs of different kinds of randomised clinical trials. Copyright (c) 2010 Elsevier Inc. All rights reserved.

  5. ICT and the future of health care: aspects of doctor-patient communication.

    Science.gov (United States)

    Haluza, Daniela; Jungwirth, David

    2014-07-01

    The current digital revolution is particularly relevant for interactions of healthcare providers with patients and the community as a whole. The growing public acceptance and distribution of new communication tools such as smart mobile phones provide the prerequisite for information and communication technology (ICT) -assisted healthcare applications. The present study aimed at identifying specifications and perceptions of different interest groups regarding future demands of ICT-supported doctor-patient communication in Austria. German-speaking Austrian healthcare experts (n = 73; 74 percent males; mean age, 43.9 years; SD 9.4) representing medical professionals, patient advocates, and administrative personnel participated in a 2-round online Delphi process. Participants evaluated scenario-based benefits and obstacles for possible prospect introduction as well as degree of innovation, desirability, and estimated implementation dates of two medical care-related future set ups. Panelists expected the future ICT-supported doctor-patient dialogue to especially improve the three factors doctors-patient relationship, patients' knowledge, and quality of social health care. However, lack of acceptance by doctors, data security, and monetary aspects were considered as the three most relevant barriers for ICT implementation. Furthermore, inter-group comparison regarding desirability of future scenarios showed that medical professionals tended to be more skeptical about health-related technological innovations (p ICT-supported collaboration and communication between doctors and patients.

  6. Attachment in the doctor-patient relationship in general practice: a qualitative study

    DEFF Research Database (Denmark)

    Frederiksen, Heidi Bøgelund; Kragstrup, Jakob; Dehlholm-Lambertsen, Birgitte

    2010-01-01

    OBJECTIVE: To explore why interpersonal continuity with a regular doctor is valuable to patients. DESIGN, SETTING, AND SUBJECTS: A qualitative study based on 22 interviews with patients, 12 who saw their regular general practitioner (GP) and 10 who saw an unfamiliar GP. The patients were selected...

  7. ABCDE in Clinical Encounters: Presentations of Self in Doctor-Patient Communication.

    Science.gov (United States)

    Ventres, William

    2015-01-01

    Professional discussions about communication in medical settings often ignore the various personal identities that doctors and patients bring to their clinical encounters. From my 26 years as a family physician, and informed by literature from other professional disciplines, I propose an alternate understanding: to think of doctors and patients as a collection of individual identities, each formed by a discrete presentation of self. I describe how at least 5 important presentations of self arise in clinical encounters, including those relating to meaning, community, agency, anxiety, and organism. I frame these presentations of self with the mnemonic ABCDE, briefly review key dimensions of each, and suggest how physicians can reflect on these dimensions in order to find equilibrium in their interactions with patients. Lastly, I submit that finding this balance can reduce relational challenges with patients and enhance the therapeutic effectiveness of doctor-patient communication. © 2015 Annals of Family Medicine, Inc.

  8. Facebook activity of residents and fellows and its impact on the doctor-patient relationship.

    Science.gov (United States)

    Moubarak, Ghassan; Guiot, Aurélie; Benhamou, Ygal; Benhamou, Alexandra; Hariri, Sarah

    2011-02-01

    Facebook is an increasingly popular online social networking site. The purpose of this study was to describe the Facebook activity of residents and fellows and their opinions regarding the impact of Facebook on the doctor-patient relationship. An anonymous questionnaire was emailed to 405 residents and fellows at the Rouen University Hospital, France, in October 2009. Of the 202 participants who returned the questionnaire (50%), 147 (73%) had a Facebook profile. Among responders, 138 (99%) displayed their real name on their profile, 136 (97%) their birthdates, 128 (91%) a personal photograph, 83 (59%) their current university and 76 (55%) their current position. Default privacy settings were changed by 61% of users, more frequently if they were registered for >1 year (p=0.02). If a patient requested them as a 'friend', 152 (85%) participants would automatically decline the request, 26 (15%) would decide on an individual basis and none would automatically accept the request. Eighty-eight participants (48%) believed that the doctor-patient relationship would be altered if patients discovered that their doctor had a Facebook account, but 139 (76%) considered that it would change only if the patient had open access to their doctor's profile, independent of its content. Residents and fellows frequently use Facebook and display personal information on their profiles. Insufficient privacy protection might have an impact the doctor-patient relationship.

  9. Web-based hazard and near-miss reporting as part of a patient safety curriculum.

    Science.gov (United States)

    Currie, Leanne M; Desjardins, Karen S; Levine, Ellen Sunni; Stone, Patricia W; Schnall, Rebecca; Li, Jianhua; Bakken, Suzanne

    2009-12-01

    As part of a patient safety curriculum, we developed a Web-based hazard and near-miss reporting system for postbaccalaureate nursing students to use during their clinical experiences in the first year of their combined BS-MS advanced practice nurse program. The 25-week clinical rotations included 2 days per week for 5 weeks each in community, medical-surgical, obstetrics, pediatrics, and psychiatric settings. During a 3-year period, 453 students made 21,276 reports. Of the 10,206 positive (yes) responses to a hazard or near miss, 6,005 hazards (59%) and 4,200 near misses (41%) were reported. The most common reports were related to infection, medication, environmental, fall, and equipment issues. Of the near misses, 1,996 (48%) had planned interceptions and 2,240 (52%) had unplanned interceptions. Types of hazards and near misses varied by rotation. Incorporating hazard and near-miss reporting into the patient safety curriculum was an innovative strategy to promote mindfulness among nursing students.

  10. Patient perspectives on online health information and communication with doctors: a qualitative study of patients 50 years old and over.

    Science.gov (United States)

    Silver, Michelle Pannor

    2015-01-13

    As health care systems around the world shift toward models that emphasize self-care management, there is increasing pressure for patients to obtain health information online. It is critical that patients are able to identify potential problems with using the Internet to diagnose and treat a health issue and that they feel comfortable communicating with their doctor about the health information they acquire from the Internet. Our aim was to examine patient-identified (1) problems with using the Internet to identify and treat a health issue, (2) barriers to communication with a doctor about online health information seeking, and (3) facilitators of communication with a doctor about patient searches for health information on the Internet. For this qualitative exploratory study, semistructured interviews were conducted with a sample of 56 adults age 50 years old and over. General concerns regarding use of the Internet to diagnose and treat a health issue were examined separately for participants based on whether they had ever discussed health information obtained through the Internet with a doctor. Discussions about barriers to and facilitators of communication about patient searches for health information on the Internet with a doctor were analyzed using thematic analysis. Six higher-level general concerns emerged: (1) limitations in own ability, (2) credibility/limitations of online information, (3) anxiety, (4) time consumption, (5) conflict, and (6) non-physical harm. The most prevalent concern raised by participants who communicated with a doctor about their online health information seeking related to the credibility or limitations in online information. Participants who had never communicated with a doctor about their online health information seeking most commonly reported concerns about non-physical harm. Four barriers to communication emerged: (1) concerns about embarrassment, (2) concerns that the doctor doesn't want to hear about it, (3) belief that there

  11. Study abroad experience is related to Japanese doctors' behavior to see foreign patients.

    Science.gov (United States)

    Tamamaki, Kinko; Nishio, Hisahide

    2013-04-17

    Globalization in Japan involves increases in the number of foreign residents. While there are some English-speaking Japanese doctors that are willing to see foreign patients, many are reluctant to do so. In this study, we attempted to clarify the factors that encourage Japanese doctors to see foreign patients. We conducted a questionnaire survey among medical doctors in Kobe City, Japan. The questionnaire was distributed to 172 doctors, and we received 139 responses. Statistical analysis showed a significant correlation between the frequency of seeing foreign patients and having the experience of studying abroad (pEnglish ability (pEnglish research articles. These data suggested that the experience of living abroad rather than the exposure to English research articles was more highly correlated with seeing greater numbers of foreign patients. In conclusion, greater exposure to colloquial English was one of the determinants of the doctors' greater willingness to see foreign patients. In the Japanese medical education curriculum, therefore, it would be necessary to offer alternatives to studying abroad for those students who do not have such opportunities.

  12. BREACHING THE SEXUAL BOUNDARIES IN THE DOCTOR-PATIENT RELATIONSHIP: SHOULD ENGLISH LAW RECOGNISE FIDUCIARY DUTIES?

    Science.gov (United States)

    Ost, Suzanne

    2016-01-01

    In this article, I argue that sexual exploitation in the doctor-patient relationship would be dealt with more appropriately by the law in England and Wales on the basis of a breach of fiduciary duty. Three different types of sexual boundary breaches are discussed, and the particular focus is on breaches where the patient's consent is obtained through inducement. I contend that current avenues of redress do not clearly catch this behaviour and, moreover, they fail to capture the essence of the wrong committed by the doctor-the knowing breach of trust for self-gain-and the calculated way in which consent is induced. Finally, I demonstrate that the fiduciary approach is compatible with the contemporary pro-patient autonomy model of the doctor-patient relationship. © The Author 2016. Published by Oxford University Press; all rights reserved. For Permissions, please email: journals.permissions@oup.com.

  13. Doctors Today

    LENUS (Irish Health Repository)

    Murphy, JFA

    2012-03-01

    Doctors’ relationship with patients and their role in society is changing. Until the 1960s doctors concentrated on the welfare of patients with less emphasis placed on patients’ rights1. Over recent decades there has been increasing empowerment of the individual across all facets of society including health care. Doctors continue to be perceived as having expertise and authority over medical science. Patients, however, now hold sway over questions of values or preferences. We all must be aware of this change in the doctor- patient interaction. We need to be more aware of the outcomes that patients view as important. The concept of shared decision-making with the patient is now widely appreciated. The process involves a change in mind set particularly for doctors who trained in an earlier era.

  14. The impact of doctor-patient communication on patients' perceptions of their risk of breast cancer recurrence.

    Science.gov (United States)

    Janz, Nancy K; Li, Yun; Zikmund-Fisher, Brian J; Jagsi, Reshma; Kurian, Allison W; An, Lawrence C; McLeod, M Chandler; Lee, Kamaria L; Katz, Steven J; Hawley, Sarah T

    2017-02-01

    Doctor-patient communication is the primary way for women diagnosed with breast cancer to learn about their risk of distant recurrence. Yet little is known about how doctors approach these discussions. A weighted random sample of newly diagnosed early-stage breast cancer patients identified through SEER registries of Los Angeles and Georgia (2013-2015) was sent surveys about ~2 months after surgery (Phase 2, N = 3930, RR 68%). We assessed patient perceptions of doctor communication of risk of recurrence (i.e., amount, approach, inquiry about worry). Clinically determined 10-year risk of distant recurrence was established for low and intermediate invasive cancer patients. Women's perceived risk of distant recurrence (0-100%) was categorized into subgroups: overestimation, reasonably accurate, and zero risk. Understanding of risk and patient factors (e.g. health literacy, numeracy, and anxiety/worry) on physician communication outcomes was evaluated in multivariable regression models (analytic sample for substudy = 1295). About 33% of women reported that doctors discussed risk of recurrence as "quite a bit" or "a lot," while 14% said "not at all." Over half of women reported that doctors used words and numbers to describe risk, while 24% used only words. Overestimators (OR .50, CI 0.31-0.81) or those who perceived zero risk (OR .46, CI 0.29-0.72) more often said that their doctor did not discuss risk. Patients with low numeracy reported less discussion. Over 60% reported that their doctor almost never inquired about worry. Effective doctor-patient communication is critical to patient understanding of risk of recurrence. Efforts to enhance physicians' ability to engage in individualized communication around risk are needed.

  15. Cleft sidedness and congenitally missing teeth in patients with cleft lip and palate patients

    Directory of Open Access Journals (Sweden)

    Abdolreza Jamilian

    2016-05-01

    Full Text Available Abstract Background The aim of this study was to investigate the prevalence of cleft sidedness, and the number of congenitally missing teeth in regard to cleft type and gender. Methods The charts, models, radiographs, and intraoral photographs of 201 cleft patients including 131 males with the mean age of 12.3 ± 4 years and 70 females with the mean age of 12.6 ± 3.9 years were used for the study. T test, Chi-square, and binomial tests were used for assessment of the data. Results and conclusions One hundred forty-eight of the subjects suffered from cleft lip and palate followed by 41 subjects who suffered from cleft lip and alveolus. Chi-square test did not show any significant difference between the genders. Binomial test showed that left-sided cleft was more predominant in unilateral cleft lip and palate patients (P < 0.001. This study also showed that the upper lateral incisors were the most commonly missing teeth in the cleft area.

  16. Analysing the doctor_patient_computer relationship: the use of video data

    Directory of Open Access Journals (Sweden)

    Christopher Pearce

    2006-12-01

    Full Text Available This paper examines the utility of using digital video data in observational studies involving doctors' and patients' use of computers in the consultation. Previous observational studies have used either direct observations or analogue videotapes. We describe a method currently in use in a study examining how doctors, patients and computers interact in the consultation. The study is set in general practice as this is the most clinically computerised section of the Australian healthcare system. Computers are now used for clinical functions in 90% of doctors' surgeries. With this rapid rise of computerisation, concerns have been expressed as to how the computer will affect the doctor_patient relationship. To assess how doctors, patients and computers interact, we have chosen an observational technique, namely to make digital videotapes of actual consultations. This analysis is based on a theoretical framework derived from dramaturgical analysis. Data are gathered from general practitioners who are high-level users of computers, as defined by their use of progress notes, as well as prescribing and test ordering. The subsequent digital data is then transferred onto computer and analysed according to our conceptual framework, making use of video-tagging software.

  17. Doctor to patient ratio and infrastructure gap in a psychiatric hospital ...

    African Journals Online (AJOL)

    This cross sectional retrospective study aimed at bringing to global attention the wide mismatch between doctors and infrastructure available to patients seeking mental health care at Psychiatric hospital, Eket, Akwa Ibom, Nigeria, and the implications of such mental health gap. Records of a total of 870 patients over a ...

  18. Nutrition Communication in Dutch General practice: integration of the patients' perspective and the family doctors' perspective

    NARCIS (Netherlands)

    Dillen, van S.M.E.

    2005-01-01

    A sound nutrition advice is important for patients with coronary heart disease, diabetes and obesity. The family doctor has high potential to promote nutrition to their patients through its broad reach, including the hard-to-reach low socio-economic class. Unfortunately, in daily practice of most

  19. Do patients want doctors to talk about spirituality? A systematic literature review.

    Science.gov (United States)

    Best, Megan; Butow, Phyllis; Olver, Ian

    2015-11-01

    The aim of this systematic literature review was to ascertain the patient perspective regarding the role of the doctor in the discussion of spirituality. We conducted a systematic search in ten databases from inception to January 2015. Eligible papers reported on original research including patient reports of discussion of spirituality in a medical consultation. Papers were separated into qualitative and quantitative for the purposes of analysis and quality appraisal with QualSyst. Papers were merged for the final synthesis. 54 studies comprising 12,327 patients were included. In the majority of studies over half the sample thought it was appropriate for the doctor to enquire about spiritual needs in at least some circumstances (range 2.1-100%, median 70.5%), but patient preferences were not straightforward. While a majority of patients express interest in discussion of religion and spirituality in medical consultations, there is a mismatch in perception between patients and doctors regarding what constitutes this discussion and therefore whether it has taken place. This review demonstrated that many patients have a strong interest in discussing spirituality in the medical consultation. Doctors should endeavor to identify which patients would welcome such conversations. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  20. Doctors in a Southeast Asian country communicate sub-optimally regardless of patients' educational background.

    NARCIS (Netherlands)

    Claramita, M.; Dalen, J.V.; Vleuten, C.P.M. van der

    2011-01-01

    OBJECTIVE: To explore the relationship between the style of doctor-patient communication and patients' educational background in a Southeast Asian teaching hospital setting using the Roter Interaction Analysis System (RIAS). METHODS: We analyzed a total of 245 audio-taped consultations involving 30

  1. Argumentation in doctor-patient interaction: medical consultation as a pragma-dialectical communicative activity type

    NARCIS (Netherlands)

    Pilgram, R.

    2009-01-01

    In medical consultation, the doctor’s advice (or the support for it) is not always immediately acceptable to the patient. The medical advice might, for instance,mean that the patient has to drastically change his behaviour. An important way in which the doctor can nonetheless make his advice

  2. Doctor-patient communication in different European health care systems: relevance and performance from the patients' perspective.

    NARCIS (Netherlands)

    Brink-Muinen, A. van den; Verhaak, P.F.M.; Bensing, J.M.; Bahrs, O.; Deveugele, M.; Gask, L.; Leiva, F.; Mead, N.; Messerli, V.; Oppizzi, L.; Peltenburg, M.; Perez, A.

    2000-01-01

    Our aim is to investigate differences between European health care systems in the importance attached by patients to different aspects of doctor-patient communication and the GPs' performance of these aspects, both being from the patients' perspective. 3658 patients of 190 GPs in six European

  3. Patient Perceptions of Wearable Face-Mounted Computing Technology and the Effect on the Doctor-Patient Relationship.

    Science.gov (United States)

    Prochaska, Micah T; Press, Valerie G; Meltzer, David O; Arora, Vineet M

    2016-10-12

    Wearable face-mounted computers such as Google Glass™ , Microsoft HoloLens™, and Oculus' Rift ® , are increasingly being tested in hospital care. These devices challenge social etiquette, raise privacy issues, and may disrupt the intimacy of the doctor patient relationship. We aimed to determine patients' perception of and their privacy concerns with an archetype of wearable face-mounted computer devices, Google Glass. Hospitalized inpatients were asked about their familiarity with Glass, how comfortable they would be and if they would be concerned about privacy if their physician wore Glass, if the use of Glass would affect their trust in their physician, and if they would want their physician to wear Glass if it improved their care. Most (73%) respondents were unfamiliar with Glass, though 64% would be comfortable if their doctor wore Glass. Under half (46%) of respondents were concerned about privacy with the use of Glass. Seventy-six percent (76%) of respondents stated their doctor wearing Glass would not affect their trust in their doctor. Patients concerned about their privacy were less likely to trust their doctor if their doctor wore Glass (17% vs. 0%, ptechnology. While some patients expressed concerns about privacy, patients were much less concerned about wearable technologies affecting the trust they have in their physician.

  4. Ethical theory, ethnography, and differences between doctors and nurses in approaches to patient care.

    Science.gov (United States)

    Robertson, D W

    1996-01-01

    OBJECTIVES: To study empirically whether ethical theory (from the mainstream principles-based, virtue-based, and feminist schools) usefully describes the approaches doctors and nurses take in everyday patient care. DESIGN: Ethnographic methods: participant observation and interviews, the transcripts of which were analysed to identify themes in ethical approaches. SETTING: A British old-age psychiatry ward. PARTICIPANTS: The more than 20 doctors and nurses on the ward. RESULTS: Doctors and nurses on the ward differed in their conceptions of the principles of beneficence and respect for patient autonomy. Nurses shared with doctors a commitment to liberal and utilitarian conceptions of these principles, but also placed much greater weight on relationships and character virtues when expressing the same principles. Nurses also emphasised patient autonomy, while doctors were more likely to advocate beneficence, when the two principles conflicted. CONCLUSION: The study indicates that ethical theory can, contrary to the charges of certain critics, be relevant to everyday health care-if it (a) attends to social context and (b) is flexible enough to draw on various schools of theory. PMID:8910782

  5. A patient with protrusion and multiple missing teeth treated with autotransplantation and space closure.

    Science.gov (United States)

    Ko, Jeong-Min; Paik, Cheol-Ho; Choi, Simon; Baek, Seung-Hak

    2014-05-01

    To present a patient treated with submerging autotransplantation (SA) of an immature premolar and subsequent orthodontic space closure (OSC) and to report a 10-year follow-up result. A 10-year-old boy had multiple missing premolars with an asymmetric pattern (maxillary right first and second premolars, teeth 14 and 15; maxillary left second premolar, tooth 25; and mandibular right second premolar, tooth 45). After considering several treatment options, tooth 35 with immature root development underwent SA into the missing site of tooth 15 at a depth 5 mm below the occlusal plane and was stabilized with sutures to create a symmetric missing condition of the premolars in the four quadrants. Three months after autotransplantation, spontaneous eruption of the transplanted tooth was observed. Nine months after autotransplantation, presence of the lamina dura of the transplanted tooth was confirmed with a periapical radiograph. Active orthodontic treatment was initiated to reduce lip protrusion by closing the missing spaces of teeth 14, 25, 35, and 45 and to correct dental midline deviation. After 33 months of active orthodontic treatment, Class I canine and molar relationships were obtained. During the 10-year follow-up, the pulp vitality of the transplanted tooth was maintained without any pathologic findings, including root resorption or pulp canal obliteration. In a patient with lip protrusion and multiple congenitally missing premolars with an asymmetric pattern, SA of one premolar from the normal quadrant into the quadrant missing two premolars with subsequent OSC of the missing sites of the other premolars can be an effective treatment modality.

  6. The missing link to patient engagement in Italy.

    Science.gov (United States)

    Palumbo, Rocco; Annarumma, Carmela; Adinolfi, Paola; Musella, Marco

    2016-11-21

    Purpose The purpose of this paper is to discuss the changing patterns of users' behavior in the health care service system. Although patient engagement and health services' co-production are understood as essential ingredients in the recipe for sustainable health systems, some determinants to patient involvement are still widely neglected by both policy makers and health care professionals. Among others, inadequate health literacy performs as a significant barrier to patient empowerment. Design/methodology/approach A survey aimed at objectively measuring health literacy-related skills was administered to a random sample of 600 Italian patients. The Italian version of the Newest Vital Sign (NVS) was used to assess the ability of the respondents to deal with written health information. Moreover, the respondents were asked to self-report their ability to navigate the health system. It was presumed that inadequate health literacy as measured by the NVS is related with impaired self-reported functional, interactive, and critical health-related competencies, paving the way for the inability and the unwillingness of patients to be involved in the health care provision. Findings About half of the sample showed inadequate health literacy. However, poor NVS scores were only slightly associated with limited self-reported functional, interactive, and critical health-related competencies. In general, patients with inadequate health-related skills were not likely to be engaged in the provision of health services. Elderly, people suffering from financial deprivation and less educated individuals were found to be at special risk of living with limited health literacy. Practical implications Limited health literacy is a common and relevant issue among people dealing with the health care service system. The impaired ability to collect, process, and use health information produces barriers to patient engagement and prevents the evolution of patients' behavior toward health care co

  7. How doctors communicate the initial diagnosis of cancer matters: cancer disclosure and its relationship with Patients' hope and trust.

    Science.gov (United States)

    Cao, Weidan; Qi, Xiaona; Yao, Ting; Han, Xuanye; Feng, Xujing

    2017-05-01

    The study is to examine the relationships between perceived initial cancer disclosure communication with doctors, levels of hope, and levels of trust in doctors among cancer patients in China. A total number of 192 cancer inpatients in a cancer hospital in China were surveyed. Perceived disclosure strategies, levels of hope, levels of trust in their doctors, as well as the demographic information were obtained from the participants. In addition to age, patients who had higher levels of perceived emotional support from doctors, or higher levels of perceived personalized disclosure from doctors, or higher levels of perceived discussion of multiple treatment plans with doctors were more likely to have higher levels of trust in doctors. In addition to perceived health status, perceived emotional support from doctors significantly predicted participants' levels of hope. That is, patients who had higher higher levels of perceived doctors' emotional support were more likely to have higher levels of hope. Key disclosure person was a marginally significant variable, that is, patients who were mainly disclosed by family members might have higher levels of hope compared with patients who were mainly disclosed by doctors. When communicating with a cancer patient, doctors might not ignore the importance of emotional support during cancer diagnosis communication. Doctors might want to involve family and collaborate with family to find out ways of personalized disclosure. During the communication process, doctors could provide their patients with multiple treatment options and discuss the benefits and side effects of each treatment. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  8. The impact of an intervention in intercultural communication on doctor-patient interaction in The Netherlands.

    Science.gov (United States)

    Schouten, Barbara C; Meeuwesen, Ludwien; Harmsen, Hans A M

    2005-09-01

    Findings of scarcely available studies indicate that there are substantial gaps in intercultural doctor-patient communication. In order to improve intercultural communication in medical practice in The Netherlands, an educational intervention was developed. The aim of the present study was to examine the effects of this intervention on doctor-patient communication. Participants (general practitioners: n=38; patients: n=124) were assigned at random to an intervention or a control group. GPs in the intervention group received 2.5 days training on intercultural communication. Patients in the intervention group were exposed to a videotaped instruction in the waiting room, right before the consultation. Data were collected through videotapes of visits of ethnic minority patients to their GP and home interviews with the patients after their medical visit. Communication behaviour was assessed using the Roter interaction analysis system (RIAS). Interview length was assessed as well. The length of the medical encounter increased significantly after having received the intervention. Total number of GP utterances increased significantly too. When comparing relative frequencies on affective and instrumental verbal behaviour of both patients and doctors, no significant changes could be detected. It is concluded that there seems to be some change in doctor-patient interaction, but RIAS may not be suitable to detect subtle changes in the medical communication process. It is recommended to use other analysis methods to assess cultural differences in medical communication. Knowledge about possible antecedents of gaps in intercultural medical communication should be increased in order to be able to design effective interventions for intercultural doctor-patient communication.

  9. Gingival Recession in a Child‑Patient; Easily Missed Etiologies ...

    African Journals Online (AJOL)

    ... be acting in consonance (Concomitant multiple etiologies [CME]). The factors were a high frenal attachment, traumatic overbite and bruxism induced by premature tooth contacts. Pedodontists and periodontists should rule out CME in cases of gingival recession in the child‑patient. Keywords: Bruxism, Gingival recession, ...

  10. Association between family doctors' practices characteristics and patient evaluation of care.

    Science.gov (United States)

    Klemenc-Ketis, Zalika; Petek, Davorina; Kersnik, Janko

    2012-08-01

    Patients' evaluations of primary care are influenced by three major dimensions: patients', family doctors' and practices' characteristics. A lot of primary care practices use possibilities of new information technologies, such as chronic patients' electronic registers, clinical guideline support systems, electronic medical records and clinical decision system. The aim of this study was to determine possible effects of quality characteristics of family doctors' practices on patients' satisfaction. This observational cross-sectional study in 36 randomly selected family doctors' practices, stratified to practices' size and urbanization was performed between 2008 and 2009. Each practice included 100 randomly selected adult patients: 30 high-risk patients for CVD, but without a history of CVD, 30 patients with an established coronary disease, and 40 healthy adult patients (aged 18-45 years). Data was collected with a questionnaire, used in European Practice Assessment of Cardiovascular risk management (EPA Cardio study), and with European Patients Evaluation of general practice care (EUROPEP) questionnaire. Final sample consisted of 2482 patients (68.9% response rate). Higher satisfaction scores were associated with worse self-rated patients' health status, with patients visiting practices where quality report was provided, where clinical audit in the past 12 months existed, where number of population attending practice quarterly was lower, where systematic reviewing of prescribed medication was not available, where annual report was not provided, where doctor did not have access to medical literature, and where patients' attendance rate for preventive check-ups was not available. Patients with higher risk for CVD were also more satisfied. The effect of practice characteristics associated with organisational access to services, chronic patients' management and some quality improvement factors is unclear and not always in favour of higher satisfaction score. Further

  11. Finding the Missing Patients With Tuberculosis: Lessons Learned From Patient-Pathway Analyses in 5 Countries.

    Science.gov (United States)

    Hanson, Christy; Osberg, Mike; Brown, Jessie; Durham, George; Chin, Daniel P

    2017-11-06

    Despite significant progress in diagnosis and treatment of tuberculosis over the past 2 decades, millions of patients with tuberculosis go unreported every year. The patient-pathway analysis (PPA) is designed to assess the alignment between tuberculosis care-seeking patterns and the availability of tuberculosis services. The PPA can help programs understand where they might find the missing patients with tuberculosis. This analysis aggregates and compares the PPAs from case studies in Kenya, Ethiopia, Indonesia, the Philippines, and Pakistan. Across the 5 countries, 24% of patients with tuberculosis initiated care seeking in a facility with tuberculosis diagnostic capacity. Forty-two percent of patients sought care at level 0 facilities, where there was generally no tuberculosis diagnostic capacity; another 42% of patients sought care at level 1 facilities, of which 39% had diagnostic capacity. Sixty-six percent of patients initially sought care in private facilities, which had considerably less tuberculosis diagnostic capacity than public facilities; only 7% of notified cases were from the private sector. The GeneXpert system was available in 14%-41% of level 2 facilities in the 3 countries for which there were data. Tuberculosis treatment capacity tracked closely with the availability of diagnostic capacity. There were substantial subnational differences in care-seeking patterns and service availability. The PPA can be a valuable planning and programming tool to ensure that diagnostic and treatment services are available to patients where they seek care. Patient-centered care will require closing the diagnostic gap and engaging the private sector. Extensive subnational differences in patient pathways to care call for differentiated approaches to patient-centered care. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.

  12. THE CONTRADICTIONS IN THE LOGIC OF PROTECTION OF PATIENTS AND DOCTORS. POSSIBLE SOLUTIONS INFORMATION

    Directory of Open Access Journals (Sweden)

    O. P. Mintser

    2016-06-01

    Full Text Available The problem of protecting the doctors' rights in legal science has developed not enough, although research in this area has great practical not only theoretical importance. The aim of the study was to streamline the ideas on the doctors' and patients' rights protection. Were discussed the issues of mutual relations between patients and doctors in Ukraine that have regulated by the Constitution of Ukraine, Civil code of Ukraine, the Law of Ukraine: «Basic laws of Ukraine on health care», «On protection of consumer rights», «On personal data protection», «On compulsory state social insurance», «On psychiatric care» and others. Were proposed quantitative approaches of doctor's responsibility justification based on individualization of medical aid and deviation from the standards and protocols. Conclusions. 1. It is necessary for further elaboration of legislative framework protection the rights of the doctor considering solidarity, using standards of care, physician participation in the activities of medical associations, etc. 2. It is necessary to be considered a development and implementation of information technology - specialized databases ontological models etc. 3. It is recommended the usage of approximation between the quantitative characteristics certain case and current medical standards (protocols, local standards.

  13. Patient Continued Use of Online Health Care Communities: Web Mining of Patient-Doctor Communication.

    Science.gov (United States)

    Wu, Bing

    2018-04-16

    In practice, online health communities have passed the adoption stage and reached the diffusion phase of development. In this phase, patients equipped with knowledge regarding the issues involved in health care are capable of switching between different communities to maximize their online health community activities. Online health communities employ doctors to answer patient questions, and high quality online health communities are more likely to be acknowledged by patients. Therefore, the factors that motivate patients to maintain ongoing relationships with online health communities must be addressed. However, this has received limited scholarly attention. The purpose of this study was to identify the factors that drive patients to continue their use of online health communities where doctor-patient communication occurs. This was achieved by integrating the information system success model with online health community features. A Web spider was used to download and extract data from one of the most authoritative Chinese online health communities in which communication occurs between doctors and patients. The time span analyzed in this study was from January 2017 to March 2017. A sample of 469 valid anonymous patients with 9667 posts was obtained (the equivalent of 469 respondents in survey research). A combination of Web mining and structural equation modeling was then conducted to test the research hypotheses. The results show that the research framework for integrating the information system success model and online health community features contributes to our understanding of the factors that drive patients' relationships with online health communities. The primary findings are as follows: (1) perceived usefulness is found to be significantly determined by three exogenous variables (ie, social support, information quality, and service quality; R 2 =0.88). These variables explain 87.6% of the variance in perceived usefulness of online health communities; (2

  14. Verbal and non-verbal behavior of doctors and patients in primary care consultations - how this relates to patient enablement.

    NARCIS (Netherlands)

    Pawlikowska, T.; Zhang, W.; Griffiths, F.; Dalen, J. Van; Vleuten, C.P.M. van der

    2012-01-01

    OBJECTIVE: To assess the relationship between observable patient and doctor verbal and non-verbal behaviors and the degree of enablement in consultations according to the Patient Enablement Instrument (PEI) (a patient-reported consultation outcome measure). METHODS: We analyzed 88 recorded routine

  15. Listening to "How the Patient Presents Herself": A Case Study of a Doctor-Patient Interaction in an Emergency Room

    Science.gov (United States)

    Delbene, Roxana

    2015-01-01

    This is a case-study based on a micro-ethnography analyzing a doctor-patient interaction in an emergency room (ER) in New York City. Drawing on the framework of narrative medicine (Charon, 2006), the study examines how a phenomenological approach to listening to the patient facilitated the patient's narrative orientation not only to relevant…

  16. Effects of individual immigrant attitudes and host culture attitudes on doctor-immigrant patient relationships and communication in Canada.

    Science.gov (United States)

    Whittal, Amanda; Rosenberg, Ellen

    2015-10-29

    In many countries doctors are seeing an increasing amount of immigrant patients. The communication and relationship between such groups often needs to be improved, with the crucial factor potentially being the basic attitudes (acculturation orientations) of the doctors and patients. This study therefore explores how acculturation orientations of Canadian doctors and immigrant patients impact the doctor-patient relationship. N = 10 participants (five doctors, five patients) participated in acculturation orientation surveys, video recordings of a regular clinic visit, and semi structured interviews with each person. Acculturation orientations were calculated using the Euclidean distance method, video recordings were analyzed according to the Verona Coding System, and thematic analysis was used to analyze the interviews. Interviews were used to explain and interpret the behaviours observed in the video recordings. The combined acculturation orientations of each the doctor and immigrant patient played a role in the doctor-patient relationship, although different combinations than expected produced working relationships. Video recordings and interviews revealed that these particular immigrant patients were open to adapting to their new society, and that the doctors were generally accepting of the immigrants' previous culture. This produced a common level of understanding from which the relationship could work effectively. A good relationship and level of communication between doctors and immigrant patients may have its foundation in acculturation orientations, which may affect the quality of care, health behaviours and quality of life of the immigrant. The implications of these findings are more significant when considering effective interventions to improve the quality of doctor-patient relationships, which should have a solid foundational framework. Our research suggests that interventions based on understanding the influence of acculturation orientations could

  17. Are patients' and doctors' accounts of the first specialist consultation for chronic back pain in agreement?

    Directory of Open Access Journals (Sweden)

    White KB

    2016-11-01

    Full Text Available Kathy B White,1 John Lee,2 Amanda C de C Williams3 1Central and North West London NHS Foundation Trust, 2School of Life and Medical Sciences, University College London, 3Research Department of Clinical, Educational and Health Psychology, Faculty of Brain Sciences, University College London, London, UK Introduction: The first consultation at a specialist pain clinic is potentially a pivotal event in a patient’s pain history, affecting treatment adherence and engagement with longer term self-management. What doctors communicate to patients about their chronic pain and how patients interpret doctors’ messages and explanations in pain consultations are under-investigated, particularly in specialist care. Yet, patients value personalized information about their pain problem.Patients and methods: Sixteen patients in their first specialist pain clinic consultation and the doctors they consulted were interviewed shortly after the consultation. Framework analysis, using patient themes, was used to identify full match, partial match, or mismatch of patient–doctor dyads’ understandings of the consultation messages.Results: Patients and doctors agreed, mainly implicitly, that medical treatment aiming at pain relief was primary and little time was devoted to discussion of self-management. Clinically relevant areas of mismatch included the explanation of pain, the likelihood of medical treatments providing relief, the long-term treatment plan, and the extent to which patients were expected to be active in achieving treatment goals.Discussion: Overall, there appears to be reasonable concordance between doctors and patients, and patients were generally satisfied with their first consultation with a specialist. Two topics showed substantial mismatch, the estimated likely outcome of the next planned intervention and, assuming (as doctors but not patients did that this was unsuccessful, the long-term treatment plan. It appeared that more complex issues

  18. Proteinuria is common among HIV patients: what are we missing?

    Science.gov (United States)

    Antonello, Vicente Sperb; Antonello, Ivan Carlos Ferreira; Herrmann, Sandra; Tovo, Cristiane Valle

    2015-10-01

    HIV-related renal diseases are the leading causes of chronic kidney diseases worldwide. The present study aimed to investigate the prevalence of pathological proteinuria and its risk factors among HIV patients. A review of the medical records of 666 HIV-infected individuals aged 18 years or older in an urban HIV/AIDS clinic based in Porto Alegre in southern Brazil. Overt proteinuria was defined as a protein-to-creatinine ratio greater than 150 mg/g according to Kidney Disease: Improving Global Outcomes. The prevalence of pathological proteinuria in the present study cohort was 20%. Characteristics associated with pathological proteinuria after univariate analysis included alcohol abuse, hepatitis C virus coinfection, the occurrence of diabetes and therapy including tenofovir. Adjusted residuals analysis indicated an association between pathological proteinuria and both a CD4 lymphocyte count below 200 cells/mm3 and a viral load higher than 1000 copies/mL. Additionally, an absence of pathological proteinuria was associated with a CD4 lymphocyte count higher than 500 cells/mm3. After adjustment for variables with pproteinuria. The risk of chronic kidney diseases in this large contemporary cohort of HIV-infected individuals appeared to be attributable to a combination of HIV-related risk factors. In addition to the traditional risk factors cited in the literature, both regimens containing tenofovir and HIV disease severity seem to be associated with chronic kidney diseases in patients with HIV. Assessment of proteinuria constitutes a novel method for chronic kidney disease staging in HIV-infected individuals and may be effectively used to stratify the risk of progression to end-stage renal disease.

  19. Proteinuria is common among HIV patients: what are we missing?

    Directory of Open Access Journals (Sweden)

    Vicente Sperb Antonello

    Full Text Available OBJECTIVES:HIV-related renal diseases are the leading causes of chronic kidney diseases worldwide. The present study aimed to investigate the prevalence of pathological proteinuria and its risk factors among HIV patients.METHODS:A review of the medical records of 666 HIV-infected individuals aged 18 years or older in an urban HIV/AIDS clinic based in Porto Alegre in southern Brazil. Overt proteinuria was defined as a protein-to-creatinine ratio greater than 150 mg/g according to Kidney Disease: Improving Global Outcomes.RESULTS:The prevalence of pathological proteinuria in the present study cohort was 20%. Characteristics associated with pathological proteinuria after univariate analysis included alcohol abuse, hepatitis C virus coinfection, the occurrence of diabetes and therapy including tenofovir. Adjusted residuals analysis indicated an association between pathological proteinuria and both a CD4 lymphocyte count below 200 cells/mm3 and a viral load higher than 1000 copies/mL. Additionally, an absence of pathological proteinuria was associated with a CD4 lymphocyte count higher than 500 cells/mm3. After adjustment for variables with p<0.2 in the univariate analysis using a Poisson regression model, tenofovir-containing regimens and a CD4 lymphocyte count below 200 cells/mm3 were significantly associated with pathological proteinuria.CONCLUSION:The risk of chronic kidney diseases in this large contemporary cohort of HIV-infected individuals appeared to be attributable to a combination of HIV-related risk factors. In addition to the traditional risk factors cited in the literature, both regimens containing tenofovir and HIV disease severity seem to be associated with chronic kidney diseases in patients with HIV. Assessment of proteinuria constitutes a novel method for chronic kidney disease staging in HIV-infected individuals and may be effectively used to stratify the risk of progression to end-stage renal disease.

  20. Beyond 'doctor and patient': developments in the study of healthcare interactions.

    Science.gov (United States)

    Pilnick, Alison; Hindmarsh, Jon; Gill, Virginia Teas

    2009-09-01

    Three decades of conversation analytic investigations of medical interaction have produced a rich collection of findings of sociological interest, from a diverse array of encounters. This paper briefly outlines the development of this field to provide a context for the special issue. The paper discusses how studies of doctor-patient interaction have revealed the ways in which participants organise the medical visit to accomplish tasks such as diagnosing and recommending treatment for illness, and how doctors and patients address various interactional issues and dilemmas that arise as they undertake these tasks. It then highlights a growing number of CA studies that explore medical settings and activities beyond the doctor-patient encounter. In doing so, it charts the distinctive interactional practices that emerge, for example, where participants are engaging in hands-on treatment, medical practitioners are interacting with one another, or various technologies are employed during the encounter. Finally, papers in this special issue are introduced and shown to build upon this latter tradition. The papers address distinctive practical problems and institutional dilemmas that arise in healthcare encounters and medical settings beyond dyadic doctor-patient interaction, with a focus on the participants' orientations to policy, their distinctive modes of participation, and the use of technology.

  1. Intercultural doctor-patient communication in daily outpatient care: relevant communication skills.

    NARCIS (Netherlands)

    Paternotte, E.; Scheele, F.; Seeleman, C.M.; Bank, L.; Scherpbier, A.J.J.A.; Dulmen, A.M. van

    2016-01-01

    Introduction Intercultural communication (ICC) between doctors and patients is often associated with misunderstandings and dissatisfaction. To develop ICC-specific medical education, it is important to find out which ICC skills medical specialists currently apply in daily clinical

  2. Attitudes of medical students in Lahore, Pakistan towards the doctor-patient relationship.

    Science.gov (United States)

    Ahmad, Waqas; Krupat, Edward; Asma, Yumna; Fatima, Noor-E-; Attique, Rayan; Mahmood, Umar; Waqas, Ahmed

    2015-01-01

    Background. A good doctor-patient relationship is the centre stone of modern medicine. Patients are getting increasingly aware about exercising their autonomy and thus modern medicine cannot deliver all its advances to the patients if a good doctor-patient relationship is not established. We initiated this study with the aim to assess the leaning of medical students, who are the future physicians, towards either a doctor-centered or a patient-centered care, and to explore the effects of personal attributes on care such as gender, academic year, etc. Materials & Methods. A cross-sectional study was conducted between July and Sep 2013. CMH Lahore Medical and Dental College Ethical Review Committee approved the study questionnaire. The study population consisted of 1,181 medical students in years 1-5 from two medical colleges. The English version of Patient Practitioner Orientation Scale (PPOS) was used to assess attitudes of medical students towards doctor-patient relationship. PPOS yields a mean score range of 1-6, where 1 signifies tendency towards a doctor centered relationship and 6 signifies patient-centered relationship. The relationship between PPOS scores and individual characteristics like gender, academic year etc. were examined by multiple regression. Results. A total of 783 students formed the final sample (response rate = 92%). Mean PPOS score of the entire sample was 3.40 (± .49 S.D.). Mean sharing sub-scale score was 3.18 (± 0.62 S.D. Mean caring sub-scale score was 3.63 (± 0.56 S.D.). Characteristics associated with most patient-centered attitudes were advanced academic year, having a clinical rotation, foreign background and studying in a private college. Gender, having doctor parents, relationship and residence status had no bearing on the attitudes (p > 0.05). Conclusion. Despite ongoing debate and the emphasis on a patient-centered curriculum, our study suggests that the current curriculum and its teachings are not producing the results they

  3. An Australian government dental scheme: Doctor-dentist-patient tensions in the triangle.

    Science.gov (United States)

    Weerakoon, Arosha; Fitzgerald, Lisa; Porter, Suzette

    2014-11-30

    Autonomy of participants is challenged when legislation to provide a public health service is weakly designed and implemented. Australia's Chronic Disease Dental Scheme was instigated to provide a government subsidy for private dental treatment for people suffering chronic illness impacting their oral health or vice versa. They were allocated AUD$4250 towards comprehensive treatment over 2 years with their eligibility determined by their general medical doctor. A qualitative research study was conducted to explore the experiences from the perspectives of the patient, medical and dental practitioner. One of the research outcomes identified a frequently reported level of discomfort in the patient/doctor/dentist triangle. Doctors and dentists reported feeling forced by patients into positions that compromised their autonomy in obeying the intent (if not the law) of the scheme. Additionally, dentists felt under pressure from doctors and patients to provide subsidized treatment to those eligible. In turn, the patients reported difficulties in gaining access to the scheme and in some cases, experiencing full or partially unmet oral health needs. REASON FOR CONFLICT: Poor inter-professional communication and lack of understanding about profession-unique patient-driven pressures, ultimately contributed to dissonance. Ill-defined eligibility guidelines rendered the doctor's ability to gate-keep challenging. OUTCOME OF CONFLICT: Inefficient gate-keeping led to exponential increase in referrals, resulting in unprecedented cost blow-outs. Ensuing government-led audits caused political tensions and contributed to the media-induced vilification of dentists. In December 2013, government financing of dental treatment through Chronic Disease Dental Scheme was discontinued, leaving many Australians without a viable alternative. There is a need for qualitative research methods to help identify social issues that affect public health policy process. In order to succeed, new health

  4. Evaluation and improvement of doctor-patient communication competence for emergency neurosurgeons: a standardized family model.

    Science.gov (United States)

    Wu, Xi; Wang, Zhinong; Hong, Bo; Shen, Shengjuan; Guo, Yan; Huang, Qinghai; Liu, Jianmin

    2014-01-01

    Disease treatments have been significantly influenced by the communications between patients, their families, and doctors the lack of which may lead to malpractice allegations and complaints. In particular, inadequate communication may delay diagnosis and treatment. Therefore, for doctors communication and interpersonal skills, are as important as clinical skills and medical knowledge. In this study we intended to develop two detailed communication content checklists and a modified interpersonal skills inventory, aiming to evaluate their integrity in the midst of communication skills assessments, to provide feedback for some participants, and to observe their communication competence in both aspects.

  5. Verbal and non-verbal behavior of doctors and patients in primary care consultations - how this relates to patient enablement.

    Science.gov (United States)

    Pawlikowska, Teresa; Zhang, Wenjuan; Griffiths, Frances; van Dalen, Jan; van der Vleuten, Cees

    2012-01-01

    To assess the relationship between observable patient and doctor verbal and non-verbal behaviors and the degree of enablement in consultations according to the Patient Enablement Instrument (PEI) (a patient-reported consultation outcome measure). We analyzed 88 recorded routine primary care consultations. Verbal and non-verbal communications were analyzed using the Roter Interaction Analysis System (RIAS) and the Medical Interaction Process System, respectively. Consultations were categorized as patient- or doctor-centered and by whether the patient or doctor was verbally dominant using the RIAS categorizations. Consultations that were regarded as patient-centered or verbally dominated by the patient on RIAS coding were considered enabling. Socio-emotional interchange (agreements, approvals, laughter, legitimization) was associated with enablement. These features, together with task-related behavior explain up to 33% of the variance of enablement, leaving 67% unexplained. Thus, enablement appears to include aspects beyond those expressed as observable behavior. For enablement consultations should be patient-centered and doctors should facilitate socio-emotional interchange. Observable behavior included in communication skills training probably contributes to only about a third of the factors that engender enablement in consultations. To support patient enablement in consultations, clinicians should focus on agreements, approvals and legitimization whilst attending to patient agendas. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  6. [The essence of doctor-patient relationship in creating image of a medical institution].

    Science.gov (United States)

    Dworzański, Wojciech; Dworzańska, Anna; Burdan, Franciszek

    2012-01-01

    Irrespective of changing standards and continuous reforms in health service, the patient should always remain the principal focus. The patient is a person who should be treated not only as a customer or a recipient of medical services but also as a person being in a situation which is difficult and often unacceptable. Among the factors affecting patients' satisfaction and contentment in the course of the disease it is profoundly important that he cooperates with his doctor. For years it has been attempted to create an ideal model of doctor-patient relationship which would be mutually beneficial and not violating privacy or welfare of any of them. These attempts focused on various theoretical models, among others paternalistic, informative and interpretive. However, special attention should be paid to adherence to principles which is based on respect for patient autonomy, harmlessness, charity and fairness.

  7. Factors Associated with Medical Doctors' Intentions to Discriminate Against Transgender Patients in Kuala Lumpur, Malaysia

    Science.gov (United States)

    Vijay, Aishwarya; Earnshaw, Valerie A.; Tee, Ying Chew; Pillai, Veena; White Hughto, Jaclyn M.; Clark, Kirsty; Kamarulzaman, Adeeba; Altice, Frederick L.

    2018-01-01

    Abstract Purpose: Transgender people are frequent targets of discrimination. Discrimination against transgender people in the context of healthcare can lead to poor health outcomes and facilitate the growth of health disparities. This study explores factors associated with medical doctors' intentions to discriminate against transgender people in Malaysia. Methods: A total of 436 physicians at two major university medical centers in Kuala Lumpur, Malaysia, completed an online survey. Sociodemographic characteristics, stigma-related constructs, and intentions to discriminate against transgender people were measured. Bivariate and multivariate linear regression were used to evaluate independent covariates of discrimination intent. Results: Medical doctors who felt more fearful of transgender people and more personal shame associated with transgender people expressed greater intention to discriminate against transgender people, whereas doctors who endorsed the belief that transgender people deserve good care reported lower discrimination intent. Stigma-related constructs accounted for 42% of the variance and 8% was accounted for by sociodemographic characteristics. Conclusions: Constructs associated with transgender stigma play an important role in medical doctors' intentions to discriminate against transgender patients. Development of interventions to improve medical doctors' knowledge about and attitudes toward transgender people are necessary to reduce discriminatory intent in healthcare settings. PMID:29227183

  8. Factors Associated with Medical Doctors' Intentions to Discriminate Against Transgender Patients in Kuala Lumpur, Malaysia.

    Science.gov (United States)

    Vijay, Aishwarya; Earnshaw, Valerie A; Tee, Ying Chew; Pillai, Veena; White Hughto, Jaclyn M; Clark, Kirsty; Kamarulzaman, Adeeba; Altice, Frederick L; Wickersham, Jeffrey A

    2018-01-01

    Transgender people are frequent targets of discrimination. Discrimination against transgender people in the context of healthcare can lead to poor health outcomes and facilitate the growth of health disparities. This study explores factors associated with medical doctors' intentions to discriminate against transgender people in Malaysia. A total of 436 physicians at two major university medical centers in Kuala Lumpur, Malaysia, completed an online survey. Sociodemographic characteristics, stigma-related constructs, and intentions to discriminate against transgender people were measured. Bivariate and multivariate linear regression were used to evaluate independent covariates of discrimination intent. Medical doctors who felt more fearful of transgender people and more personal shame associated with transgender people expressed greater intention to discriminate against transgender people, whereas doctors who endorsed the belief that transgender people deserve good care reported lower discrimination intent. Stigma-related constructs accounted for 42% of the variance and 8% was accounted for by sociodemographic characteristics. Constructs associated with transgender stigma play an important role in medical doctors' intentions to discriminate against transgender patients. Development of interventions to improve medical doctors' knowledge about and attitudes toward transgender people are necessary to reduce discriminatory intent in healthcare settings.

  9. Doctors in a Southeast Asian country communicate sub-optimally regardless of patients' educational background.

    Science.gov (United States)

    Claramita, Mora; Dalen, Jan Van; Van Der Vleuten, Cees Pm

    2011-12-01

    To explore the relationship between the style of doctor-patient communication and patients' educational background in a Southeast Asian teaching hospital setting using the Roter Interaction Analysis System (RIAS). We analyzed a total of 245 audio-taped consultations involving 30 internal medicine residents with 7-10 patients each in the internal medicine outpatient clinics. The patients were categorized into a group with a high and a group with a low educational level. We ranked the data into 41 RIAS utterances and RIAS-based composite categories in order of observed frequency during consultations. The residents invariantly used a paternalistic style irrespective of patients' educational background. The RIAS utterances and the composite categories show no significant relationship between communication style and patients' educational level. Doctors in a Southeast Asian country use a paternalistic communication style during consultations, regardless of patients' educational background. To approach a more partnership doctor-patient communication, culture and clinical environment concern of Southeast Asian should be further investigated. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  10. Should doctors provide futile medical treatment if patients or their ...

    African Journals Online (AJOL)

    or refused against the wishes of the patients or their legal proxies? Many ethical theories regarding futile treatment could be invoked, such as virtue ethics, Kantian deontology, utilitarianism, communitarianism, liberal individualism, social contract theory, ethics of care, and casuis- try.[6] However, most of these are not useful ...

  11. Illness cognitions, doctor-patient communication and prescription ...

    African Journals Online (AJOL)

    Perceived stress and the belief of incurability of hypertension were, however, related with adherence behaviour. Patients frequently mentioned mental and environmental stress as causative and management beliefs. On the contrary, the treating physicians did not allude to mental and environmental stress. Physicians gave ...

  12. Question-answer sequences between doctors and patients in a ...

    African Journals Online (AJOL)

    However, observation and analysis of a small number of consultations between ... analysis, which means that we study these sequences not in isolation, but within their discursive and institutional ... most patients had limited vocabularies, made grammatical errors typical of the interlanguages of language learners, and often ...

  13. Misperception, misfearing, missed treatment, missed opportunities

    Directory of Open Access Journals (Sweden)

    Marcelo Katz

    2014-11-01

    Full Text Available Cardiovascular disease still represents the leading cause of death worldwide. Preventive measures are essential to avoid the burden of disease, saving lives and costs. However, the current prevalence of optimal management of cardiovascular risk factors is far from ideal. In the real world, physicians are not succeeding in convincing their patients to assume healthy behaviors. According to the health belief model theory, if a patient feels he/she is vulnerable to one condition, it enhances the chance that this patient will engage medical recommendations to avoid this condition. However, a couple of articles, evaluating individual perception of risk, show that, in fact, subjects, children and adults, usually have a misperception of risk, with an optimistic bias about their risk. Physicians are missing the opportunity to really prevent the burden of cardiovascular disease and it is time to explore patients' behavior deeply. In the office, physicians should dedicate time to apply in practice the components of the health belief model. If a patient is unaware about his/her actual risk, doctors should detail these risks, graduating severity and anticipating possible implications on the patient's cardiovascular health. Physicians should appraise the accuracy of the patients' perception of own risk and in case of underestimation, work on calibrating this perception. But physicians should go ahead, trying to empower and engage the patient and his/her family into the treatment plan.

  14. The Doctor Patient Relationship; what if Communication Skills are not used? A Maltese Story.

    Science.gov (United States)

    Woodhead, Sophie; Lindsley, Isabella; Micallef, Claranne; Agius, Mark

    2015-09-01

    The doctor patient relationship is fundamental to the practice of medicine. In the UK, much work has been carried out to develop taining in communication skills for both doctors and medical students. Whereas it is true that controled trials of communication skills are now beginning to emerge in the primary care literature, it is also true that there is need for studies of communication skills on the hospital ward. One alternative form of evidence for the need of communication skills is that of anthropological studies of hospital wards. We here summarise the observations made in one such anthropological study which was carried out in a renal unit in Malta. The conclusion of these observations is that the inability of the doctors to utilise communication skills is that patients develop meaningful relationships with other groups of professionals, to the extent that they consider them as part of an extended family. Doctors remain isolated from all these relationships and only relate to patients from a position of power.

  15. Does Depressive Symptomatology Influence Teenage Patients and Their Mothers’ Experience of Doctor-Patient Relationship in Two Balkan Countries?

    Directory of Open Access Journals (Sweden)

    Vaitsa Giannouli

    2014-04-01

    Full Text Available Doctor-patient relationship is considered to be a special relationship and a keystone of medical care. A fundamental factor in this sort of relationship is the communication, which is strictly examined between the two involving parts, without taking into consideration in the case of children and teenagers the possible influence of their parents. The mothers more often accompany their children to the doctor and they become a third part of the doctor-patient relationship. In Greece during February-May 2013, 196 mothers and their teenage children (suffering from acute or chronic illnesses completed two questionnaires: the Center for Epidemiological Studies-Depression Scale (CES-D and a series of questions on a Likert scale from the Patient Satisfaction Questionnaire (PSQ about the experienced satisfaction with the characteristics of this communication. In Bulgaria during July-August 2013, 60 mothers and their children completed the same questionnaires. The results revealed an unexpected finding only for the Greek sample - the quality of relationship between doctor and patient (for both Greek mothers and adolescents was negatively associated with their scores on CES-D (i.e. low level of depression together with low satisfaction derived from the relationship with the doctor, while no differences were found between the participants’ groups (mothers, children, acute or chronic disease. This surprising finding of high depression-high satisfaction was not found in the Bulgarian sample and therefore needs further investigation.

  16. Reconciliation of patient/doctor vocabulary in a structured resource.

    Science.gov (United States)

    Tapi Nzali, Mike Donald; Aze, Jérôme; Bringay, Sandra; Lavergne, Christian; Mollevi, Caroline; Optiz, Thomas

    2018-01-01

    Today, social media is increasingly used by patients to openly discuss their health. Mining automatically such data is a challenging task because of the non-structured nature of the text and the use of many abbreviations and the slang terms. Our goal is to use Patient Authored Text to build a French Consumer Health Vocabulary on breast cancer field, by collecting various kinds of non-experts' expressions that are related to their diseases and then compare them to biomedical terms used by health care professionals. We combine several methods of the literature based on linguistic and statistical approaches to extract candidate terms used by non-experts and to link them to expert terms. We use messages extracted from the forum on ' cancerdusein.org ' and a vocabulary dedicated to breast cancer elaborated by the Institut National Du Cancer. We have built an efficient vocabulary composed of 192 validated relationships and formalized in Simple Knowledge Organization System ontology.

  17. The communicative dimension in medical training: A proposal to strengthen the doctor-patient relationship

    Directory of Open Access Journals (Sweden)

    Jacinto Sánchez-Angarita

    2017-10-01

    Based on these approaches, a proposal is made to promote education considering the PBL teaching strategy that favors training in the communicative dimension, in order to promote the integration of disciplines, the construction of meaningful learning, interdisciplinary work, and problem solving with a holistic vision. Additionally, obtaining information to solve learning situations, making decisions and finding ways of communicating with patients is intended with the purpose of strengthening the doctor-patient relationship.

  18. Rational versus unreasonable persuasion in doctor-patient communication: A normative account

    OpenAIRE

    Rubinelli Sara

    2013-01-01

    Objective: Persuasion plays a critical role in doctor patient communication. The relevant literature tends to equate persuasion to manipulation as a suboptimal form of interaction. The objective of this paper is to distinguish among different types of persuasion processes and to highlight when their use can be beneficial or risky from the perspective of the patient's autonomy. Methods: This paper presents a conceptual analysis of persuasion based on the analytical and normative frameworks of ...

  19. [Family doctor clinical aptitude confronting gestational diabetes patients].

    Science.gov (United States)

    Pivaral, Carlos Enrique Cabrera; Clara, Elizabeth Rivera; Peña, Luz María Adriana Balderas; Centeno, Mayari Cabrera; Reynoso, Carlos Alonso

    2008-02-01

    Gestational diabetes mellitus complicates 7% of all pregnancies. Recognizing and treating this entity result in a diminished number of materno-fetal complications; this study explores the family physician clinical aptitude to identify risk factors, to diagnose and treat gestational diabetes. Identify clinical aptitude level of family physician to the treatment of diabetes gestational patients. Transversal study to describe the level of clinical aptitude in 85 family physicians working in Guadalajara. Were studied: speciality, genre, work condition, working years, working hours, and place of work. The evaluation instrument was designed to this specific purpose and validated by an expert group; were evaluated four indicators: 1) identification of risk factors, 2) diagnosis, 3) use of therapeutic resources and 4) use of paraclinic resources. Confidence coefficient to the assessment instrument was (21 formula from Kuder-Richardson) 0.92 in global evaluation. The global clinical aptitude in the four family medicine units studied was less than 21 points in 41% of physician population and very low (22 a 40 points) in 38% of the evaluated physicians. The clinical aptitude from family physician in gestational diabetes is low, this situation represents an urgent need to design a system to provide to these groups of health providers specialized continuous education to enhance the attention quality to this group of patients in family medicine units.

  20. How nonverbal communication shapes the doctor-patient relationship: from paternalism to the ethics of care in oncology.

    Science.gov (United States)

    Bommier, C; Mamzer, M F; Desmarchelier, D; Hervé, C

    2013-12-01

    The purpose of this research, led in the wake of years of pressure to reject paternalism, was to study whether controlled practice of nonverbal communication by doctors inheres a continued risk of paternalistic attitudes in oncology clinic interviews (chosen to illustrate the doctor-patient relationship). This study involved qualitative descriptive research based on interview observations and questionnaires and mobilized recognized theory borrowed from sociology and anthropology. We found that the legislative framework governing the doctor-patient relationship has simply shifted the paternalism issue from verbal communication over to a new area that doctors have not yet mastered and patients have not yet understood, i.e., nonverbal communication. This study shows that all the laws framing the doctor-patient relationship can be circumvented, and that by controlling nonverbal communication, the doctor can fall back into paternalism. The rejection of paternalism therefore needs to lead to an appropriate reading of the patient's story, which in ethical terms can only happen if hospital structures are made non-paternalizing by design, if doctors learn to understand the patient's different chronemic timeframe, and if doctors committedly engage in the Hippocratic Oath codified through the ethics of care.

  1. Doctors' attentiveness to the spirituality/religion of their patients in pediatric and oncology settings in the Northwest USA.

    Science.gov (United States)

    King, Stephen D W; Dimmers, Martha A; Langer, Shelby; Murphy, Patricia E

    2013-01-01

    Research indicates that spirituality/religion is important to many patients and they want this to be an integrated component of their care. This study's aim was to better understand doctors' attentiveness to patients'/families' spiritual/religious concerns and the contributing factors for this in the Northwest USA as well as doctor's attitudes about referrals to chaplains. Study participants included 108 pediatricians and oncologists who completed an online self-report questionnaire regarding their beliefs about the health relevance of patients' spirituality/religion and their attentiveness to this. Few doctors routinely addressed this concern. Doctors who were Christian, did not expect negative reactions to inquiring, and were knowledgeable regarding chaplains were more likely to address spirituality/religion. Doctors who felt less adequate in addressing spirituality/religion and were concerned about patients negative reactions were less likely to value referral to chaplains. On the other hand, those who had an understanding regarding chaplains were more likely to support referral.

  2. Exploring the Dimensions of Doctor-Patient Relationship in Clinical Practice in Hospital Settings

    Directory of Open Access Journals (Sweden)

    Saurabh RamBiharilal Shrivastava

    2014-05-01

    Full Text Available The Doctor-Patient Relationship (DPR is a complex concept in the medical sociology in which patients voluntarily approach a doctor and thus become a part of a contract in which they tends to abide with the doctor’s guidance. Globally, the DPR has changed drastically over the years owing to the commercialization and privatization of the health sector. Furthermore, the dynamics of the DPR has shown a significant change because of the formulation of consumer protection acts; clauses for professional misconduct and criminal negligence; establishment of patient forums and organizations; massive expansion of the mass media sector leading to increase in health awareness among people; and changes in the status of the doctors. Realizing the importance of DPR in the final outcome and quality of life of the patient, multiple measures have been suggested to make a correct diagnosis and enhance healing. To conclude, good DPR is the crucial determinant for a better clinical outcome and satisfaction with the patients, irrespective of the socio-cultural determinants.

  3. Doctors and the Web. Help your patients surf the Net safely.

    Science.gov (United States)

    Grandinetti, D A

    2000-03-06

    The Internet promises to touch every aspect of a physician's professional life, from patient relations to access to clinical studies, from billing to patient records, from marketing to e-mail. To help you make sense of what may be the most profound force in medical practice today, we're kicking off a new series with this article on helping patients navigate the Internet. Future installments, which will run in our first issue of every month, will look at such topics as online patient charts; Web-based electronic medical records; services that electronically connect doctors with health plans, hospitals, and other providers; and online supply purchasing.

  4. Modified serial extraction treatment in a patient with congenitally missing lower second premolars

    OpenAIRE

    Al Hummayani, Fadia Mohammed

    2015-01-01

    Serial extraction is a sequential plan of premature removal of one or more deciduous teeth in order to improve the alignment of permanent teeth and then removal of permanent teeth to maintain the proper ratio between tooth size and arch size. The aim of this case report was to present a case treated successfully with a modified serial extraction protocol in the lower arch because the patient had congenitally missing lower second premolars with severe crowding. The treatment consisted of selec...

  5. Accounting for psychotropic medication changes in prisons: patient and doctor perspectives.

    Science.gov (United States)

    Hassan, Lamiece; Edge, Dawn; Senior, Jane; Shaw, Jenny

    2015-07-01

    Psychotropic medicines are widely used to treat mental illness; however, people entering prison commonly report that prescribed psychotropic medicines are changed or withdrawn, adding to their distress in difficult times. Drawing on three extracts from a larger qualitative dataset in which patients and doctors were interviewed about psychotropic medication use in English prisons, we combined discursive psychological and Foucauldian discourse analysis techniques to examine how individuals accounted for medication changes. Patients used four discursive strategies to organize descriptions of medication changes: they established entitlement to psychotropic medication, questioned the clinical judgment of prison doctors; highlighted communication problems; and attributed negative health outcomes to medication regime changes. In contrast, we examined an effective defense by a general practitioner, which showed how clinical needs were prioritized over previously held prescriptions when making prescribing decisions. Wider implications for continuity and equivalence of care between prisons and the wider community are discussed. © The Author(s) 2014.

  6. Doctor patient communication-a vital yet neglected entity in Indian medical education system.

    Science.gov (United States)

    Agarwal, Akhilesh; Agarwal, Anshu; Nag, Kushal; Chakraborty, Saurav; Ali, Kamran

    2011-06-01

    Doctor patient communication is the most important and an integral part of any treatment regimen. Properly carried out it has been shown to have a therapeutic effect equivalent to drugs. Despite being so important part of treatment it is more than often taken and carried out casually. Apart from apathy towards this practice, its omission in the medical study curriculum is an important factor. This study was carried in amongst the surgical residents of surgical departments of various medical colleges to assess the attitude of surgical residents towards patient doctor communication. A questionnaire was forwarded by mail and email and the response was assessed: The responses of the surgical residents from various residents from different medical colleges were similar. Most of the residents prefer inclusion of communication skill in medical education curriculum.

  7. Patient participation in patient safety still missing: Patient safety experts' views.

    Science.gov (United States)

    Sahlström, Merja; Partanen, Pirjo; Rathert, Cheryl; Turunen, Hannele

    2016-10-01

    The aim of this study was to elicit patient safety experts' views of patient participation in promoting patient safety. Data were collected between September and December in 2014 via an electronic semi-structured questionnaire and interviews with Finnish patient safety experts (n = 21), then analysed using inductive content analysis. Patient safety experts regarded patients as having a crucial role in promoting patient safety. They generally deemed the level of patient safety as 'acceptable' in their organizations, but reported that patient participation in their own safety varied, and did not always meet national standards. Management of patient safety incidents differed between organizations. Experts also suggested that patient safety training should be increased in both basic and continuing education programmes for healthcare professionals. Patient participation in patient safety is still lacking in clinical practice and systematic actions are needed to create a safety culture in which patients are seen as equal partners in the promotion of high-quality and safe care. © 2016 John Wiley & Sons Australia, Ltd.

  8. Cost incentives for doctors

    DEFF Research Database (Denmark)

    Schottmüller, Christoph

    2013-01-01

    If doctors take the costs of treatment into account when prescribing medication, their objectives differ from their patients' objectives because the patients are insured. This misalignment of interests hampers communication between patient and doctor. Giving cost incentives to doctors increases...... welfare if (i) the doctor's examination technology is sufficiently good or (ii) (marginal) costs of treatment are high enough. If the planner can costlessly choose the extent to which doctors take costs into account, he will opt for less than 100%. Optimal health care systems should implement different...... degrees of cost incentives depending on type of disease and/or doctor....

  9. The Effect of Screen-to-Screen Versus Face-to-Face Consultation on Doctor-Patient Communication: An Experimental Study with Simulated Patients

    NARCIS (Netherlands)

    Tates, K.; Antheunis, M.L.; Kanters, S.; Nieboer, T.E.; Gerritse, M.B.E.

    2017-01-01

    BACKGROUND: Despite the emergence of Web-based patient-provider contact, it is still unclear how the quality of Web-based doctor-patient interactions differs from face-to-face interactions. OBJECTIVE: This study aimed to examine (1) the impact of a consultation medium on doctors' and patients'

  10. Between professional values, social regulations and patient preferences: medical doctors' perceptions of ethical dilemmas.

    Science.gov (United States)

    Bringedal, Berit; Isaksson Rø, Karin; Magelssen, Morten; Førde, Reidun; Aasland, Olaf Gjerløv

    2018-04-01

    We present and discuss the results of a Norwegian survey of medical doctors' views on potential ethical dilemmas in professional practice. The study was conducted in 2015 as a postal questionnaire to a representative sample of 1612 doctors, among which 1261 responded (78%). We provided a list of 41 potential ethical dilemmas and asked whether each was considered a dilemma, and whether the doctor would perform the task, if in a position to do so. Conceptually, dilemmas arise because of tensions between two or more of four doctor roles: the patient's advocate, a steward of societal interests, a member of a profession and a private individual. 27 of the potential dilemmas were considered dilemmas by at least 50% of the respondents. For more than half of the dilemmas, the anticipated course of action varied substantially within the professional group, with at least 20% choosing a different course than their colleagues, indicating low consensus in the profession. Doctors experience a large range of ethical dilemmas, of which many have been given little attention by academic medical ethics. The less-discussed dilemmas are characterised by a low degree of consensus in the profession about how to handle them. There is a need for medical ethicists, medical education, postgraduate courses and clinical ethics support to address common dilemmas in clinical practice. Viewing dilemmas as role conflicts can be a fruitful approach to these discussions. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  11. Doctors' involvement in torture.

    Science.gov (United States)

    Jesper, Sonntag

    2008-01-01

    Doctors from both non-democratic and democratic countries are involved in torture. The majority of doctors involved in torture are doctors at risk. Doctors at risk might compromise their ethical duty towards patients for the following possible reasons: individual factors (such as career, economic or ideological reasons), threats, orders from a higher ranking officer, political initiatives, working in atrocity-producing situations or dual loyalty. In dual loyalty conflicts, factors that might compromise doctors' ethical obligations towards detainees/patients are: ideological totalitarianism, moral disengagement, victim blame, patriotism, individual factors or threats. Another important reason why doctors are involved in torture is that not all doctors are trained in addressing human rights issues of detainees. Torture survivors report that they have experienced doctors' involvement in torture and doctors themselves report that they have been involved in torture. Testimonies from both torture survivors and doctors demonstrate that the most common way doctors are involved is in the diagnosis/medical examination of torture survivors/prisoners. And it is common before, during and after torture. Both torture survivors and doctors state that doctors are involved during torture by treatment and direct participation. Doctors also falsify journals, certificates and reports. When doctors are involved in torture it has devastating consequences for both torture survivors and doctors. The consequences for the survivors can be mistrust of doctors, avoidance of seeking doctors' help and nightmares involving doctors. Mistrust and avoidance of doctors could be especially fatal to the survivor, as it could mean a survivor who is ill may not seek medical attention. When the unambiguous role of the doctor as the protector and helper of people is questioned, it affects the medical profession all over the world.

  12. Doctors' perspectives on the barriers to appropriate prescribing in older hospitalized patients: A qualitative study.

    LENUS (Irish Health Repository)

    Cullinan, S

    2014-11-18

    Older patients commonly suffer from multimorbidites and take multiple medications. As a result, these patients are more vulnerable to potentially inappropriate prescribing (PIP). PIP in older patients may result in adverse drug events and hospitalisations. However, little has been done to identify why PIP occurs. The objectives of this study were; (1) to identify hospital doctors\\' perceptions as to why PIP occurs, (2) to identify the barriers to addressing the issues identified, and (3) to determine which intervention types would be best suited to improving prescribing.

  13. The association between number of doctors per bed and readmission of elderly patients with pneumonia in South Korea.

    Science.gov (United States)

    Lee, Joo Eun; Kim, Tae Hyun; Cho, Kyoung Hee; Han, Kyu-Tae; Park, Eun-Cheol

    2017-06-08

    There is an urgent need to reduce readmission of patients with pneumonia and improve quality of care. To assess the association between hospital resources and quality of care, we examined the effect of number of doctors per bed on 30-day readmission and investigated the combined effect of number of doctors per bed and number of beds. We used nationwide cohort sample data of health insurance claims by the National Health Insurance Service (NHIS) from 2002 to 2013. Pneumonia admissions to acute care hospitals among 7446 inpatients older than 65 were examined. We conducted a multivariate Cox proportional hazard model to analyze the association between the number of doctors per bed and 30-day readmission, as well as that of pneumonia-specific 30-day readmission with the combined effects of number of doctors per bed and number of beds. Overall, 1421 (19.1%) patients were readmitted within 30 days and 756 (11.2%) patients were readmitted for pneumonia within 30 days. Patients with pneumonia treated by very low or low number of doctors per bed showed higher readmission (pneumonia-specific readmission: hazard ratio [HR] = 1. 406, 95% confidence interval [CI] = 1.072-1.843 for low number of doctors per bed; all-cause readmissions: HR = 1.276, 95% CI = 1.026-1.587 for very low number of doctors per bed, and HR = 1.280, 95% CI = 1.064-1.540 for low number of doctors per bed). This empirical study showed that patients with pneumonia cared for in hospitals with more doctors were less likely to be readmitted. Pneumonia-specific 30-day readmission was also significantly associated with the combined effect of the number of doctors and the number of hospital beds.

  14. How physician electronic health record screen sharing affects patient and doctor non-verbal communication in primary care.

    Science.gov (United States)

    Asan, Onur; Young, Henry N; Chewning, Betty; Montague, Enid

    2015-03-01

    Use of electronic health records (EHRs) in primary-care exam rooms changes the dynamics of patient-physician interaction. This study examines and compares doctor-patient non-verbal communication (eye-gaze patterns) during primary care encounters for three different screen/information sharing groups: (1) active information sharing, (2) passive information sharing, and (3) technology withdrawal. Researchers video recorded 100 primary-care visits and coded the direction and duration of doctor and patient gaze. Descriptive statistics compared the length of gaze patterns as a percentage of visit length. Lag sequential analysis determined whether physician eye-gaze influenced patient eye gaze, and vice versa, and examined variations across groups. Significant differences were found in duration of gaze across groups. Lag sequential analysis found significant associations between several gaze patterns. Some, such as DGP-PGD ("doctor gaze patient" followed by "patient gaze doctor") were significant for all groups. Others, such DGT-PGU ("doctor gaze technology" followed by "patient gaze unknown") were unique to one group. Some technology use styles (active information sharing) seem to create more patient engagement, while others (passive information sharing) lead to patient disengagement. Doctors can engage patients in communication by using EHRs in the visits. EHR training and design should facilitate this. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  15. Objective assessment of mastication predominance in healthy dentate subjects and patients with unilateral posterior missing teeth.

    Science.gov (United States)

    Yamasaki, Y; Kuwatsuru, R; Tsukiyama, Y; Oki, K; Koyano, K

    2016-08-01

    We aimed to investigate mastication predominance in healthy dentate individuals and patients with unilateral posterior missing teeth using objective and subjective methods. The sample comprised 50 healthy dentate individuals (healthy dentate group) and 30 patients with unilateral posterior missing teeth (partially edentulous group). Subjects were asked to freely chew three kinds of test foods (peanuts, beef jerky and chewing gum). Electromyographic activity of the bilateral masseter muscles was recorded. The chewing side (right side or left side) was judged by the level of root mean square electromyographic amplitude. Mastication predominance was then objectively assessed using the mastication predominant score and the mastication predominant index. Self-awareness of mastication predominance was evaluated using a modified visual analogue scale. Mastication predominance scores of the healthy dentate and partially edentulous groups for each test food were analysed. There was a significant difference in the distribution of the mastication predominant index between the two groups (P < 0·05). The mastication predominant score was weakly correlated with self-awareness of mastication predominance in the healthy dentate group, whereas strong correlation was observed in the partially edentulous group (P < 0·05). The results suggest that the individuals with missing unilateral posterior teeth exhibited greater mastication predominance and were more aware of mastication predominance than healthy dentate individuals. Our findings suggest that an objective evaluation of mastication predominance is more precise than a subjective method. © 2016 John Wiley & Sons Ltd.

  16. Modified serial extraction treatment in a patient with congenitally missing lower second premolars.

    Science.gov (United States)

    Al Hummayani, Fadia Mohammed

    2015-01-01

    Serial extraction is a sequential plan of premature removal of one or more deciduous teeth in order to improve the alignment of permanent teeth and then removal of permanent teeth to maintain the proper ratio between tooth size and arch size. The aim of this case report was to present a case treated successfully with a modified serial extraction protocol in the lower arch because the patient had congenitally missing lower second premolars with severe crowding. The treatment consisted of selective removal of the deciduous mandibular teeth only (C, D, and E) and no permanent premolar removal. However, the space of the missing second premolars was utilized to resolve the anterior crowding along with the spontaneous closure of the extra spaces by physiologic movement of the permanent mandibular teeth. Whereas in the upper arch conventional serial extraction was performed.

  17. KIDMAP, a web based system for gathering patients' feedback on their doctors

    Directory of Open Access Journals (Sweden)

    Lin Ching-Yih

    2009-06-01

    Full Text Available Abstract Background The gathering of feedback on doctors from patients after consultations is an important part of patient involvement and participation. This study first assesses the 23-item Patient Feedback Questionnaire (PFQ designed by the Picker Institute, Europe, to determine whether these items form a single latent trait. Then, an Internet module with visual representation is developed to gather patient views about their doctors; this program then distributes the individualized results by email. Methods A total of 450 patients were randomly recruited from a 1300-bed-size medical center in Taiwan. The Rasch rating scale model was used to examine the data-fit. Differential item functioning (DIF analysis was conducted to verify construct equivalence across the groups. An Internet module with visual representation was developed to provide doctors with the patient's online feedback. Results Twenty-one of the 23 items met the model's expectation, namely that they constitute a single construct. The test reliability was 0.94. DIF was found between ages and different kinds of disease, but not between genders and education levels. The visual approach of the KIDMAP module on the WWW seemed to be an effective approach to the assessment of patient feedback in a clinical setting. Conclusion The revised 21-item PFQ measures a single construct. Our work supports the hypothesis that the revised PFQ online version is both valid and reliable, and that the KIDMAP module is good at its designated task. Further research is needed to confirm data congruence for patients with chronic diseases.

  18. Shrinking social space in the doctor-modern patient relationship: a review of forces for, and implications of, homologisation.

    Science.gov (United States)

    Buetow, Stephen; Jutel, Annemarie; Hoare, Karen

    2009-01-01

    Forces for modernisation appear to have led to role convergence and reduced social distances between doctors and modern patients. This review aims to document and understand this process in theory and practice, and to consider the implications for modern patients in particular but also non-modern patients and doctors. Narrative review of published and grey literature identified from sources including electronic databases, the Internet and reference lists of retrieved works. Forces for role convergence between doctors and modern patients include consumerism and increased patient literacy; socio-technological changes; values convergence; increased licence for doctors to use their emotions in patient care; and structural changes in the social organisation of health care. As a result, modern patients appear to have gained more in health care than they have lost and more than have the non-modern (or less modern) patients. Doctors have lost authority and autonomy in patient care. The net impulse toward role convergence is, on balance, a positive development. The differential uptake of modernisation by patients has increased health inequalities between modern and non-modern patients. The need of doctors to accommodate these changes has contributed to a form of reprofessonalisation. A key challenge is to make available the benefits of modernisation, for example through patient education, to as many patients as possible while minimising the risk of harm. It is important therefore to elucidate and be responsive to patient preferences for modernisation, for example by enlisting the support of the modern patients in overcoming barriers to the modernisation of non-modern patients. There is also a need to support doctors as they redefine their own professional role identity.

  19. Missed strokes using computed tomography imaging in patients with vertigo: population-based cohort study.

    Science.gov (United States)

    Grewal, Keerat; Austin, Peter C; Kapral, Moira K; Lu, Hong; Atzema, Clare L

    2015-01-01

    The purpose of this study was to determine the proportion of emergency department (ED) patients with a diagnosis of peripheral vertigo who received computed tomography (CT) head imaging in the ED and to examine whether strokes were missed using CT imaging. This population-based retrospective cohort study assessed patients who were discharged from an ED in Ontario, Canada, with a diagnosis of peripheral vertigo, April 2006 to March 2011. Patients who received CT imaging (exposed) were matched by propensity score methods to patients who did not (unexposed). If performed, CT imaging was presumed to be negative for stroke because brain stem/cerebellar stroke would result in hospitalization. We compared the incidence of stroke within 30, 90, and 365 days subsequent to ED discharge between groups, to determine whether the exposed group had a higher frequency of early strokes than the matched unexposed group. Among 41 794 qualifying patients, 8596 (20.6%) received ED head CT imaging, and 99.8% of these patients were able to be matched to a control. Among exposed patients, 25 (0.29%) were hospitalized for stroke within 30 days when compared with 11 (0.13%) among matched nonexposed patients. The relative risk of a 30- and 90-day stroke among exposed versus unexposed patients was 2.27 (95% confidence interval, 1.12-4.62) and 1.94 (95% confidence interval, 1.10-3.43), respectively. There was no difference between groups at 1 year. Strokes occurred at a median of 32.0 days (interquartile range, 4.0-33.0 days) in exposed patients, compared with 105 days (interquartile range, 11.5-204.5) in unexposed patients. One fifth of patients diagnosed with peripheral vertigo in Ontario received imaging that is not recommended in guidelines, and that imaging was associated with missed strokes. © 2014 American Heart Association, Inc.

  20. Determinants of patient delay in doctor consultation in head and neck cancers (Protocol DEREDIA).

    Science.gov (United States)

    Christophe, Véronique; Leroy, Tanguy; Seillier, Mélanie; Duthilleul, Camille; Julieron, Morbize; Clisant, Stéphanie; Foncel, Jérôme; Vallet, Fanny; Lefebvre, Jean-Louis

    2014-07-25

    Reducing the time between the onset of the first symptoms of cancer and the first consultation with a doctor (patient delay) is essential to improve the vital prognosis and quality of life of patients. Longer patient delay is linked to the already known sociodemographic, socioeconomic, socioeducational, sociocultural and socioprofessional factors. However, recent data suggest that some sociocognitive and emotional determinants may explain patient delay from a complementary point of view. The main objective of this study is to assess whether, in head and neck cancer, patient delay is linked to these sociocognitive and emotional factors, in addition to previously known factors. We intend to include in this study 400 patients with a not yet treated head and neck cancer diagnosed in one of six health centres in the North of France region. The main evaluation criterion is 'patient delay'. Sociocognitive, emotional, medical, sociodemographic, socioeconomic, educational, professional and geographic factors will be assessed by means of (1) a case report form, (2) a questionnaire completed by the clinical research associate together with the patient, (3) a questionnaire completed by the patient and (4) a recorded semidirective interview of the patient by a psychologist (for 80 patients only). The collected data will be analysed to underline the differences between patients who consulted a doctor earlier versus those who consulted later. The study has obtained all the relevant authorisations for the protection of patients enrolled in clinical trials (CCTIRS, CCP, CNIL), does not involve products mentioned in article L.5311-1 of the French Code of Public Health, and does not imply any changes in the medical care received by the patients. The study began in October 2012 and will end in June 2015. ID-RCB 2012-A00005-38. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  1. [Doctor-patient communication: one of the basic competencies, but different].

    Science.gov (United States)

    Moore, Philippa; Gómez, Gricelda; Kurtz, Suzanne

    2012-06-01

    Effective communication skills form part of being a good doctor. Today there is solid evidence to support the teaching of effective communication skills in all medical schools. This article describes how communication is different from the other skills that medical students and residents need to learn, how this affects teaching and learning, and the application of these ideas in a Chilean medical school. We describe the premises that need to be taken into consideration when planning teaching communication in medicine and illustrate how these affected the development of our teaching of communication in our undergraduate curriculum. All medical education programmes should include formal teaching on the doctor-patient relationship, but must take into consideration the aspects of communication teaching that make it different from teaching other aspects of medicine. Copyright © 2010 Elsevier España, S.L. All rights reserved.

  2. Do patients with chronic rhinosinusitis benefit from consultation with an ENT-doctor?

    DEFF Research Database (Denmark)

    Lange, Bibi; Thilsing, Trine; Baelum, Jesper

    2015-01-01

    CONCLUSION: By consulting an ENT-doctor, patients with chronic rhinosinusitis (CRS), in the general population, receive disease information and adjustment of treatment which can improve disease-specific Quality-of-Life and may improve objective measurements. OBJECTIVES: This study aims to follow...... persons with clinical diagnosed CRS from the general population, to evaluate their benefit from consultation with an ENT-doctor in terms of severity of symptoms and Quality-of-Life. METHODS: As part of a trans-European study, selected respondents to a survey questionnaire were invited for a clinical visit....... Based on the European Position Paper on Rhinosinusitis and Nasal Polyps, persons were diagnosed with CRS and followed for 2 years. Quality-of-Life was measured using the Sino Nasal Outcome Test 22 and European Quality-of-Life - 5 Dimensions. Clinical examination included rhinoscopy, acoustic rhinometry...

  3. Reduced joint counts misclassify patients with oligoarticular psoriatic arthritis and miss significant numbers of patients with active disease.

    Science.gov (United States)

    Coates, Laura C; FitzGerald, Oliver; Gladman, Dafna D; McHugh, Neil; Mease, Philip; Strand, Vibeke; Helliwell, Philip S

    2013-06-01

    To evaluate joint counts in patients with oligoarticular psoriatic arthritis (PsA) for their correlation with treatment decisions and to determine the proportion of patients in whom active disease was missed using reduced joint counts. The international Group for Research and Assessment of Psoriasis and Psoriatic Arthritis Composite Exercise cohort was used for this study. Oligoarthritis was defined as count (TJC) using 68 joints and a swollen joint count (SJC) using 66 joints (66/68-joint counts) were assessed. Reduced joint counts designed for use in rheumatoid arthritis (RA), including 28- and 44-joint counts, were analyzed. In addition, the following proposed joint counts for PsA were tested: the PsA-44 (which includes elbows, wrists, metacarpophalangeal joints, finger proximal interphalangeal [PIP] joints, distal interphalangeal joints, knees, and metatarsophalangeal joints) and the PsA-56 (which includes the same joints as those assessed for the PsA-44 plus ankles and toe PIP joints). Receiver operating characteristic (ROC) curve analysis was used to assess whether joint counts predict treatment changes. The proportion of patients in whom active disease was missed using reduced joint counts designed for RA was also assessed. Among 503 patients recruited to the study, 266 (53%) had oligoarthritis. ROC curve analysis revealed that no TJC or active joint count (AJC), even a 66/68-joint count, predicted treatment change (for the TJC, area under the curve [AUC] 0.57, P = 0.125; for the AJC, AUC 0.56, P = 0.159). Use of the SJC in 66 joints did predict treatment change (AUC 0.62, P = 0.006), as did the SJC using the PsA-44 and the PsA-56 (P counts designed for RA predicted treatment change. A 28-joint count designed for RA missed 21% of patients with tender joints (n = 29) and 27% of patients with swollen joints (n = 23). The PsA-44 and PsA-56 joint counts missed tender joints in 25 patients and 13 patients, respectively, and missed swollen joints in 11 patients

  4. Evaluation of patient and doctor perception toward the use of telemedicine in Apollo Tele Health Services, India

    Directory of Open Access Journals (Sweden)

    Rajesh V Acharya

    2016-01-01

    Full Text Available Introduction: Telemedicine incorporates electronic information and medical technology. It connects healthcare through vast distances which would benefit both patients and doctors. The aim of this questionnaire study was to evaluate the effects of telemedicine on patients and medical specialists. Methods: A cross-sectional study was conducted among 122 participants (71 patients and 51 doctors on satisfaction in quality of service, cost-effectiveness, and problems encountered in healthcare provided by the telemedicine in Apollo Tele Health Services, Hyderabad, Telangana, India. The data for each group were calculated and compared. Results: About 80% patients and all the doctors reported their satisfaction on the quality of treatment given through telemedicine. Approximately, 90% of the participants found telemedicine cost-effective and 61% of the doctors found an increase in patient's inflow apart for their regular practice. Problems encountered in telemedicine were 47% in technical issues and 39% in time scheduling by doctors and 31% of patients were uncomfortable to face the camera, and 24% had technical issues. Conclusions: The results of the present study showed that telemedicine in healthcare could prove to be useful to patients in distant regions and to rural doctors in India. In the near future, telemedicine can be considered as an alternate to face to face patient care.

  5. Examination of third molar Missing in skeletal Cl I , Cl II in Tehran dental school patients during

    Directory of Open Access Journals (Sweden)

    Chalipa J

    2010-06-01

    Full Text Available "nBackground and Aims: One of the common human evolutionary anomalies is dental Missing. Evolution of dental system is toward deduction of teeth number. The Missing of third molar is interesting subject for dentists and genetic researches because of its variety in different races. Consideration of bilateral effect of third molar Missing with jaw relation is an important subject. The aim of this study was to evaluate the third molar missing in Cl I and Cl II skeletal (without rotation and comparison of them together. "nMaterials and Methods: The patients of the orthodontic department of school of Dentistry (Tehran University of Medical Sciences were analyzed. About 121 patients had Cl I and 60 patients had ClI jaw relation. This relation identified based on cephalometric lateral radiographic ANB corner angle. Patient who had rotation in maxilla or mandible based on SN-Go Gn angle were excluded. The incidence of third molars agenesis in individual dentition quadrants, upper and lower jaw and right and left side of dentition was examined from panoramic radiography. AChi-square test was used for statistical analysis of data. "nResults: Missing of one or more third molar in skeletal Cl I and Cl II was 43% and 33.3%, respectively. Missing of one or more third molar in Cl II was fewer than Cl I, but no statistically significant differences were seen between them. "nConclusion: There was not a direct relationship between jaw relation and third molar Missing.

  6. Missing Teeth and Prosthetic Treatment in Patients Treated at College of Dentistry, University of Dammam

    Directory of Open Access Journals (Sweden)

    Shaimaa M. Fouda

    2017-01-01

    Full Text Available The percentage of completely and partially edentulous patients and their prosthetic treatment at the Department of Substitutive Dental Sciences (SDS, College of Dentistry, University of Dammam, were investigated. Panoramic radiographs and medical records of adult patients (n=479, mean age 45.9 years, and range 25–96 years treated in 2011–2014 were examined. 6% of the patients were completely edentulous, 8% had single jaw edentulousness, and 74% were partially edentulous. Edentulousness was significantly correlated with age and the number of missing teeth was significantly higher among males (p<0.026. Diabetes was significantly associated with complete edentulousness, single edentulous jaw (p value 0.015, and partial edentulousness (p value 0.023. Kennedy class III was the most frequent class of partial edentulousness in single and/or both jaws (p=0.000. Patients having class I and/or class II were treated most often with removable partial dentures (RPD (p=0.000, while patients having class III were treated with fixed partial dentures (FPD. It was found that complete edentulousness increases in older age and the number of missing teeth was significantly higher among males. Kennedy class III was most common in both upper and lower jaw and was treated more often with FPD than with RPD.

  7. Development of a patient-doctor communication skills model for medical students.

    Science.gov (United States)

    Lee, Young Hee; Lee, Young-Mee

    2010-09-01

    Communication is a core clinical skill that can be taught and learned. The authors intended to develop a patient-doctor communication model for teaching and assessing undergraduate medical students in Korea. To develop a model, literature reviews and an iterative process of discussion between faculty members of a communication skills course for second year medical students were conducted. The authors extracted common communication skill competencies by comparing the Kalamazoo Consensus Statement, SEGUE framework communication skills, the Calgary Cambridge Observation Guides, and previous communication skills lists that have been used by the authors. The content validity, with regard to clinical importance and feasibility, was surveyed by both faculty physicians and students. The first version of the model consisted of 36 items under 7 categories: initiating the session (8 items), building a relationship (6), gathering information (8), understanding a patient's perspectives (4), sharing information (4), reaching an agreement (3), and closing the session (3). It was used as a guide for both students and teachers in an actual communication skills course. At the end of the course, student performance was assessed using two 7-minute standardized patient interviews with a 34-item checklist. This assessment tool was modified from the first version of the model to reflect the case specificity of the scenarios. A patient-doctor communication model, which can be taught to those with limited patient care experience, was finally developed. We recommended a patient-doctor communication skills model that can be used for teaching and evaluating preclinical and clinical students. Further studies are needed to verify its validity and reliability.

  8. Placebo and the New Physiology of the Doctor-Patient Relationship

    Science.gov (United States)

    2013-01-01

    Modern medicine has progressed in parallel with the advancement of biochemistry, anatomy, and physiology. By using the tools of modern medicine, the physician today can treat and prevent a number of diseases through pharmacology, genetics, and physical interventions. Besides this materia medica, the patient's mind, cognitions, and emotions play a central part as well in any therapeutic outcome, as investigated by disciplines such as psychoneuroendocrinoimmunology. This review describes recent findings that give scientific evidence to the old tenet that patients must be both cured and cared for. In fact, we are today in a good position to investigate complex psychological factors, like placebo effects and the doctor-patient relationship, by using a physiological and neuroscientific approach. These intricate psychological factors can be approached through biochemistry, anatomy, and physiology, thus eliminating the old dichotomy between biology and psychology. This is both a biomedical and a philosophical enterprise that is changing the way we approach and interpret medicine and human biology. In the first case, curing the disease only is not sufficient, and care of the patient is of tantamount importance. In the second case, the philosophical debate about the mind-body interaction can find some important answers in the study of placebo effects. Therefore, maybe paradoxically, the placebo effect and the doctor-patient relationship can be approached by using the same biochemical, cellular and physiological tools of the materia medica, which represents an epochal transition from general concepts such as suggestibility and power of mind to a true physiology of the doctor-patient interaction. PMID:23899563

  9. Developing skilled doctor-patient communication in the workplace: a qualitative study of the experiences of trainees and clinical supervisors

    NARCIS (Netherlands)

    Giroldi, E.; Veldhuijzen, W.; Geelen, K.; Muris, J.; Bareman, F.; Bueving, H.; Weijden, T.T. van der; Vleuten, C. van der

    2017-01-01

    To inform the development of recommendations to facilitate learning of skilled doctor-patient communication in the workplace, this qualitative study explores experiences of trainees and supervisors regarding how trainees learn communication and how supervisors support trainees' learning in the

  10. Missing needle during episiotomy repair

    Directory of Open Access Journals (Sweden)

    Joydeb Roychowdhury

    2008-01-01

    Full Text Available Breakage and missing of the episiotomy needle is not uncommon occurrence at the hands of the junior doctors. Retrieving it from deeper tissue planes following its migration can be a challenging task.

  11. Improving communication between doctor and patient: eHealth in the Netherlands, an established cloud solution

    Science.gov (United States)

    Kool, Anton

    2012-01-01

    In the Netherlands, like in many West European countries, demand for healthcare is already sharply increasing, with further acceleration expected soon. All parties involved are convinced that the resulting demand for funding of healthcare will not be met by economic growth. The resulting paradigma shift (live longer healthy, self-care and patient centred care) is a challenge not only for scientists, but for politicians and healthcare-providers as well. One of the solutions in the paradigma shift is eHealth. eHealth can refer to automated data-exchange between a device and a central database, but also to healthcare practices that use webbased communication. Strengthening patient participation, motivation and self-management is the hope for better therapy outcome. Early deviations need to be recognized, adverse reactions to be understood and appropriate action to be taken. In itself not new, diaries have been around for decades, but appropriate assessment of its content is too time-consuming. Therefore, the challenge is to involve both the patient and the attending professional (-s) and give eHealth solutions a place in the context of regular care. We combined the internet cloud with advanced security-technology to provide an answer to that: Curavista health, a database driven internetplatform for patient@home and doctor@work. Patient@home replies to webquestionnaires and fill online diaries. The responses are summarized in tables, graphs or automated follow-ups and the patient has immediate insight in the progression achieved. Not only does database technology allow for immediate processing of the responses into summaries; it is also possible to highlight differences, produce alerts or (refer to) educational information. Doctor@work, using an own account, has access to the responses as well as to the summaries, resulting in early insight. Because the patient@home does not necessarily record only biometrics, but also has the opportunity to add other types of replies

  12. Caregivers' role in breaking bad news: patients, doctors, and nurses' points of view.

    Science.gov (United States)

    Rassin, Michal; Levy, Orna; Schwartz, Tirza; Silner, Dina

    2006-01-01

    The aim of the research was to identify the caregivers' response patterns when breaking bad news at the first time of cancer diagnosis and their affect on the patient. These issues were examined from 3 points of view: patients, doctors, and nurses. A total of 152 Israelis subjects participated in the research: 51 patients with cancer, 51 nurses, and 50 doctors. They filled out a questionnaire developed for the research that included 35 items. Support patterns identified as effective were as follows: allowing for the expression of emotions, empathetic silence, support through touch, and the use of participatory, commendation, and encouragement statements. The research findings indicate the crucial need in the involvement of a family member and a nurse in the process and in supplying written information for the receiver of the news. Significant differences (P < .05) between patients and caregivers were found in the type of information given, in the timing and quantity, and in the support and communication patterns. The principal emotions professional caregivers experienced were identification and helplessness. Most of them were not trained in this field. The research findings could bridge the gap between what patients want and what caregivers do and would benefit in designing guidelines for breaking bad news and formulating a workshop program for furthering the team skills.

  13. [Caregivers' role in breaking bad news: patients, doctors, and nurses' points of view].

    Science.gov (United States)

    Rassin, Michal; Levy, Orna; Schwartz, Tirza; Silner, Dina

    2006-06-01

    The aim of the research was to identify the behavioral patterns employed by caregivers when breaking bad news, and their affect on the patient. These issues were examined from three points of view: patients, doctors, and nurses. A total of 152 interviewees participated in the research: 51 patients, 51 nurses, and 50 doctors. They completed a constructed questionnaire that included 35 items developed for the research. Support patterns identified as effective were: allowing for the expression of emotions, empathic silence, support through touch, and the use of participatory, commendation, and encouragement statements. The research findings point to the crucial need for the involvement of a family-member and a nurse in the process, and providing written information for the receiver of the news. Significant differences (p < 0.05) between patients and caregivers were found in the type of information given, the timing and quantity, as well as in the support and communication patterns. The principal emotions caregivers experienced were identification and helplessness, and most of them were not trained in this field. The research findings could bridge the gap between what patients want and what caregivers actually do, and would be beneficial in designing guidelines for breaking bad news, as well as formulating a workshop program for furthering the team skills.

  14. THE PATIENT-DOCTOR-PSYCHOLOGIST TRIANGLE IN A CASE Of SEVERE IMUNOSUPRESSION IN THE HIV INFECTION.

    Science.gov (United States)

    Manciuc, Carmen; Filip-Ciubotaru, Florina; Badescu, Aida; Duceag, Letiţia Doina; Largu, Alexandra Maria

    2016-01-01

    In the last two years the Romanian adult population infected with the human immunodeficiency virus (HIV) has increased due to sexual transmission, both heterosexual and homosexual. The case presented is that of a 33 year-old man, admitted to the Infectious Diseases Hospital in Iasi with acute respiratory failure and a confirmation of Kaposi's sarcoma. Tests later proved positive for HIV, the patient being included in the stage AIDS C3 (acute immunodeficiency syndrome). The respiratory failure was suspected to be caused by Pneumocystis carinii and cotrimoxazol therapy, oxygen therapy and anti-retroviral therapy were established. He was also referred to the oncology hospital for treatment of Kaposi's sarcoma. The patient's adherence to therapy was influenced by a strong doctor-patient relationship, as well as by psychological counseling and support. Creating a functional doctor-patient-psychologist team is key throughout the HIV-positive patient's existence, for supporting long term adherence to therapy and acceptance of the diagnosis. This case highlights the need for a strong psychosocial compartment in every medical center that deals with HIV-infected individuals.

  15. [Crossed perceptions about malnutrition in patients and their doctors in oncology].

    Science.gov (United States)

    Raynard, Bruno; Hébuterne, Xavier; Goldwasser, François; Ait Hssain, Ali; Dubray Longeras, Pascale; Barthélémy, Philippe; Rosso, Edoardo; Phoutthasang, Valérie; Bories, Camille; Digue, Laurence; Laharie, David; Desport, Jean-Claude; Falkowski, Sabrina; Lacau Saint Guily, Jean; Gyan, Emmanuel

    2017-11-01

    Malnutrition is common in oncology. However, it is often detected too late and nutritional support is sub-optimal. The patient's opinion, although often sought in therapeutic decisions in oncology, does not appear to be frequently taken into account in dietetic management. In NutriCancer2012 study, we interviewed patients, relatives and doctors about their perceptions of the impact of malnutrition and its quality of care. Of the 2209 patients questioned, majority said they were concerned about nutrition with 75% considering it essential to take appropriate nutritional care but only 19% self-reported link between malnutrition and fatigue. Physicians underestimated impact of malnutrition on patient's "quality of life". Doctors referred to the lack of human resources and knowledge in nutrition, and more than 80% wished the creation of nutrition teams. Sensitization of the general public and patients (and relatives) as soon as the cancer diagnosis could lead to better malnutrition's screening. Better nutrition training for physicians and creation of nutrition team could optimize management and improve efficacy during cancer treatments. Copyright © 2017 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.

  16. Touch in primary care consultations: qualitative investigation of doctors' and patients' perceptions.

    Science.gov (United States)

    Cocksedge, Simon; George, Bethan; Renwick, Sophie; Chew-Graham, Carolyn A

    2013-04-01

    Good communication skills are integral to successful doctor-patient relationships. Communication may be verbal or non-verbal, and touch is a significant component, which has received little attention in the primary care literature. Touch may be procedural (part of a clinical task) or expressive (contact unrelated to a procedure/examination). To explore GPs' and patients' experiences of using touch in consultations. Qualitative study in urban and semi-rural areas of north-west England. Participating GPs recruited registered patients with whom they felt they had an ongoing relationship. Data were collected by semi-structured interviews and subjected to constant comparative qualitative analysis. All participants described the importance of verbal and non-verbal communication in developing relationships. Expressive touch was suggested to improve communication quality by most GPs and all patients. GPs reported a lower threshold for using touch with older patients or those who were bereaved, and with patients of the same sex as themselves. All patient responders felt touch on the hand or forearm was appropriate. GPs described limits to using touch, with some responders rarely using anything other than procedural touch. In contrast, most patient responders believed expressive touch was acceptable, especially in situations of distress. All GP responders feared misinterpretation in their use of touch, but patients were keen that these concerns should not prevent doctors using expressive touch in consultations. Expressive touch improves interactions between GPs and patients. Increased educational emphasis on the conscious use of expressive touch would enhance clinical communication and, hence, perhaps patient wellbeing and care.

  17. [The doctor-patient relationship against the backdrop of patient-centered medicine. The conclusions of dialogical ethics].

    Science.gov (United States)

    Kreß, H

    2012-09-01

    "Health" and "illness" are multilayered terms. The understanding of human health depends, apart from scientific aspects, on people's individual perceptions as well as on aspects of culture and world view. The ideal of patient-centered medicine requires that a physician does not merely have to establish an objectifiable diagnosis. Rather, a physician should also respect the patients' right to self-determination, their personal values, and their subjective view of health and illness. The philosophy of dialogue, which developed in the twentieth century, offers a conceptual background for this ideal. On an empirical basis, the successful communication between doctor and patient can be interpreted as a useful placebo phenomenon. Alternative medicine puts great emphasis on the doctor's attentive care. This also explains why the alternative branch of medicine has appealed to many patients. Therefore, science-oriented medicine should review methods in which the doctor's empathy and dialogue ability are crucial to treatment success. It is part of the physician's responsibility to appreciate the personal perspectives of patients, to respect them and, if necessary, to engage with them critically.

  18. Frequency of methotrexate intolerance in rheumatoid arthritis patients using methotrexate intolerance severity score (MISS questionnaire).

    Science.gov (United States)

    Fatimah, Nibah; Salim, Babur; Nasim, Amjad; Hussain, Kamran; Gul, Harris; Niazi, Sarah

    2016-05-01

    The objective of the study was to determine the frequency of methotrexate intolerance in rheumatoid arthritis (RA) patients by applying the methotrexate intolerance severity score (MISS) questionnaire and to see the effect of dose and concomitant use of other disease-modifying antirheumatic drugs (DMARDS) on methotrexate (MTX) intolerance. For the descriptive study, non-probability sampling was carried out in the Female Rheumatology Department of Fauji Foundation Hospital (FFH), Rawalpindi, Pakistan. One hundred and fifty diagnosed cases of RA using oral MTX were selected. The MISS questionnaire embodies five elements: abdominal pain, nausea, vomiting, fatigue and behavioural symptoms. The amplitude of each element was ranked from 0 to 3 being no complaint (0 points), mild (1 point), moderate (2 points) and severe (3 points). A cut-off score of 6 and above ascertained intolerance by the physicians. A total of 33.3 % of the subjects exhibited MTX intolerance according to the MISS questionnaire. Out of which, the most recurring symptom of all was behavioural with a value of 44 % whereas vomiting was least noticeable with a figure of 11 %. About 6.6 % of the women with intolerance were consuming DMARDs in conjunction with MTX. Those using the highest weekly dose of MTX (20 mg) had supreme intolerance with prevalence in 46.2 % of the patients. The frequency of intolerance decreased with a decrease in weekly dose to a minimum of 20 % with 7.5 mg of MTX. MTX intolerance has moderate prevalence in RA patients and if left undetected, the compliance to use of MTX as a first-line therapy will decrease. Methotrexate intolerance is directly proportional to the dose of MTX taken. Also, there is no upstroke seen in intolerance with the use of other disease-modifying agents.

  19. Doctors' unawareness of the drugs their patients are taking: a major cause of overprescribing?

    Science.gov (United States)

    Price, D; Cooke, J; Singleton, S; Feely, M

    1986-01-11

    We studied the accuracy of both hospital and general practitioners' records of current drug treatment in consecutive patients who attended a general medical review clinic. Either the hospital or the general practitioner's records (obtained in a questionnaire), or both, were inaccurate for over 70% of 59 patients interviewed with their medicine. Most of the errors were due to patients taking drugs in addition to those shown in their records. Some of these were inappropriate, and many seemed unnecessary. It appears that neither hospital doctors nor general practitioners are fully aware which drugs their patients are taking, and this may contribute to overprescribing. We believe that considerable financial savings might be made if patients brought all their medicines to every consultation.

  20. Effects of Oral Nutritional Supplements on Mortality, Missed Dialysis Treatments, and Nutritional Markers in Hemodialysis Patients.

    Science.gov (United States)

    Benner, Debbie; Brunelli, Steven M; Brosch, Becky; Wheeler, Jane; Nissenson, Allen R

    2017-12-06

    Protein-energy wasting is common in end-stage renal disease patients undergoing dialysis and is strongly associated with mortality and adverse outcomes. Intradialytic oral nutritional supplements (ONS) reduce risk of mortality in these patients. Large studies characterizing the impact of ONS on other outcomes are lacking. We assessed the associations between administration of ONS and clinical and nutritional outcomes. Retrospective evaluation of a pilot program providing ONS to patients at a large dialysis organization in the United States. The pilot program provided ONS to in-center hemodialysis patients with serum albumin ≤3.5 g/dL at 408 facilities. ONS patients were compared to matched controls with serum albumin ≤3.5 g/dL, identified from facilities not participating in the ONS program (n = 3,374 per group). Receipt of ONS. Death, missed dialysis treatments, hospitalizations, serum albumin, normalized protein catabolic rate, and postdialysis body weight were abstracted from large dialysis organization electronic medical records. There was a 69% reduction in deaths (hazard ratio = 0.31; 95% confidence interval = 0.25-0.39), and 33% fewer missed dialysis treatments (incidence rate ratio = 0.77; 95% confidence interval = 0.73-0.82) among ONS patients compared to controls (P nutritional indices were mixed: serum albumin was lower, whereas normalized protein catabolic rate values, a surrogate for dietary protein intake, and postdialysis body weights were higher for ONS patients compared to controls during follow-up. Our evaluation confirmed the beneficial effects of ONS in reducing mortality and improving some indices of nutritional status for hypoalbuminemic hemodialysis patients. We also report the novel finding that ONS can reduce the number of missed dialysis treatments. These results support the use of intradialytic ONS as an effective intervention to improve the outcomes in hemodialysis patients with low serum albumin. Copyright © 2017

  1. Miss Evers' Boys (1997). Study of the spontaneous evolution of syphilis in black patients

    OpenAIRE

    Agustín del Cañizo Fernández-Roldán

    2008-01-01

    Miss Evers' Boys (1997) is a movie based on a real fact happened in the State of Alabama (United States), where it was carried out a research work that begun in 1932 and was prolonged up to 1972. It consisted on watching the evolution of syphilis in black male patients, who were not given any anti-syphilitic treatment at any moment. Once the fact was public, a great polemic on the ethics of the research with human fellows was originated and publications dealt with this case...

  2. Improving patient safety in radiotherapy by learning from near misses, incidents and errors.

    Science.gov (United States)

    Williams, M V

    2007-05-01

    Radiotherapy incidents involving a major overdose such as that which affected a patient in Glasgow in 2006 are rare. The publicity surrounding this patient's treatment and the subsequent publication of the enquiry by the Scottish Executive have led to a re-evaluation of procedures in many departments. However, other incidents and near misses that might also generate learning are often surrounded by obsessive secrecy. With the passage of time, even those incidents that have been subject to a public enquiry are lost from view. Indeed, the report on the incident in Glasgow draws attention to strong parallels with that in North Staffordshire, the report of which is not freely available despite being in the public domain. A web-based system to archive and make available previously published reports should be relatively simple to establish. A greater challenge is to achieve open reporting of near misses, incidents and errors. The key elements would be the effective use of keywords, a system of classification and a searchable anonymized database with free access. There should be a well designed system for analysis, response and feedback. This would ensure the dissemination of learning. The development of a more open culture for reports under the Ionising Radiation (Medical Exposure) Regulations (IR(ME)R) is essential: at the very least, their main findings and recommendations should be routinely published. These changes should help us to achieve greater safety for our patients.

  3. [Doctor-Patient Relationship from the Perspective of Medical Students' Portfolio].

    Science.gov (United States)

    Girela Pérez, Beatriz; Rodríguez Cano, María Araceli; Girela López, Eloy

    2018-01-01

    Doctor-patient relationship is of paramount importance for a good medical practice, however as long as medicine has been increasingly influenced by technology and science, it may be at risk of losing contact with basic human values of respect for the beliefs and preferences of the other person. In this study, we have analyzed the deontological vision of the physician-patient relationship perceived through clinical situations reflected in the portfolios carried out by 225 students of the 5th year of the Degree of Medicine at the University of Córdoba, during the courses 2014/15 and 2015/16. 201 out of 833 deontological considerations on articles of the Code of Medical Ethics constitute non-compliances. It is noteworthy that these breaches to the Code of Medical Ethics considered refer mainly (73%) to Chapter III (doctor-patient relationship). It is particularly interesting that the problems most frequently detected are those related to attitude, forms or language and lack of understanding/confidence of the physician with the patient (article 8 with 46 noncompliances), as well as problems in providing information (articles 12.1 and 15, with 18 and 42 noncompliances respectively).

  4. Investigating acculturation orientations of patients with an immigration background and doctors in Canada: implications for medical advice adherence.

    Science.gov (United States)

    Whittal, Amanda; Hanke, Katja; Lippke, Sonia

    2017-05-01

    Increased immigration requires successful interaction of different cultures in various life domains, such as health. This study investigates acculturation orientation (AO) of immigrant patients and doctors native to the country, as a potential factor related to perceived medical advice adherence. N = 171 immigrant patients (M = 54.38 years, SD = 17.94, range = 23-96, 74.3 % female) and their N = 12 doctors (M = 38.88 years, SD = 13.42, range = 27-66, 83 % female) from a hospital in Montreal, Canada, participated in a paper-based survey to assess AOs, patients' perceived expectations of their doctor (regarding adopting the new culture or keeping their previous culture), doctors' actual expectations, perceived quality of care and perceived adherence. AO of patients significantly related to perceived adherence, via a path model involving perceptions of doctors' expectations and perceived quality of care. Integration was positively related to perceived adherence, while Marginalization was negatively related to it. Doctors' AOs were not significant. Patient perceptions seem to be a significant factor to be considered when striving to improve immigrant medical advice adherence.

  5. Treatment choices for patients with invasive lobular breast cancer: a doctor survey.

    Science.gov (United States)

    Jacobs, Carmel; Ibrahim, Mohamed F K; Clemons, Mark; Hutton, Brian; Simos, Demetrios; Caudrelier, Jean-Michel; Graham, Ian D; Smith, Stephanie; Addison, Christina; Arnaout, Angel

    2015-08-01

    Invasive lobular breast cancer (ILC) has distinct features that present challenges for management. We surveyed doctors regarding management approaches, opinions on quality of evidence supporting their practice, and future research needs. An online questionnaire was developed and circulated to breast cancer surgical, radiation and medical oncologists. The questionnaire was completed by 88/428 doctors (20.6%); 22/56 (39.3%) surgeons, 21/64 (32.8%) radiation oncologists and 45/308 (14.6%) medical oncologists. The majority (65%) of surgeons were comfortable treating ILC patients using the same surgical management as patients with invasive ductal cancers (IDC). Furthermore, 25% would perform a similar surgery but would obtain larger gross margins. There was equipoise for radiation oncologists regarding whether or not ILC was an independent risk factor for local-regional recurrence after either breast-conserving surgery or mastectomy. Of those radiation oncologists who believe ILC is an independent risk factor for recurrence after mastectomy, 44.4% would offer radiation in the absence of usual indications. Medical oncologists approached systemic therapy for ILC patients similarly to those with comparable IDCs. Areas identified as most controversial and requiring future research were preoperative magnetic resonance imaging, radiotherapy post-mastectomy and the responsiveness of ILC to adjuvant chemotherapy compared with endocrine therapy. There is a variation in doctors' beliefs, management and opinions regarding the quality of evidence for the management of ILC. Clinical trials specifically assessing the management of ILC are required to guide clinical practice. © 2015 John Wiley & Sons, Ltd.

  6. Mobile health IT: The effect of user interface and form factor on doctor-patient communication

    DEFF Research Database (Denmark)

    Alsos, Ole Andreas; Das, Anita; Svanæs, Dag

    2012-01-01

    -establishment of eye contact, better verbal and non-verbal contact, more gesturing, good visibility of actions, and quick information retrieval. The digital information devices lacked many of these affordances; physicians’ actions were not visible for the patients, the user interfaces required much attention...... support or hinder aspects of doctor–patient communication, such as face-to-face dialogue, nonverbal communication, and action transparency. Method The study draws on two different experimental simulation studies where 22 doctors, in 80 simulated ward rounds, accessed patient-related information from...... that physicians can use the devices to support face-to-face dialogue, nonverbal communication, and action visibility. The ability to facilitate and support the doctor–patient collaboration is a noteworthy usability factor in the design of mobile EPR systems. The paper also presents possible design guidelines...

  7. Bakhtin's philosophy and medical practice--toward a semiotic theory of doctor-patient interaction.

    Science.gov (United States)

    Puustinen, R

    1999-01-01

    Doctor-patient interaction has gained increasing attention among sociologists and linguists during the last few decades. The problem with the studies performed so far, however, has been a lack of a theoretical framework which could bring together the various phenomena observed within medical consultations. Mikhail Bakhtin's philosophy of language offers us tools for studying medical practice as socio-cultural semiotic phenomenon. Applying Bakhtin's ideas of polyphonic, context-dependent and open-ended nature of human communication opens the possibilities to develop prevailing theoretical and empirical approaches to the study of medical consultations.

  8. Bilateral implant-retained auricular prosthesis for a patient with congenitally missing ears. A clinical report.

    Science.gov (United States)

    Kumar, Preeti Satheesh; Satheesh Kumar, K S; Savadi, Ravindra C

    2012-06-01

    Microtia is a major congenital anomaly of the external ear. It includes a spectrum of deformities from a grossly normal but small ear to the absence of the entire external ear. These deformities account for three in every 10,000 births, with bilaterally missing ears seen in fewer than 10% of all cases. Congenital abnormalities of the ear are unlikely to result in the complete absence of the ears, but the patient presented in this article had bilateral congenitally missing ears. There was loss of anatomic landmarks and alteration of normal bony architecture. Minimal tissue was available for retention; therefore, conventional techniques could not be used for achieving retention. A two-implant-supported auricular prosthesis was planned, but the patient was found to have deficient bone in the implant site. Hence the implants were placed posterior to these sites, and the superstructure was modified to accommodate for this change in position of the implant to ensure the esthetic positioning of the prosthesis. © 2012 by the American College of Prosthodontists.

  9. Acetaminophen, the missing anion gap in the patient with metabolic acidosis

    Directory of Open Access Journals (Sweden)

    Camilo Pena

    2017-01-01

    Full Text Available Acetaminophen intake is well-known but an often missed cause of high anion gap (AG metabolic acidosis, and physicians must understand the metabolic pathway which increases the AG. Multiple mnemonics for common causes of metabolic acidosis have been developed and are widely taught in medical schools. Some of them, such as MUDPILES and KUSMAE, may not lead to an adequate workup and miss the diagnosis for the acidosis. More recently developed memory tools, such as GOLDMARK, provide a complete differential diagnosis for high AG metabolic acidosis. Pyroglutamic acid accumulates after alterations of the gamma-glutamyl cycle mediated by acetaminophen and glutathione deficiency in some patients. The lower capacity of 5-oxiprolinase to metabolize pyroglutamic acid into glutamate results in the gradual accumulation of oxoproline/pyroglutamic acid. Treatment is mainly supportive with the major aim of restoring glutathione levels, optimizing nutrition, and using N-acetylcysteine as needed. Different modalities of renal replacement therapy have also been used in these patients.

  10. Incidence of missed inferior alveolar nerve blocks in vital asymptomatic subjects and in patients with symptomatic irreversible pulpitis.

    Science.gov (United States)

    Fowler, Sara; Reader, Al; Beck, Mike

    2015-05-01

    The purpose of this retrospective study was to determine the incidence of missed inferior alveolar nerve (IAN) blocks by using a 1- or 2-cartridge volume of 2% lidocaine with 1:100,000 epinephrine in vital asymptomatic teeth and in emergency patients with symptomatic irreversible pulpitis. As part of 37 studies, 3169 subjects/patients were evaluated for missed IAN blocks. The study included 2450 asymptomatic subjects and 719 emergency patients presenting with symptomatic irreversible pulpitis. Each subject or patient received either a 1- or 2-cartridge volume of 2% lidocaine with 1:100,000 epinephrine. A missed block was defined as no lip numbness at 15-20 minutes after the IAN block. The effect of anesthetic volume on the incidence of missed blocks was assessed by using mixed models logistic regression with individual studies as a random effect. The incidence of missed blocks for asymptomatic subjects was 6.3% for the 1-cartridge volume and 3.8% for the 2-cartridge volume. For patients presenting with irreversible pulpitis, the incidence of missed blocks was 7.7% for the 1-cartridge volume and 2.3% for the 2-cartridge volume. In both asymptomatic subjects and patients with irreversible pulpitis, the 2-cartridge volume was significantly (P = .0395) better than the 1-cartridge volume. There were no significant effects for pulpal diagnosis (P = .7523) or the pulpal diagnosis and anesthetic volume interaction (P = .3973). Concerning missed IAN blocks, we concluded that administration of a 2-cartridge volume was significantly better (P = .0395) than a 1-cartridge volume in both asymptomatic subjects and emergency patients presenting with irreversible pulpitis. Copyright © 2015 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  11. Are Dutch patients willing to be seen by a physician assistant instead of a medical doctor?

    Directory of Open Access Journals (Sweden)

    Kuilman Luppo

    2012-09-01

    Full Text Available Abstract Background The employment of physician assistants (PAs is a strategy to improve access to care. Since the new millennium, a handful of countries have turned to PAs as a means to bridge the growing gap between the supply and demand of medical services. However, little is known about this new workforce entity from the patient’s perspective. The objective of this study was to assess the willingness of Dutch patients to be treated by a PA or a medical doctor (MD under various time constraints and semi-urgent medical scenarios. Methods A total of 450 Dutch adults were recruited to act as surrogate patients. A convenience sample was drawn from patients in a medical office waiting room in a general hospital awaiting their appointments. Each participant was screened to be naive as to what a PA and a nurse practitioner are and then read a definition of a PA and an MD. One of three medical scenarios was assigned to the participants in a patterned 1-2-3 strategy. Patients were required to make a trade-off decision of being seen after 1 hour by a PA or after 4 hours by a doctor. This forced-choice method continued with the same patient two more times with 30 minutes and 4 hours and another one of 2 hours versus 4 hours for the PA and MD, respectively. Results Surrogate patients chose the PA over the MD 96 % to 98 % of the time (depending on the scenario. No differences emerged when analysed by gender, age, or parenthood status. Conclusion Willingness to be seen by a PA was tested a priori to determine whether surrogate Dutch patients would welcome this new health-care provider. The findings suggest that employing PAs, at least in concept, may be an acceptable strategy for improving access to care with this population.

  12. The difficult doctor? Characteristics of physicians who report frustration with patients: an analysis of survey data

    Science.gov (United States)

    Krebs, Erin E; Garrett, Joanne M; Konrad, Thomas R

    2006-01-01

    Background Literature on difficult doctor-patient relationships has focused on the "difficult patient." Our objective was to determine physician and practice characteristics associated with greater physician-reported frustration with patients. Methods We conducted a secondary analysis of the Physicians Worklife Survey, which surveyed a random national sample of physicians. Participants were 1391 family medicine, general internal medicine, and medicine subspecialty physicians. The survey assessed physician and practice characteristics, including stress, depression and anxiety symptoms, practice setting, work hours, case-mix, and control over administrative and clinical practice. Physicians estimated the percentage of their patients who were "generally frustrating to deal with." We categorized physicians by quartile of reported frustrating patients and compared characteristics of physicians in the top quartile to those in the other three quartiles. We used logistic regression to model physician characteristics associated with greater frustration. Results In unadjusted analyses, physicians who reported high frustration with patients were younger (p frustration included age 55 per week, higher stress, practice in a medicine subspeciality, and greater number of patients with psychosocial problems or substance abuse. Conclusion Personal and practice characteristics of physicians who report high frustration with patients differ from those of other physicians. Understanding factors contributing to physician frustration with patients may allow us to improve the quality of patient-physician relationships. PMID:17026762

  13. The decreased expression of TIPE2 protein in the decidua of patients with missed abortion and possible significance.

    Science.gov (United States)

    Sun, Yingshuo; Wang, Xiaoyan; Li, Yue; Sun, Han; Wan, Lu; Wang, Xishuang; Zhang, Lining; Fang, Zhenghui; Wei, Zengtao

    2017-08-29

    Missed abortion is a common occurrence for otherwise healthy women. Immunological factor is one of the most important reasons. Tumor necrosis factor-α-induced protein-8 like-2 (TIPE2) is a novel negative immune regulator related to several human diseases. However, the expression level and clinical significance of TIPE2 in missed abortion remain unclear. The expression of TIPE2 mRNA and protein in decidua and chorion from 36 missed abortion patients and 36 healthy controls was detected using quantitative real-time PCR, western blot and immunohistochemistry. In addition, serum TNF-ɑ and IL-10 levels were measured using flow cytometry. Serum estradiol and progesterone levels were measured by radioimmunoassay test. The correlations of TIPE2 protein levels with TNF-ɑ, IL-10, estradiol and progesterone were further analyzed. TIPE2 protein levels were significantly lower in decidual tissues of missed abortion patients than those in healthy controls. The patients with missed abortion had significantly higher levels of serum TNF-ɑ, and lower levels of serum IL-10, estradiol and progesterone compared with healthy controls. The TIPE2 protein levels were positively related to serum IL-10 levels. Our data indicate TIPE2 could play important roles in maintaining the maternal-fetal tolerance and decreased TIPE2 expression in the decidua may be related to the development of missed abortion.

  14. Miss Evers' Boys (1997. Study of the spontaneous evolution of syphilis in black patients

    Directory of Open Access Journals (Sweden)

    Agustín del Cañizo Fernández-Roldán

    2008-10-01

    Full Text Available Miss Evers' Boys (1997 is a movie based on a real fact happened in the State of Alabama (United States, where it was carried out a research work that begun in 1932 and was prolonged up to 1972. It consisted on watching the evolution of syphilis in black male patients, who were not given any anti-syphilitic treatment at any moment. Once the fact was public, a great polemic on the ethics of the research with human fellows was originated and publications dealt with this case. The movie, faithful as for the bottom of the problem, it’s made as a novel about a research team’s nurse and four black participants patients.

  15. [Analysis of the patients who missed their appointments at the neurology clinic of the Marina Alta].

    Science.gov (United States)

    Morera-Guitart, J; Mas-Server, M A; Más-Sesé, G

    To analyze the frequency, reasons and characteristics of patients who missed their appointments (NP) at the Neurology Clinic (CEN). To compare the characteristics of the NP with the patients who did not miss their appointment. Suggest measures to reduce avoidable causes of NP. During the period 1/10/99 to 30/4/2000 the cases of NP were prospectively recorded and compared with a sample of patients who attended the CEN during the same period. We analyze the data on age, sex, distance of home from CEN, diagnosis, type of consultation and date of last consultation. The NP were contacted by phone and asked why they had not gone for their appointments. The reasons given were then classified as avoidable or unavoidable. Of the 1,842 consultations scheduled, 19% were NP. When the NP and the patients who did attend were compared we found statistically significant differences regarding the distance home/CEN. According to the diagnosis, the NP had more 'symptoms/signs' and other MIA, whilst those who attended the clinic had more 'neuropathies' and 'awaiting diagnosis'. The commonest avoidable reasons (55.8%) for NP were forgetting, administrative error and communication failure, and for unavoidable reasons (44.2%) physical disability, other priorities and improvement. There is a large proportion of NP in the CEN of the Marina Alta. The distance from home to CEN (over 25 km) was the main factor affecting the rate of NP. Since 56% of the NP were due to avoidable causes, strategies could be designed to reduce this percentage. In the NP group, the main causes were forgetting, administrative errors and communication failure.

  16. Faculty and medical students' perceptions of teaching and learning about the doctor-patient relationship.

    Science.gov (United States)

    Egnew, Thomas R; Wilson, Hamish J

    2010-05-01

    To explore student and faculty perceptions of how students are learning doctor-patient relationship skills in their clinical medical education. Exploratory qualitative study involving data from interviews and focus groups with students and interviews with teaching faculty. Respondents reported that pre-clinical relationship skills curricula were not well-coordinated with clinical curricula. Within the clinical curriculum, respondents perceived a disparity between general practice and hospital-based attachments. Teaching of relationship skills on the wards was highly variable, rarely explicit, and primarily dependent on role-modelling. In contrast, general practice runs included explicit teaching with feedback that reinforced skills taught in the pre-clinical curriculum. Respondents recommended increased focus on and assessment of students' interpersonal skills within clinical settings. Pre-clinical and clinical relationship skills curricula were not coordinated. The tension between service commitments and student teaching in hospital-based attachments contributed to an insufficient focus on communication and relationship skills acquisition and did not reinforce teaching in pre-clinical and ambulatory clinical settings. The teaching of doctor-patient relationship skills can be augmented by coordinating pre-clinical and clinical curricula and by requiring observation and structured feedback related to explicit criteria of student skills acquisition across all clinical learning experiences. Copyright (c) 2009 Elsevier Ireland Ltd. All rights reserved.

  17. Promoting medical competencies through international exchange programs: benefits on communication and effective doctor-patient relationships.

    Science.gov (United States)

    Jacobs, Fabian; Stegmann, Karsten; Siebeck, Matthias

    2014-03-04

    Universities are increasingly organizing international exchange programs to meet the requirements of growing globalisation in the field of health care. Analyses based on the programs' fundamental theoretical background are needed to confirm the learning value for participants. This study investigated the extent of sociocultural learning in an exchange program and how sociocultural learning affects the acquisition of domain-specific competencies. Sociocultural learning theories were applied to study the learning effect for German medical students from the LMU Munich, Munich, Germany, of participation in the medical exchange program with Jimma University, Jimma, Ethiopia. First, we performed a qualitative study consisting of interviews with five of the first program participants. The results were used to develop a questionnaire for the subsequent, quantitative study, in which 29 program participants and 23 matched controls performed self-assessments of competencies as defined in the Tuning Project for Health Professionals. The two interrelated studies were combined to answer three different research questions. The participants rated their competence significantly higher than the control group in the fields of doctor-patient relationships and communication in a medical context. Participant responses in the two interrelated studies supported the link between the findings and the suggested theoretical background. Overall, we found that the exchange program affected the areas of doctor-patient relationships and effective communication in a medical context. Vygotsky's sociocultural learning theory contributed to explaining the learning mechanisms of the exchange program.

  18. Introducing a partnership doctor-patient communication guide for teachers in the culturally hierarchical context of Indonesia.

    Science.gov (United States)

    Claramita, Mora; Susilo, Astrid Pratidina; Kharismayekti, Manik; van Dalen, Jan; van der Vleuten, Cees

    2013-01-01

    A guide for a partnership style of doctor-patient communication tailored to a Southeast Asian culture was previously developed and validated. We introduced the guide to clinical teachers in Indonesia through a participatory approach. Evaluation was based on teachers' demonstrated comprehension and ability to teach the guide. Three junior researchers invited twelve senior clinical teachers to learn about the guide by writing a chapter on doctor-patient communication using their clinical expertise, reflections on the guide, and the international literature. A participatory study comprised of two cycles (producing first and second drafts of the chapters) was conducted over 18 months with guidance from researchers and written feedback from an expert in communication skills. Qualitative content-analysis was used to assess the content of the submitted chapters. The clinical teachers understood the concept of partnership style doctor-patient communication but demonstrated limited reflection on the Southeast Asian culture. Teachers had difficulty translating the guide into a written learning guide. However, teachers proposed an adapted guide with a simpler structure, tailored to their clinical environment characterized by high patient load and limited time for doctor-patient communications. The adapted guide was proof of the teachers' willingness to learn about a partnership style of doctor-patient communications. However, the process of introducing the guide was hindered by the wide power distance between participants throughout all aspects of the study, including communication between senior teachers and more junior researchers.

  19. The doctor/patient relationship for the 21st century. Clash of 'cultural creatives' and 'traditionals' helps focus the future of patient care.

    Science.gov (United States)

    Bottles, K

    2001-01-01

    The doctor/patient relationship is at a crossroads. Some patients--traditionals--want the doctor calling all the shots, deciding the best treatment path to follow. But cultural creatives--heavily influenced by bioethics--desire more of a give and take when it comes to their health care. They see the physician as an advisor, and they want to decide the best treatment on their own terms. Take a close-up look at factors influencing the doctor/patient relationship in the 21st Century.

  20. Should doctors provide futile medical treatment if patients or their proxies are prepared to pay for it?

    Science.gov (United States)

    McQuoid-Mason, D J

    2017-01-30

    Ethically and legally doctors are not obliged to provide futile treatment to patients, even if the patient or their proxies are prepared to pay for it. However, it may be justified where such treatment is harmless and has a placebo effect. In deciding about a request for futile treatment, doctors should be guided by the ethical principles of patient autonomy, beneficence, non-maleficence and justice. Guidelines are provided to assist doctors in making such decisions. Where futile treatment is withdrawn or refused, palliative care must always be offered. If it isdecided to withdraw or refuse treatment, the patient or their proxy should be given the opportunity to contact another practitioner or institution that may be prepared to offer such treatment.

  1. Comparison of patients' needs and doctors' perceptions of information requirements related to a diagnosis of oesophageal or gastric cancer.

    Science.gov (United States)

    Wittmann, E; Beaton, C; Lewis, W G; Hopper, A N; Zamawi, F; Jackson, C; Dave, B; Bowen, R; Willacombe, A; Blackshaw, G; Crosby, T D L

    2011-03-01

    The aim of this study was to assess the information needs of patients diagnosed with oesophageal and gastric cancer and to compare these with their perceived information needs in the opinion of junior doctors. One hundred patients and 100 doctors responded to a questionnaire regarding the information needs of cancer patients. Seventy-nine per cent of patients wanted as much information as possible about their diagnosis, but only 35% of doctors were willing to give all the available information (P communicate a serious illness with a good prognosis, yet only 43% would communicate a diagnosis with a poor prognosis (P bad news, but 20 considered this inadequate. Socio-economic deprivation was associated with poor access to supplementary Internet derived information (P issue. © 2010 Blackwell Publishing Ltd.

  2. Encountering hysteria: doctors' and patients' perspectives on hysteria in Denmark, 1875-1918.

    Science.gov (United States)

    Møllerhøj, Jette

    2009-06-01

    The history of hysteria stretches over several millennia and contains a plethora of different understandings and interpretations. This paper focuses on a central part of its Danish history, from the last decades of the nineteenth-century 'age of nervousness' until the end of World War I. It is argued that the understanding and negotiation of hysteria and its explanations took place in a complex interaction between doctors and their patients. Whereas the psychiatrists during this period moved towards an understanding of hysteria as a functional disorder, the patients, of whom approximately one-third were male, maintained that their illness was of somatic origin, and closely related to social, economic and working conditions.

  3. Guidelines for doctors on identifying and helping their patients who batter.

    Science.gov (United States)

    Adams, D

    1996-01-01

    While there are a growing number of medical guides for assisting physicians to identify and help victims of domestic violence, there has been scant attention to how physicians can best respond to perpetrators. The medical model's deficient grasp of violence, combined with the minimizing and excuse-making strategies employed by batterers hinder physicians' ability to detect batterers in their practices and to prescribe the right solutions. Earlier detection is possible, however, when doctors adopt routine diagnostic procedures for all patients and ask informed follow-up questions when there are indications of domestic violence. Finally, physicians should become aware of the effective batterer treatment programs in their areas and make this information easily available to their patients who batter.

  4. Communication as a Bridge to Build a Sound Doctor-Patient/Parent Relationship.

    Science.gov (United States)

    Singh, Meharban

    2016-01-01

    Effective communication is essential to establish a good doctor-patient/parent relationship and practice high quality medicine. It is indeed the key to build confidence, faith and trust of the parents to augment the process of healing. Most parental complaints of dissatisfaction and mismanagement originate due to lack of communication or because of abrasive, cold or callous attitude of the doctor or members of the health care team and not due to lack of knowledge and skills or unsatisfactory management of the patient. The patients and parents must feel all times that they are treated with respect and dignity. We should consider patients as our clients and handle them with due confidence, humility, concern and empathy. It is important to communicate with the parents by literally coming down to their level and by maintaining an eye-to-eye contact. We should not judge, belittle or argue with the parents and handle them with due courtesy and consideration. We should be careful, tactful and diplomatic in deciding not only "what to tell the parents" but also "how to tell it". The parents should be told about the condition of the child in a simple, easy-to-understand language without any medical jargons. We should be pragmatic but honest in communicating the true medical status of the child but nevertheless try to keep the hope alive which has tremendous healing capabilities. We should not allow the technology to further dehumanize medicine and try to resurrect the declining image of the medical profession. It is desirable that all the medical and nursing colleges in the country should initiate regular education programs in the fields of social and behavioral sciences, art of communication and medical ethics for graduate and postgraduate medical and nursing students.

  5. Qualitative study of interpretation of reassurance among patients attending rheumatology clinics: "just a touch of arthritis, doctor?".

    Science.gov (United States)

    Donovan, J L; Blake, D R

    2000-02-26

    To examine commonly used methods of reassurance by clinicians and explore their effect on patients. Qualitative study of tape recordings of in-depth, semistructured interviews with patients before and after consultation and of their consultations with doctors. NHS specialist rheumatology clinics in two large British cities. 35 patients selected by consultant rheumatologists from general practitioner referral letters (28 women, 7 men; 24 with inflammatory arthropathies, 11 other rheumatological complaints). Patients' perceptions of reassurance. Reassurance was an important part of consultations, whether the diagnosis was clear or uncertain. Clinicians tried to reduce anxiety by emphasising the mildness, early stage, or non-seriousness of the disorder and the likelihood that patients would recover. Patients interpreted reassurance in the context of their own views and perceptions. Doctors' emphasis on the mildness or earliness of the condition raised the spectre of future pain and disability rather than providing reassurance. Patients who felt that their problems were properly acknowledged felt more reassured. Typical patterns of reassurance were not successful because of the differences in perspective of patients and doctors. A key to successful reassurance seemed to be the doctor's ability to acknowledge patients' perspectives of their difficulties.

  6. Interdisciplinary management of an adult patient with class II div 1 Malocclusion, Anterior Open Bite and multiple missing molars

    Directory of Open Access Journals (Sweden)

    Rohit Mehrotra

    2014-01-01

    Full Text Available This case report describes the esthetic and functional rehabilitation of a female patient in her mid forties having Class II Div 1 malocclusion, anterior open bite and multiple missing molars, with orthodontics and implant prosthodontics. The patient had bilaterally missing upper first and third molars and lower first and second molars. Orthodontic treatment using skeletal anchorage was performed to retract and align the upper anteriors and correct the open bite. In the upper arch, first molar spaces were closed and no prosthesis was needed. In the lower arch, the anteriors and premolars were aligned and implants were placed bilaterally to replace the missing molars and provide proper occlusion with the upper posteriors. Significant improvement in the occlusion, smile and facial esthetics was achieved. This article highlights the importance of an interdisciplinary team approach for providing optimum treatment to many adult patients.

  7. Missing dosages and neuroleptic usage may prolong length of stay in hospitalized Parkinson's disease patients.

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    Daniel Martinez-Ramirez

    Full Text Available Parkinson's disease patients are more likely to be hospitalized, have higher rates of hospital complications, and have an increased risk of deterioration during hospitalization. Length of stay is an important underlying factor for these increased risks. We aimed to investigate potential medication errors that may occur during hospitalization and its impact on length of hospital stay.A cross-sectional chart review of 339 consecutive hospital encounters from 212 PD subjects was performed. Medication errors were defined as wrong timing or omission of administration for dopaminergic drugs and administration of contraindicated dopamine blockers. An analysis of covariance was applied to examine whether these medication errors were related to increased length of hospital stays.A significant effect for dopaminergic administration (p<0.01 on length of hospital stay was observed. Subjects who had delayed administration or missed at least one dose stayed longer (M=8.2 days, SD=8.9 vs. M=3.6 days SD=3.4. Contraindicated dopamine blocking agents were administered in 23% (71/339 of cases, and this was also significantly related to an increased length of stay (M=8.2 days, SD=8.9 vs. M=3.6 days SD=3.4, p<0.05. Participants who received a contraindicated dopamine blocker stayed in the hospital longer (M=7.5 days, SD=9.1 compared to those who did not (M=5.9 days, SD=6.8. Neurologists were consulted in 24.5% of encounters. Specialty consultation had no effect on the medication related errors.Missing dopaminergic dosages and administration of dopamine blockers occur frequently in hospitalized Parkinson's disease patients and this may impact length of stay. These potentially modifiable factors may reduce the risk of a longer stay related to hospitalization.

  8. A Proposal of a Communication Medium between Patients with Facial Disorder and the Doctors

    Science.gov (United States)

    Ito, Kyoko; Kurose, Hiroyuki; Takami, Ai; Shirai, Masayuki; Shimizu, Ryosuke; Nishida, Shogo

    There are diseases with the disorder in the face although human's face is an important body site with the social role. In this study, it is focused on “patient's facial expression” as a medium supporting communications between the patient with facial disorder and the doctor toward the satisfaction improvement to the patient's treatment on the medical treatment site. And, “expression to be expressed” and “difference between the expression actually expressed aiming at the expression to be expressed and the expression to be expressed” were selected as information transmitted through patient's expression. The design and development of an interface with the functions of an expression setting and an expression confirmation were carried out as an environmental setting for the patient to express selected information. Fourteen dentists in total who had the treatment experience of the facial disorder evaluated the possibility of the proposed interface as utility and a communication tool in the medical treatment site. The possibility of leading to the expression of the expectation for the patient's treatment was suggested as the results of the experiment, and concrete challenge points and the method for use in the medical treatment field were proposed.

  9. Factors influencing the missed nursing care in patients from a private hospital.

    Science.gov (United States)

    Hernández-Cruz, Raúl; Moreno-Monsiváis, María Guadalupe; Cheverría-Rivera, Sofía; Díaz-Oviedo, Aracely

    2017-07-10

    to determine the factors that influence the missed nursing care in hospitalized patients. descriptive correlational study developed at a private hospital in Mexico. To identify the missed nursing care and related factors, the MISSCARE survey was used, which measures the care missed and associated factors. The care missed and the factors were grouped in global and dimension rates. For the analysis, descriptive statistics, Spearman's correlation and simple linear regression were used. Approval for the study was obtained from the ethics committee. the participants were 71 nurses from emergency, intensive care and inpatient services. The global missed care index corresponded to M=7.45 (SD=10.74); the highest missed care index was found in the dimension basic care interventions (M=13.02, SD=17.60). The main factor contributing to the care missed was human resources (M=56.13, SD=21.38). The factors related to the care missed were human resources (rs=0.408, pcuidado de enfermagem omitido em pacientes hospitalizados. estudo descritivo correlacional, desenvolvido em um hospital particular do México. Para identificar o cuidado omitido e fatores relacionados, utilizou-se o instrumento MISSCARE, que mede o cuidado omitido e os fatores associados. O cuidado omitido e os fatores foram agrupados em índices globais e por dimensões. Para fins de análise, foi utilizada estatística descritiva, correlação de Spearman e regressão linear simples. O estudo recebeu aprovação de comité de ética. participaram 71 enfermeiras dos serviços de urgências, terapia intensiva e hospitalização. O índice global de cuidado omitido mostrou um coeficiente M=7,45 (DE=10,74); o índice com maior cuidado omitido correspondeu à dimensão de intervenções de cuidado básico (M=13,02, DE=17,60). O principal fator que contribuiu ao cuidado omitido foi o de recursos humanos (M=56,13, DE=21,38). Os fatores relacionados ao cuidado omitido foram os recursos humanos (rs=0,408, pcuidado omitido de

  10. Diagnosis and Management of a Patient with Congenitally Missing Maxillary First Permanent Molars: A Rare Case Report

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    Megha Gupta

    2016-01-01

    Full Text Available Congenitally missing teeth are the most commonly seen dental anomalies. Agenesis of the permanent first molar has the least frequency of all the tooth types, and it usually occurs in association with oligodontia or anodontia. Thus, agenesis of the bilateral maxillary first permanent molar is an extremely rare occurrence, and no such case has been reported in ethnic Saudi Arabian population. We hereby report a case of nonsyndromic bilateral congenitally missing maxillary first permanent molar in an eight-year-old Saudi female patient. Comprehensive oral rehabilitation was done for the patient. The implications of the tooth agenesis are also discussed. The prognosis of this case is presented.

  11. The Norwegian National Summary Care Record: a qualitative analysis of doctors' use of and trust in shared patient information.

    Science.gov (United States)

    Dyb, Kari; Warth, Line Lundvoll

    2018-04-06

    This paper explores Norwegian doctors' use of and experiences with a national tool for sharing core patient health information. The summary care record (SCR; the Kjernejournal in Norwegian) is the first national system for sharing patient information among the various levels and institutions of health care throughout the country. The health authorities have invested heavily in the development, implementation and deployment of this tool, and as of 2017 all Norwegian citizens have a personalised SCR. However, as there remains limited knowledge about health professionals' use of, experiences with and opinions regarding this new tool, the purpose of this study was to explore doctors' direct SCR experiences. We conducted 25 in-depth interviews with 10 doctors from an emergency ward, 5 doctors from an emergency clinic and 10 doctors from 5 general practitioner offices. We then transcribed, thematically coded and analysed the interviews utilising a grounded theory approach. The SCRs contain several features for providing core patient information that is particularly relevant in acute or emergency situations; nonetheless, we found that the doctors generally used only one of the tool's six functions, namely, the pharmaceutical summary. In addition, they primarily used this summary for a few subgroups of patients, including in the emergency ward for unconscious patients, for elderly patients with multiple prescriptions and for patients with substance abuse conditions. The primary difference of the pharmaceutical summary compared with the other functions of the tool is that patient information is automatically updated from a national pharmaceutical server, while other clinically relevant functions, like the critical information category, require manual updates by the health professionals themselves, thereby potentially causing variations in the accuracy, completeness and trustworthiness of the data. Therefore, we can assume that the popularity of the pharmaceutical summary

  12. The social negotiation of fitness for work: tensions in doctor-patient relationships over medical certification of chronic pain.

    Science.gov (United States)

    Wainwright, Elaine; Wainwright, David; Keogh, Edmund; Eccleston, Christopher

    2015-01-01

    The UK government is promoting the health benefits of work, in order to change doctors' and patients' behaviour and reduce sickness absence. The rationale is that many people 'off sick' would have better outcomes by staying at work; but reducing the costs of health care and benefits is also an imperative. Replacement of the 'sick note' with the 'fit note' and a national educational programme are intended to reduce sickness-certification rates, but how will these initiatives impact on doctor-patient relationships and the existing tension between the doctor as patient advocate and gate-keeper to services and benefits? This tension is particularly acute for problems like chronic pain where diagnosis, prognosis and work capacity can be unclear. We interviewed 13 doctors and 30 chronic pain patients about their experiences of negotiating medical certification for work absence and their views of the new policies. Our findings highlight the limitations of naïve rationalist approaches to judgements of work absence and fitness for work for people with chronic pain. Moral, socio-cultural and practical factors are invoked by doctors and patients to contest decisions, and although both groups support the fit note's focus on capacity, they doubt it will overcome tensions in the consultation. Doctors value tacit skills of persuasion and negotiation that can change how patients conceptualise their illness and respond to it. Policy-makers increasingly recognise the role of this tacit knowledge and we conclude that sick-listing can be improved by further developing these skills and acknowledging the structural context within which protagonists negotiate sick-listing. © The Author(s) 2014.

  13. Building trust and rapport early in the new doctor-patient relationship: a longitudinal qualitative study.

    Science.gov (United States)

    Dang, Bich N; Westbrook, Robert A; Njue, Sarah M; Giordano, Thomas P

    2017-02-02

    New patients are a particularly vulnerable population because they are at high risk of missing a subsequent visit or dropping out of care completely. However, few data exist on what new patients value in the beginning of a relationship with a new provider. Persons with HIV infection may be an ideal population to study the drivers of a positive initial patient-provider relationship, as it is a chronic and serious condition that requires a reliable, ongoing relationship with a provider. Informed by patients' real experiences, this study aims to identify what patients see as the most critical elements for building trust and rapport from the outset. We conducted longitudinal, in-person interviews with 21 patients new to the HIV clinic at the Michael E. DeBakey Veterans Affairs Medical Center in Houston, Texas, from August 2013 to March 2015. Patients were interviewed across three time points: once before their first provider visit, a second time within two weeks after the first visit, and a third time at 6 to 12 months after the first provider visit. We conducted 61 h of patient interviews. The mean age was 53 years; 52% were non-Hispanic white, 23% were non-Hispanic black and 19% were Hispanic. Patients described significant anxiety and vulnerability not just from HIV itself, but also in starting a relationship as a new patient to a new provider. Our analysis of these experiences revealed five actions providers can take to reduce their patients' anxiety and build trust early in the first visit: 1) provide reassurance to patients, 2) tell patients it's okay to ask questions, 3) show patients their lab results and explain what they mean, 4) avoid language and behaviors that are judgmental of patients, and 5) ask patients what they want [i.e., treatment goals and preferences]. Our study incorporates direct input from patients and highlights the unique psychological challenges that patients face in seeking care from a new provider. The actionable opportunities cited by

  14. Effects of exam room EHR use on doctor-patient communication: a systematic literature review

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    Zainab Kazmi

    2014-01-01

    Full Text Available Background High levels of funding have been invested in health information technologies, especially electronic health records (EHRs, in an effect to coordinate and organize patient health data. However, the effect of EHRs in the exam room on doctor–patient communication has not been sufficiently explored.Objective The purpose of this systematic review was to determine how physician use of EHRs in medical consultations affects doctor–patient communication, both in terms of patient perceptions and actual physician behaviours.Method The reviewer conducted a comprehensive online database search in March 2013 of EMBASE, MEDLINE, and SCOPUS, using a combination of synonyms of the terms “patient”, “doctor”, “communication”, and “EHR” or “computing”. For inclusion in this review, articles had to be published in English, take place in an outpatient setting and demonstrate an empirical investigation into whether EHR affects doctor–patient communication. The reviewer then analysed 13 articles that met the inclusion criteria.Results Studies showed EHR use encouraged biomedical questioning of the patient, and encouraged patient-led questioning and doctor-led information provision. EHR-related behaviours such as keyboarding and screen gaze impaired relationships with patients, by reducing eye contact, rapport, and provision of emotional support. EHRs negatively affected physician-led patient-centred communication. Computer use may have amplified existing physician behaviours regarding medical record use.Conclusion We noted both positive and negative effects of EHR use. This review highlights the need for increased EHR-specific communication training to mitigate adverse effects and for continued acknowledgement of patient perspectives.

  15. A systematic review and development of a classification framework for factors associated with missing patient-reported outcome data.

    Science.gov (United States)

    Palmer, Michael J; Mercieca-Bebber, Rebecca; King, Madeleine; Calvert, Melanie; Richardson, Harriet; Brundage, Michael

    2018-02-01

    Missing patient-reported outcome data can lead to biased results, to loss of power to detect between-treatment differences, and to research waste. Awareness of factors may help researchers reduce missing patient-reported outcome data through study design and trial processes. The aim was to construct a Classification Framework of factors associated with missing patient-reported outcome data in the context of comparative studies. The first step in this process was informed by a systematic review. Two databases (MEDLINE and CINAHL) were searched from inception to March 2015 for English articles. Inclusion criteria were (a) relevant to patient-reported outcomes, (b) discussed missing data or compliance in prospective medical studies, and (c) examined predictors or causes of missing data, including reasons identified in actual trial datasets and reported on cover sheets. Two reviewers independently screened titles and abstracts. Discrepancies were discussed with the research team prior to finalizing the list of eligible papers. In completing the systematic review, four particular challenges to synthesizing the extracted information were identified. To address these challenges, operational principles were established by consensus to guide the development of the Classification Framework. A total of 6027 records were screened. In all, 100 papers were eligible and included in the review. Of these, 57% focused on cancer, 23% did not specify disease, and 20% reported for patients with a variety of non-cancer conditions. In total, 40% of the papers offered a descriptive analysis of possible factors associated with missing data, but some papers used other methods. In total, 663 excerpts of text (units), each describing a factor associated with missing patient-reported outcome data, were extracted verbatim. Redundant units were identified and sequestered. Similar units were grouped, and an iterative process of consensus among the investigators was used to reduce these units to a

  16. A qualitative study of sexual harassment of female doctors by patients.

    Science.gov (United States)

    Schneider, M; Phillips, S P

    1997-09-01

    This paper reports the qualitative data from a study of sexual harassment of female family physicians by patients. In addition to the everyday harassment that any woman might encounter in a work setting, the physicians in this study also reported types of harassment which are unique to the practice of medicine. These include opportunistic harassment such as exposure of the genitals, inappropriately touching the physician when the examination requires close contact, excessive discussion of sexual matters for apparent erotic gratification, and acting out behaviours from non-competent patients. Other reported behaviours were not, strictly speaking, sexual harassment but were troublesome nonetheless, including spontaneous erections during physical examinations, physically intimidating behaviour, and ambiguous behaviours which were sexual in nature, but difficult to interpret. The findings are discussed in the context of theory pertaining to contrapower harassment. It is concluded that for some patients the gender of the physician takes precedence over her occupational status and, this combined with the unique characteristics of the doctor/patient relationship, can make the practice of family medicine more conductive to sexual harassment than other professions.

  17. Rational versus unreasonable persuasion in doctor-patient communication: a normative account.

    Science.gov (United States)

    Rubinelli, Sara

    2013-09-01

    Persuasion plays a critical role in doctor-patient communication. The relevant literature tends to equate persuasion to manipulation as a suboptimal form of interaction. The objective of this paper is to distinguish among different types of persuasion processes and to highlight when their use can be beneficial or risky from the perspective of the patient's autonomy. This paper presents a conceptual analysis of persuasion based on the analytical and normative frameworks of argumentation theory. Persuasion is a generic term that refers to at least four main forms of persuasion: rational persuasion, unintentional unreasonable persuasion, intentional (without deception) unreasonable persuasion and intentional (with deception) unreasonable persuasion (i.e., manipulation). Rational persuasion can be a process of value for the medical encounter. The other forms of persuasion can negatively impact patients' decision making. They are suboptimal for different reasons that are partly due to the quality of communication, and partly due to ethics of the medical conduct. This paper offers a basis for developing training opportunities that foster deeper understanding of different forms and uses of persuasion. Also, it can inspire the development of educational material for patients targeted to the enhancement of their critical health literacy. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  18. Nursing care missed in patients at risk of or having pressure ulcers.

    Science.gov (United States)

    Valles, Jonathan Hermayn Hernández; Monsiváis, María Guadalupe Moreno; Guzmán, Ma Guadalupe Interial; Arreola, Leticia Vázquez

    2016-11-21

    to determine the nursing care missed as perceived by the nursing staff and its relation with the nursing care missed identified in the assessment of patients at risk of or having pressur ulcers. descriptive correlation study. The participants were 161 nurses and 483 patients from a public hospital. The MISSCARE survey was used in combination with a Nursing Care Assessment Form for Patients at Risk of or having pressure ulcers. For the analysis, descriptive and inferential statistics were used. the nursing staff indicated greater omission in skin care (38.5%), position change (31.1%) and the registration of risk factors for the development of pressure ulcers (33.5%). The nursing care missed identified in the assessment related to the use of pressure relief on bony prominences and drainage tubes interfering in the patient's movements (both with 58.6%) and the use of pneumatic mattresses (57.6%). a high percentage of nursing care missed was found according to the staff's perception. Nevertheless, the assessment of the nursing care missed was much higher. No significant relation was found between both. Therefore, it is a priority to reflect on the importance of objective patient assessments. determinar o cuidado de enfermagem omitido percebido pela equipe de enfermagem e sua relação com o cuidado omitido identificado na avaliação de pacientes com risco ou com de úlceras por pressão. estudo descritivo correlacional. Participaram 161 enfermeiras e 483 pacientes de um hospital público. Foram utilizados o levantamento MISSCARE e um Formulário de Avaliação de Cuidados de Enfermagem em Pacientes com Risco ou com úlceras por pressão. Para a análise foi utilizada estatística descritiva e inferencial. a equipe de enfermagem assinalou que há maior omissão no cuidado da pele (38,5%), reposicionamento (31,1%) e no registro de fatores de risco para o aparecimento de úlceras por pressão (33,5%). Os cuidados de enfermagem omitidos identificados na avaliação foram

  19. [Psychiatric patients at the police station in the southern South Holland region: assessment by the District Health Service forensic doctor].

    Science.gov (United States)

    Aardoom, H A; Huisman-Wolfs, M M; Nijs, H G T

    2002-09-21

    To describe the epidemiological characteristics of ambulant psychiatric patients who were either brought to the police station or who came by themselves, but who were not kept in a cell, as a basis for the development of a reception protocol. Descriptive. The data from the medical records from 2000 kept by the forensic doctors employed by the district health services for the Southern South Holland region were inventoried. On request by the police, the forensic doctors examined 203 clients. The majority of these were middle-aged men who did have a place of residence. The reason for police involvement was bizarre or confused behaviour in public. Half of the patients had received or were receiving some form of psychiatric treatment from the mental health service. In approximately half of the cases the forensic doctor found a solution together with the police. In the other half of the cases the forensic doctor asked the crisis intervention team at the mental health service for an evaluation. Two thirds of these patients were hospitalised and one third was sent away. Because examination by both the forensic doctor and the mental health service psychiatrist and other procedures were lengthy (up to 6 hours), patients had to spend a long time in a holding cell at the police station that was not designed for stays of this length of time, and often lacked toilet facilities. The forensic doctor treated about half the clients without the need of assistance from the crisis intervention psychiatrist. The temporary accommodation for these confused clients was inadequate.

  20. Characteristics of patients with missing information on stage: a population-based study of patients diagnosed with colon, lung or breast cancer in England in 2013.

    Science.gov (United States)

    Di Girolamo, Chiara; Walters, Sarah; Benitez Majano, Sara; Rachet, Bernard; Coleman, Michel P; Njagi, Edmund Njeru; Morris, Melanie

    2018-05-02

    Stage is a key predictor of cancer survival. Complete cancer staging is vital for understanding outcomes at population level and monitoring the efficacy of early diagnosis initiatives. Cancer registries usually collect details of the disease extent but staging information may be missing because a stage was never assigned to a patient or because it was not included in cancer registration records. Missing stage information introduce methodological difficulties for analysis and interpretation of results. We describe the associations between missing stage and socio-demographic and clinical characteristics of patients diagnosed with colon, lung or breast cancer in England in 2013. We assess how these associations change when completeness is high, and administrative issues are assumed to be minimal. We estimate the amount of avoidable missing stage data if high levels of completeness reached by some Clinical Commissioning Groups (CCGs), were achieved nationally. Individual cancer records were retrieved from the National Cancer Registration and linked to the Routes to Diagnosis and Hospital Episode Statistics datasets to obtain additional clinical information. We used multivariable beta binomial regression models to estimate the strength of the association between socio-demographic and clinical characteristics of patients and missing stage and to derive the amount of avoidable missing stage. Multivariable modelling showed that old age was associated with missing stage irrespective of the cancer site and independent of comorbidity score, short-term mortality and patient characteristics. This remained true for patients in the CCGs with high completeness. Applying the results from these CCGs to the whole cohort showed that approximately 70% of missing stage information was potentially avoidable. Missing stage was more frequent in older patients, including those residing in CCGs with high completeness. This disadvantage for older patients was not explained fully by the

  1. Cast Partial Denture versus Acrylic Partial Denture for Replacement of Missing Teeth in Partially Edentulous Patients

    Directory of Open Access Journals (Sweden)

    Pramita Suwal

    2017-03-01

    Full Text Available Aim: To compare the effects of cast partial denture with conventional all acrylic denture in respect to retention, stability, masticatory efficiency, comfort and periodontal health of abutments. Methods: 50 adult partially edentulous patient seeking for replacement of missing teeth having Kennedy class I and II arches with or without modification areas were selected for the study. Group-A was treated with cast partial denture and Group-B with acrylic partial denture. Data collected during follow-up visit of 3 months, 6 months, and 1 year by evaluating retention, stability, masticatory efficiency, comfort, periodontal health of abutment. Results: Chi-square test was applied to find out differences between the groups at 95% confidence interval where p = 0.05. One year comparison shows that cast partial denture maintained retention and stability better than acrylic partial denture (p< 0.05. The masticatory efficiency was significantly compromising from 3rd month to 1 year in all acrylic partial denture groups (p< 0.05. The comfort of patient with cast partial denture was maintained better during the observation period (p< 0.05. Periodontal health of abutment was gradually deteriorated in all acrylic denture group (p

  2. Creating opportunities for interdisciplinary collaboration and patient-centred care: how nurses, doctors, pharmacists and patients use communication strategies when managing medications in an acute hospital setting.

    Science.gov (United States)

    Liu, Wei; Gerdtz, Marie; Manias, Elizabeth

    2016-10-01

    This paper examines the communication strategies that nurses, doctors, pharmacists and patients use when managing medications. Patient-centred medication management is best accomplished through interdisciplinary practice. Effective communication about managing medications between clinicians and patients has a direct influence on patient outcomes. There is a lack of research that adopts a multidisciplinary approach and involves critical in-depth analysis of medication interactions among nurses, doctors, pharmacists and patients. A critical ethnographic approach with video reflexivity was adopted to capture communication strategies during medication activities in two general medical wards of an acute care hospital in Melbourne, Australia. A mixed ethnographic approach combining participant observations, field interviews, video recordings and video reflexive focus groups and interviews was employed. Seventy-six nurses, 31 doctors, 1 pharmacist and 27 patients gave written consent to participate in the study. Data analysis was informed by Fairclough's critical discourse analytic framework. Clinicians' use of communication strategies was demonstrated in their interpersonal, authoritative and instructive talk with patients. Doctors adopted the language discourse of normalisation to standardise patients' illness experiences. Nurses and pharmacists employed the language discourses of preparedness and scrutiny to ensure that patient safety was maintained. Patients took up the discourse of politeness to raise medication concerns and question treatment decisions made by doctors, in their attempts to challenge decision-making about their health care treatment. In addition, the video method revealed clinicians' extensive use of body language in communication processes for medication management. The use of communication strategies by nurses, doctors, pharmacists and patients created opportunities for improved interdisciplinary collaboration and patient-centred medication

  3. The Doctor-Patient Relationship and Information-Seeking Behavior: Four Orientations to Cancer Communication.

    Science.gov (United States)

    Adamson, Matthew; Choi, Kelsey; Notaro, Stephen; Cotoc, Crina

    2018-04-01

    In cancer communication, patients and physicians often understand a patient's experience and situation differently. This can negatively impact health outcomes and the physician-patient relationship. To explore how cancer patients' interpretations of the physician's role as information giver affect the communication relationship with the physician and their information-seeking behavior regarding different aspects of their cancer care. Participants completed a semistructured qualitative interview addressing their treatment experience and communication with their physician. Interviews were coded and analyzed using inductive thematic analysis. Ten patients with cancer treated at a regional cancer center in central Illinois participated in the study. Cancer stages I to IV and 4 cancer types were represented. Participants' orientations to the relationship with their physician (and their information-seeking behavior) were classified into 4 general categories: (1) "questioners" have a general mistrust toward their physicians and the information doctors are giving; (2) "the undecided" focuses on physician "fit," often requiring time to step away in order to make decisions and process information; (3) "cross-checkers" are concerned with content of their treatment protocol, often double-checking the treatment plan; and (4) "the experience-oriented" feel a gap between their experience and their physician's experience (and perspective), often seeking information from other survivors. All categories described a perceived lack of adequate exchange of information and the need to seek information outside of the physician-patient relationship to compensate. Participants exhibited different information-seeking behaviors based on how they interpreted the role of their physician as information giver. This affected what kind of information they sought and how they understood the information received, which in turn affected understanding of their broader experience and care.

  4. Doctors in Balzac's work.

    Science.gov (United States)

    Moulin, Thierry

    2013-01-01

    Balzac wrote his novels during a time of great literary and scientific change. Romanticism gave way to the school of realism, of which Balzac could be considered the founder. It was via realism, where both the positive and negative aspects of life were depicted, that doctors naturally gained a much more active role in novels. In conjunction with this was the development of science and medicine, which fascinated Balzac, also leading to the significant and prevalent role of doctors in his works. His fascination with the sciences led to him to gain many acquaintances and much knowledge in the medical domain, especially in neuropsychiatry and physiology. His fictional doctors, such as Desplein and Bianchon, thus demonstrate considerable knowledge of pathology, physiology, and neuropsychiatry. The doctors in Balzac's novels can be grouped into four categories: provincial doctors, Parisian doctors, country doctors, and military doctors. They were most often fictitious representations of real individuals (e.g. Guillaume Dupuytren), and often symbolize schools of thought which were in vogue at the time. In addition to the accurate scientific depiction of doctors, it must be noted that his doctors not only played an active role in clinically assessing their patients, but also had a sociological role in assessing society; it is through his doctors that Balzac gave his opinion of the world in which he lived. Copyright © 2013 S. Karger AG, Basel.

  5. 'How do you know what Aunt Martha looks like?' A video elicitation study exploring tacit clues in doctor-patient interactions.

    Science.gov (United States)

    Henry, Stephen G; Forman, Jane H; Fetters, Michael D

    2011-10-01

    Theory suggests that tacit clues inform clinical judgements, but the prevalence and role of tacit clues during clinical interactions is unknown. This study explored whether doctors and patients identify information likely to be tacit clues or judgements based on tacit clues during health maintenance examinations. Qualitative analysis of video elicitation interview transcripts involving 18 community-based primary care doctors and 36 patients. Outcomes were description and analysis of tacit clues and judgements based on tacit clues mentioned by participants. A total of 57 references to tacit clues and 53 references to judgements based on tacit clues were identified from patient and doctor transcripts. Non-verbal behaviours comprised the most common category of tacit clues (53% of doctor comments; 42% of patient comments). Patients mostly discussed judgements based on tacit clues that related to the doctor-patient relationship. Doctors discussed actively using non-verbal behaviours to provide patients with tacit clues about the doctor-patient relationship. They also mentioned tacit clues that informed medical judgements and decision making. Gestalt judgements based on tacit clues were common (33% of doctor comments). Several participants identified instances in which they had difficulty articulating their rationale for specific judgements. Doctors varied widely in how frequently they mentioned tacit clues. During video elicitation interviews, patients and doctors identified tacit clues and judgements based on these clues as playing a role during health maintenance examinations. Future research should further elucidate the role of tacit clues in medical judgements and doctor-patient relationships. Published 2011. This article is a US Government work and is in the public domain in the USA.

  6. Developing Skilled Doctor-Patient Communication in the Workplace: A Qualitative Study of the Experiences of Trainees and Clinical Supervisors

    Science.gov (United States)

    Giroldi, Esther; Veldhuijzen, Wemke; Geelen, Kristel; Muris, Jean; Bareman, Frits; Bueving, Herman; van der Weijden, Trudy; van der Vleuten, Cees

    2017-01-01

    To inform the development of recommendations to facilitate learning of skilled doctor-patient communication in the workplace, this qualitative study explores experiences of trainees and supervisors regarding how trainees learn communication and how supervisors support trainees' learning in the workplace. We conducted a qualitative study in a…

  7. [Supervision of junior doctors and allocation of work tasks regarding admissions and further treatment of acute admitted patients.

    DEFF Research Database (Denmark)

    Folkestad, Lars; Brabrand, Mikkel; Hallas, Peter

    2010-01-01

    at emergency departments, nor how often these patients are debated with an attending doctor. MATERIAL AND METHODS: Questionnaire survey performed January-April 2008, in which medical interns on call at Danish public hospitals completed an online questionnaire. The questions regarded: admissions and follow...... for help from a senior colleague. Udgivelsesdato: 2010-May-31...

  8. What we talk about when we talk about depression: doctor-patient conversations and treatment decision outcomes.

    NARCIS (Netherlands)

    Karasz, A.; Dowrick, C.; Byng, R.; Buszewicz, M.; Ferri, L.; Olde Hartman, T.C.; Dulmen, S. van; Weel-Baumgarten, E.M. van; Reeve, J.

    2012-01-01

    BACKGROUND: Efforts to address depression in primary care settings have focused on the introduction of care guidelines emphasising pharmacological treatment. To date, physician adherence remains low. Little is known of the types of information exchange or other negotiations in doctor-patient

  9. What we talk about when we talk about depression: doctor-patient conversations and treatment decision outcomes.

    NARCIS (Netherlands)

    Karasz, A.; Dowrick, C.; Byng, R.; Buszewicz, M.; Ferri, L.; Olde Hartman, T.C.; Dulmen, S. van; Weel-Baumgarten, E. van; Reeve, J.

    2012-01-01

    Background: Efforts to address depression in primary care settings have focused on the introduction of care guidelines emphasising pharmacological treatment. To date, physician adherence remains low. Little is known of the types of information exchange or other negotiations in doctor-patient

  10. [Medically unexplained symptoms' care in internal medicine: A paradigm of doctor-patient relationship in situation of uncertainty].

    Science.gov (United States)

    Ranque, B; Nardon, O

    2017-07-01

    Medically unexplained symptoms (MUS) are extremely common in general practice as in all medical specialties, but their designation is not unambiguous and the approaches to take care of the patients differ from conventional therapeutic approaches. The difficulty is not to confirm the diagnosis, which is rapidly obvious with some experience, but to establish a genuinely human therapeutic relationship, without any technical help, which pushes the doctor to the edge of his empathy and communication skills. The discomfort or even distress regularly encountered by physicians in front of a patient with MUS shows that the foundations of the doctor-patient relationship under uncertainty are poorly mastered. Patients with MUS are regularly abused by the doctors, who unwittingly participate in the maintenance of their symptoms and even freeze them, leading to disastrous psychosocial and economic consequences. Yet the doctor-patient relationship is the key to their recovery or, at least, their improvement. The means of a successful patient-centered relationship are not always intuitive but can be learned. It is therefore essential to include SMI in medical school curricula and post-graduate medical education. Finally, if the management of early MUS mainly concerns the family medicine, that of severe MUS, including some fibromyalgia and chronic fatigue syndromes, falls within the scope of the internist doctor, who should be able to deliver a comprehensive care in partnership with the general practitioner and possibly a psychiatrist. Copyright © 2016 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier SAS. All rights reserved.

  11. Can a mobile app improve the quality of patient care provided by trainee doctors? Analysis of trainees? case reports

    OpenAIRE

    Webb, Katie; Bullock, Alison; Dimond, Rebecca; Stacey, Mark

    2016-01-01

    Objectives To explore how a medical textbook app (?iDoc?) supports newly qualified doctors in providing high-quality patient care. Design The iDoc project, funded by the Wales Deanery, provides new doctors with an app which gives access to key medical textbooks. Participants? submitted case reports describing self-reported accounts of specific instances of app use. The size of the data set enabled analysis of a subsample of ?complex? case reports. Of the 568 case reports submitted by Foundati...

  12. Patients' need for information provision and perceived participation in decision making in doctor-patient consultation: Micro-cultural differences between French- and Italian-speaking Switzerland.

    Science.gov (United States)

    Camerini, Anne-Linda; Schulz, Peter J

    2016-03-01

    To explore micro-cultural differences in patients' need for information provision, perceived participation in decision making, and related concepts during the doctor-patient consultation between French- and Italian-speaking patients in Switzerland. In 2012, 153 French- and 120 Italian-speaking patients with chronic low back pain (cLBP) were surveyed on their need for information provision, perceived participation in decision making, cLBP knowledge, psychological empowerment, and trust in their doctor. T-tests and regression analyses with interaction terms were performed. Results show that French- and Italian-speaking patients significantly differed in their participation in decision making, with French-speaking patients reporting higher involvement. Need for information provision was related to empowerment among French- and to trust among Italian-speaking patients. For participation in decision making, trust was the only related concept among French-, and cLBP knowledge among Italian-speaking patients. Significant interaction terms indicate a moderation of micro-cultural background. Findings point towards differences in the relationships between individual patient characteristics (i.e. knowledge, empowerment) and relational doctor-patient characteristics (i.e. trust) and patients' need for information provision and participation in decision making between French- and Italian-speaking patients in Switzerland. Doctors should be aware of these differences when dealing with patients of different micro-cultural backgrounds. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  13. The agency of patients and carers in medical care and self-care technologies for interacting with doctors.

    Science.gov (United States)

    Nunes, Francisco; Andersen, Tariq; Fitzpatrick, Geraldine

    2017-06-01

    People living with Parkinson's disease engage in self-care for most of the time but, two or three times a year, they meet with doctors to re-evaluate the condition and adjust treatment. Patients and (informal) carers participate actively in these encounters, but their engagement might change as new patient-centred technologies are integrated into healthcare infrastructures. Drawing on a qualitative study that used observations and interviews to investigate consultations, and digital ethnography to understand interactions in an online community, we describe how patients and carers living with Parkinson's participate in the diagnosis and treatment decisions, engage in discussions to learn about certain topics, and address inappropriate medication. We contrast their engagement with a review of self-care technologies that support interactions with doctors, to investigate how these artefacts may influence the agency of patients and carers. Finally, we discuss design ideas for improving the participation of patients and carers in technology-mediated scenarios.

  14. Doctors' decisions when faced with contradictory patient advance directives and health care proxy opinion: a randomized vignette-based study.

    Science.gov (United States)

    Escher, Monica; Perrier, Arnaud; Rudaz, Sandrine; Dayer, Pierre; Perneger, Thomas V

    2015-03-01

    Sometimes a written advance directive contradicts the opinion of a health care proxy. How this affects doctors' decision making is unknown. To quantify the influence of contradictory instructions on doctors' decisions. All the generalists and internists in French-speaking Switzerland were mailed the questionnaire. Respondents (43.5%) evaluated three vignettes that described medical decisions for incapacitated patients. Each vignette was produced in four versions: one with an advance directive, one with a proxy opinion, one with both, and one with neither (control). In the first vignette, the directive and proxy agreed on the recommendation to forgo a medical intervention; in the second, the advance directive opposed, but the proxy favored the intervention; and in the third, the roles were reversed. Each doctor received one version of each vignette, attributed at random. The outcome variables were the doctor's decision to forgo the medical intervention and the rating of the decision as difficult. Written advance directives and proxy opinions significantly influenced doctors' decision making. When both were available and concordant, they reinforced each other (odds ratio [OR] of forgoing intervention 35.7, P proxy disagreed, the resulting effect was to forgo the intervention (ORs 2.1 and 2.2 for the two discordant vignettes, both P proxy opinions result in a weak preference for abstention from treatment and increase the difficulty of the decision. Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  15. Doctors and pharmaceutical industry.

    Science.gov (United States)

    Beran, Roy G

    2009-09-01

    The pharmaceutical industry is seen as seducing doctors by providing expensive gifts, subsidising travel and underwriting practice expenses in return for those doctors prescribing products that otherwise they would not use. This paints doctors in a very negative light; suggests doctors are available to the highest bidder; implies doctors do not adequately act as independent agents; and that doctors are driven more by self-interest than by patient needs. Similar practices, in other industries, are accepted as normal business behaviour but it is automatically assumed to be improper if the pharmaceutical industry supports doctors. Should the pharmaceutical industry withdraw educational grants then there would be: fewer scientific meetings; reduced attendance at conferences; limited post graduate education; and a depreciated level of maintenance of professional standards. To suggest that doctors prescribe inappropriately in return for largesse maligns their integrity but where there is no scientific reason to choose between different treatments then there can be little argument against selecting the product manufactured by a company that has invested in the doctor and the question arises as to whether this represents bad medicine? This paper will examine what constitutes non-professional conduct in response to inducements by the pharmaceutical industry. It will review: conflict of interest; relationships between doctors and pharma and the consequences for patients; and the need for critical appraisal before automatically decrying this relationship while accepting that there remain those who do not practice ethical medicine.

  16. Exposure to coughed airborne pathogens in a double bed hospital patient room with overhead mixing ventilation: impact of posture of coughing patient and location of doctor

    DEFF Research Database (Denmark)

    Kierat, W.; Bolashikov, Zhecho Dimitrov; Melikov, Arsen Krikor

    2010-01-01

    The exposure of a doctor and a patient to air coughed by a second infected patient was studied in a mock-up of two-bed hospital infectious ward with mixing ventilation at 22oC (71.6 F) room air temperature. The effect of posture of the coughing patient lying sideways or on back), position...

  17. Doctor - patient relationship La relación médico-paciente

    Directory of Open Access Journals (Sweden)

    Jaime Bedoya Restrepo

    1994-03-01

    Full Text Available

    Llama la atención el inusitado interés que en los últimos tiempos ha despertado el aspecto ético del ejercicio de la medicina. Este interés, no obstante, parece más centrado en los aspectos legales y sólo tangencialmente en el dilema moral que se origina en muchas de las actuaciones de los médicos. 

    La relación médico-paciente se puede entender como de tipo contractual, fundamentada en la confianza

    y el respeto mutuos, condicionada por la necesidad de ayuda por parte del enfermo y suministrada ésta por un profesional competente.

    Some brief considerations are made concerning doctor-patient relationship with emphasis on informed consent and on respect for the autonomy of the patient.

  18. Power imbalance and consumerism in the doctor-patient relationship: health care providers' experiences of patient encounters in a rural district in India.

    Science.gov (United States)

    Fochsen, Grethe; Deshpande, Kirti; Thorson, Anna

    2006-11-01

    The aim of this study is to explore health care providers' experiences and perceptions of their encounters with male and female patients in a rural district in India with special reference to tuberculosis (TB) care. The authors conducted semistructured interviews with 22 health care providers, 17 men and 5 women, from the public and private health care sectors. Findings reveal that doctors adopted an authoritarian as well as a consumerist approach in the medical encounter, indicating that power imbalances in the doctor-patient relationship are negotiable and subject to change. Gender was identified as an influencing factor of the doctor's dominance. A patient-centered approach, acknowledging patients' own experiences and shared decision making, is called for and should be included in TB control activities. This seems to be especially important for female patients, whose voices were not heard in the medical encounter.

  19. Parent's use of the Internet in the search for healthcare information and subsequent impact on the doctor-patient relationship.

    Science.gov (United States)

    Harvey, S; Memon, A; Khan, R; Yasin, F

    2017-11-01

    The Internet is an unavoidable source of healthcare information. This information, both reliable and unreliable, has previously been shown to influence carer's decisions. Our aim was to evaluate this information seeking behavior among parents and its subsequent potential impact on the doctor-patient relationship. We undertook a cross-sectional questionnaire-based survey of paediatric outpatients. Enrollment took place over 4 weeks in March 2015. There were no inclusion or exclusion criteria and enrollment was voluntary. In total 100 questionnaires were completed. General Practitioners were the most common source of healthcare information. The Internet ranked third as a reliable source of healthcare information. The Internet was commonly used as an educational resource to learn about causes, treatment, and medications. A significant percentage of our population expressed concern regarding Internet information reliability. A small percentage of parents were concerned that disclosing Internet usage may worsen the relationship with their doctor. Parents showed a willingness to learn about diseases and treatments, and felt that the Internet was a good resource to do so. This study shows that open discussion about Internet usage between parents and doctors is not common and carers feel at risk of judgment should they admit to Internet usage. The Internet should be seen as a positive adjunct to patient education which can improve understanding, thus strengthening the doctor-patient relationship. The Internet will never replace the role of healthcare professionals but must be seen as an integral part of a multi-disciplinary approach.

  20. What is missed in self-immolated patients' care? A grounded theory study.

    Science.gov (United States)

    Norouzi, Kian; Taghinejad, Hamid; Mohammadi, Farahnaz; Mohammadi, Eesa; Suhrabi, Zainab

    2012-12-01

    To explore rehabilitation care process in patients who commit self-immolation. Self-immolation is not only a type of burn injury, but it is also a suicidal method. It is placed in burn injury category that requires long-term rehabilitation and treatment measures. As a suicidal method, among all forms of suicidal attempts, it is the most dramatic, violent and often difficult one to understand. Unfortunately, there are few reported studies investigating experiences and perceptions of nurses about burn care and with qualitative study about the patients' experiences and perceptions. On the basis of the research question, the grounded theory method was used. Considering ethical codes of Belmont and Helsinki statements, purposive sampling was used to select the participants. The patients were deliberately selected, based on the research needs. They were self-immolated patients being referred to Talaghani hospital of Ilam (western Iran) or discharged previously (time of interview and observation ranged from immediately later the burn till 5 years after), in Ilam, where self-immolation rate is very high. The main methods for data collection were deep, open ended, semi-structured interviews, dairies and observations. The interviews were audio taped in Persian, and verbatim transcriptions were made. By doing so, semantic meaning is preserved, and misinterpretation of data due to translation into English is minimised. Data analysis was conducted using the Strauss and Corbin method. Five main categories were emerged: situation of crisis unprofessional care, prolongation and formidability of the journey, self-immolation as paralyse, and attempt for self-management. Finally, by constant, comparison of collected data and emerged categories, central variable entitled unintegrated care emerged as the main problem of self-immolated patients' care. The study comes to the conclusion that we need to focus on specific considerations to provide integrated care for the burned patients as

  1. Health information wanted and obtained from doctors/nurses: a comparison of Chinese cancer patients and family caregivers.

    Science.gov (United States)

    Xie, Bo; Su, Zhaohui; Liu, Yihao; Wang, Mo; Zhang, Ming

    2015-10-01

    To assess and compare health information wanted and obtained from doctors/nurses by Chinese cancer patients and family caregivers. (1) What are the instrument's psychometrics in Chinese cancer patients and family caregivers? (2) How might Chinese cancer patients and family caregivers differ in the amount of different types of health information they want to have? and (3) How might Chinese cancer patients and family caregivers differ in the amount of different types of information they were able to obtain from doctors/nurses? This was a cross-sectional study using a paper-pen questionnaire. A total of 198 participants (79 cancer patients; 119 family caregivers) from a general hospital in Sichuan, China completed the instrument in March 2014. The instrument has excellent reliability and validity. Participants wanted to have a wide range of health information, including but not limited to information about diagnosis or treatment. Across all types of information, participants obtained from doctors/nurses significantly less than what they wanted. The discrepancy between information wanted and obtained varied across different types of information. The discrepancy was largest for information about complementary and alternative medicine (CAM) and psychosocial aspects and smallest for information about diagnosis and self-care. Patients and caregivers did not differ in the amount of different types of information they wanted or obtained from medical professionals. There is a great need for providing more information to both patients and their families, particularly information about CAM and psychosocial aspects.

  2. The importance of physician listening from the patients' perspective: enhancing diagnosis, healing, and the doctor-patient relationship.

    Science.gov (United States)

    Jagosh, Justin; Donald Boudreau, Joseph; Steinert, Yvonne; Macdonald, Mary Ellen; Ingram, Lois

    2011-12-01

    The research findings reported here describe the importance and various functions of physician listening according to patients. Fifty-eight patients of the McGill University Health Centre were interviewed using a qualitative, interpretive design approach. Patients explained why listening was important to them and these findings were organized into three themes: (a) listening as an essential component of clinical data gathering and diagnosis; (b) listening as a healing and therapeutic agent; and (c) listening as a means of fostering and strengthening the doctor-patient relationship. The findings are presented along with a conceptual model on the functions of physician listening. Elucidating the multiple functions of listening in the clinical encounter from patient perspectives can assist physicians in improving their listening approach. For training purposes, we recommend that a module on listening should lead to a discussion not only about the skill required in listening attentively, but also to the values, beliefs, attitudes, and intentions of physicians who choose to listen to their patients. This teaching objective may be facilitated by future research that explores the concept of 'authenticity' in a physician's listening approach, which we argue is central to successful clinical outcomes. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  3. Comparison of patient-reported need of psycho-oncologic support and the doctor's perspective: how do they relate to disease severity in melanoma patients?

    Science.gov (United States)

    Nolte, Sandra; van der Mei, Sicco H; Strehl-Schwarz, Kerstin; Köster, Johanna; Bender, Armin; Rose, Matthias; Kruse, Johannes; Peters, Eva M J

    2016-11-01

    Psycho-neuro-immune research suggests an association between cancer outcomes and psychosocial distress. Objective criteria to determine patients' levels of distress are important to establish potential links to disease outcomes. We compared three patient-reported with one doctor-reported measures of psycho-oncologic distress frequently used in routine cancer care and investigated associations with standard disease severity parameters in melanoma patients. We enrolled n = 361 patients, successively seen at two outpatient university clinics in Germany. In the naturalistic study, n = 222 patients had been diagnosed 180 days and were in after-care (Group II). Across groups, only moderate associations were seen between patient- reported and doctor-reported measures. Regarding clinical variables, disease severity and perceived need of psycho-oncologic support reported by patients or doctors showed hardly any association. After subgroup stratification, in patients of Group II, patient-reported and doctor-reported instruments showed some small associations with disease parameters commonly linked to more rapid cancer progression in patients who are in cancer after-care. Overall, the few and low associations suggest that need of psycho-oncologic support and clinical variables were largely independent of each other and doctors' perception may not reflect the patient's view. Therefore, the assessment of the patient perspective is indispensable to ensure that melanoma patients receive appropriate support, as such need cannot be derived from other disease parameters or proxy report. More research is needed applying psychometrically robust instruments that are ideally combined with sensitive biomarkers to disentangle psycho-neuro-immune implications in melanoma patients. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

  4. Critical and Creative Thinking Nexus: Learning Experiences of Doctoral Students

    Science.gov (United States)

    Brodin, Eva M.

    2016-01-01

    Critical and creative thinking constitute important learning outcomes at doctoral level across the world. While the literature on doctoral education illuminates this matter through the lens of experienced senior researchers, the doctoral students' own perspective is missing. Based upon interviews with 14 doctoral students from four disciplines at…

  5. Digital Natives Versus Digital Immigrants: Influence of Online Health Information Seeking on the Doctor-Patient Relationship.

    Science.gov (United States)

    Haluza, Daniela; Naszay, Marlene; Stockinger, Andreas; Jungwirth, David

    2017-11-01

    Ubiquitous Internet access currently revolutionizes the way people acquire information by creating a complex, worldwide information network. The impact of Internet use on the doctor-patient relationship is a moving target that varies across sociodemographic strata and nations. To increase scientific knowledge on the patient-Web-physician triangle in Austria, this study reports findings regarding prevailing online health information-seeking behavior and the respective impact on doctor-patient interactions among a nonprobability convenience sample of Internet users. To investigate digital age group-specific influences, we analyzed whether digital natives and digital immigrants differed in their perspectives. The questionnaire-based online survey collected sociodemographic data and online health information-seeking behavior from a sample of 562 respondents (59% females, mean age 37 ± 15 years, 54% digital natives). Most respondents (79%) referred to the Internet to seek health information, making it the most commonly used source for health information, even more prevalent then the doctor. We found similar predictors for using the Internet as a source for health-related information across digital age groups. Thus, the overall generational gap seems to be small among regular Internet users in Austria. However, study participants expressed a rather skeptical attitude toward electronic exchange of health data between health care professionals and patients, as well as toward reliability of online health information. To improve adoption of electronic doctor-patient communication and patient empowerment, public education and awareness programs are required to promote consumer-centered health care provision and patient empowerment.

  6. Low Body Mass Index Can Identify Majority of Osteoporotic Inflammatory Bowel Disease Patients Missed by Current Guidelines

    Directory of Open Access Journals (Sweden)

    Ashish Atreja

    2012-01-01

    Full Text Available Background. Patients with inflammatory bowel disease (IBD are at high risk of developing osteoporosis. Our objective was to determine the usefulness of IBD guidelines in identifying patients at risk for developing osteoporosis. Methods. We utilized institutional repository to identify patients seen in IBD center and extracted data on demographics, disease history, conventional, and nonconventional risk factors for osteoporosis and Dual Energy X-ray Absorptiometry (DXA findings. Results. 59% of patients (1004/1703 in our IBD cohort had at least one risk factor for osteoporosis screening. DXA was documented in 263 patients with indication of screening (provider adherence, 26.2%, and of these, 196 patients had DXA completed (“at-risk” group. Ninety-five patients not meeting guidelines-based risk factors also had DXA completed (“not at-risk” group. 139 (70.9% patients in “at-risk” group had low BMD, while 51 (53.7% of “not-at-risk” patients had low BMD. Majority of the patients with osteoporosis (83.3% missed by the current guidelines had low BMI. Multivariate logistic regression analysis showed that low BMI was the strongest risk factor for osteoporosis (OR 3.07; 95% CI, 1.47–6.42; P=0.003. Conclusions. Provider adherence to current guidelines is suboptimal. Low BMI can identify majority of the patients with osteoporosis that are missed by current guidelines.

  7. Doctors' knowledge of patients' rights at King Fahd Hospital of the University

    Directory of Open Access Journals (Sweden)

    Sarah A Al-Muammar

    2017-01-01

    CONCLUSION: Reinforcement and strict implementation of PBR are necessary. The institution should provide training and motivate physicians, especially younger doctors regarding PBR to ensure good health for all and safeguard the integrity of both the physician and the hospital.

  8. Do doctors' attachment styles and emotional intelligence influence patients' emotional expressions in primary care consultations? An exploratory study using multilevel analysis.

    Science.gov (United States)

    Cherry, M Gemma; Fletcher, Ian; Berridge, Damon; O'Sullivan, Helen

    2018-04-01

    To investigate whether and how doctors' attachment styles and emotional intelligence (EI) might influence patients' emotional expressions in general practice consultations. Video recordings of 26 junior doctors consulting with 173 patients were coded using the Verona Coding Definition of Emotional Sequences (VR-CoDES). Doctors' attachment style was scored across two dimensions, avoidance and anxiety, using the Experiences in Close Relationships: Short Form questionnaire. EI was assessed with the Mayer-Salovey-Caruso Emotional Intelligence Test. Multilevel Poisson regressions modelled the probability of patients' expressing emotional distress, considering doctors' attachment styles and EI and demographic and contextual factors. Both attachment styles and EI were significantly associated with frequency of patients' cues, with patient- and doctor-level explanatory variables accounting for 42% of the variance in patients' cues. The relative contribution of attachment styles and EI varied depending on whether patients' presenting complaints were physical or psychosocial in nature. Doctors' attachment styles and levels of EI are associated with patients' emotional expressions in primary care consultations. Further research is needed to investigate how these two variables interact and influence provider responses and patient outcomes. Understanding how doctors' psychological characteristics influence PPC may help to optimise undergraduate and postgraduate medical education. Copyright © 2017 Elsevier B.V. All rights reserved.

  9. What am I going to say here? The experiences of doctors and nurses communicating with patients in a cancer unit

    Directory of Open Access Journals (Sweden)

    Margaret eMcLean

    2011-11-01

    Full Text Available This paper describes a study investigating the provider-patient communication perceptions, experiences, needs and strategies of doctors and nurses working together in a UK cancer setting. This was a qualitative study using individual interviews and focus group discussions. Interpretative Phenomenological analysis (IPA was used to underpin data collection and analysis. Twenty-six staff participated in the project (18 nurses and 8 doctors. Both professional groups identified an inherent emotional strain in their daily interactions with patients. The strategies they adopted to reduce this strain fell into two main categories: 1 Handling or managing the patient to keep negative emotion at bay; and 2 Managing self to keep negative emotion at bay. These strategies allowed staff to maintain a sense of control in an emotionally-stressful environment. Most believed that their communication skills were sufficient. In conclusion, communicating with and caring for cancer patients causes considerable psycho-social burden for doctors and nurses. Managing this burden influences their communication with patients. Without recognition of the need for staff to protect their own emotional well-being, communication skills training programmes, emphasised in current UK cancer care guidelines, may have little impact on practice.

  10. Long-term doctor-patient relationships: patient perspective from online reviews.

    Science.gov (United States)

    Detz, Alissa; López, Andrea; Sarkar, Urmimala

    2013-07-02

    Continuity of patient care is one of the cornerstones of primary care. To examine publicly available, Internet-based reviews of adult primary care physicians, specifically written by patients who report long-term relationships with their physicians. This substudy was nested within a larger qualitative content analysis of online physician ratings. We focused on reviews reflecting an established patient-physician relationship, that is, those seeing their physicians for at least 1 year. Of the 712 Internet reviews of primary care physicians, 93 reviews (13.1%) were from patients that self-identified as having a long-term relationship with their physician, 11 reviews (1.5%) commented on a first-time visit to a physician, and the remainder of reviews (85.4%) did not specify the amount of time with their physician. Analysis revealed six overarching domains: (1) personality traits or descriptors of the physician, (2) technical competence, (3) communication, (4) access to physician, (5) office staff/environment, and (6) coordination of care. Our analysis shows that patients who have been with their physician for at least 1 year write positive reviews on public websites and focus on physician attributes.

  11. The Effect of Screen-to-Screen Versus Face-to-Face Consultation on Doctor-Patient Communication: An Experimental Study with Simulated Patients.

    Science.gov (United States)

    Tates, Kiek; Antheunis, Marjolijn L; Kanters, Saskia; Nieboer, Theodoor E; Gerritse, Maria Be

    2017-12-20

    Despite the emergence of Web-based patient-provider contact, it is still unclear how the quality of Web-based doctor-patient interactions differs from face-to-face interactions. This study aimed to examine (1) the impact of a consultation medium on doctors' and patients' communicative behavior in terms of information exchange, interpersonal relationship building, and shared decision making and (2) the mediating role of doctors' and patients' communicative behavior on satisfaction with both types of consultation medium. Doctor-patient consultations on pelvic organ prolapse were simulated, both in a face-to-face and in a screen-to-screen (video) setting. Twelve medical interns and 6 simulated patients prepared 4 different written scenarios and were randomized to perform a total of 48 consultations. Effects of the consultations were measured by questionnaires that participants filled out directly after the consultation. With respect to patient-related outcomes, satisfaction, perceived information exchange, interpersonal relationship building, and perceived shared decision making showed no significant differences between face-to-face and screen-to-screen consultations. Patients' attitude toward Web-based communication (b=-.249, P=.02 and patients' perceived time and attention (b=.271, P=.03) significantly predicted patients' perceived interpersonal relationship building. Patients' perceived shared decision making was positively related to their satisfaction with the consultation (b=.254, P=.005). Overall, patients experienced significantly greater shared decision making with a female doctor (mean 4.21, SD 0.49) than with a male doctor (mean 3.66 [SD 0.73]; b=.401, P=.009). Doctor-related outcomes showed no significant differences in satisfaction, perceived information exchange, interpersonal relationship building, and perceived shared decision making between the conditions. There was a positive relationship between perceived information exchange and doctors

  12. [A virtual patient to improve doctor-patient communication : reality or fiction ?

    Science.gov (United States)

    Bragard, I; Guillaume, M; Ghuysen, A; Servotte, J C; Ortiz, I; Pétré, B

    2018-02-01

    The transformations of the health system and the preferences of the patients themselves have led healthcare professionals to rethink the place and role of the patient in the healthcare system, putting the caregivercare relationship and communication at the heart of public health issues. The literature shows that empathic communication is associated with better adherence to treatment, better patient satisfaction and less litigation. However, the initial training programs of health professionals are little oriented towards this field. Moreover, they are mainly based on a direct transition from theory to clinical practice with all the risks that this entails for patients. Some recent studies suggest an interest in virtual reality simulation for the development of these communication skills. This article offers an overview of the potential of virtual clinical simulation as a complementary or even alternative method to traditional teaching methods. Different studies will illustrate these innovations in the training of physicians in clinical reasoning, empathic communication, and in a highly emotional situation such as breaking bad news.

  13. How stressful is doctor-patient communication? Physiological and psychological stress of medical students in simulated history taking and bad-news consultations

    NARCIS (Netherlands)

    Hulsman, Robert L.; Pranger, Susan; Koot, Stephanie; Fabriek, Marcel; Karemaker, John M.; Smets, Ellen M. A.

    2010-01-01

    Introduction: Medical communication can be a stressful experience for both doctors and patients. In particular, inexperienced doctors facing the demanding task of a bad news consultation may experience high levels of distress. The aim of this exploratory study is to test students' differential

  14. Two loose screws: near-miss fall of a morbidly obese patient after an operating room table failure.

    Science.gov (United States)

    McAllister, Russell K; Booth, Robert T; Bittenbinder, Timothy M

    2016-09-01

    Operating room surgical table failure is a rare event but can lead to a dangerous situation when it does occur. The dangers can be compounded in the presence of obesity, especially in the anesthetized or sedated patient. We present a case of a near-miss fall of a morbidly obese patient while turning the patient in preparation to transfer from the operating room table to the hospital bed when 2 fractured bolts in the tilt cylinder mechanism led to an operating room table failure. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. The major clinical determinants of maternal death among obstetric near-miss patients: a tertiary centre experience

    International Nuclear Information System (INIS)

    Simsek, Y.; Yilmaz, E.; Celik, E.

    2013-01-01

    Objective: To evaluate the characteristics of obstetric near-miss patients to clarify the major risk factors of maternal mortality. Methods: From among the patients referred to the Department of Obstetrics and Gynaecology, Inonu University of Medical Sciences, Turkey, between August 1, 2010 and March 1, 2012, electronic records of obstetric near-miss cases were retrospectively analysed. The obstetric and demographic characteristics of cases that were successfully treated (Group 1) as well as cases with maternal death (Group 2) were analysed and compared. SPSS 11.5 was used for statistical analysis. Results: Of the total 2687 cases handled during the study period, 95 (3.53%) were of the near-miss nature. The most frequently encountered underlying aetiology was severe preeclampsia (n=55; 57.89%) and haemolysis, elevated liver enzymes, low platelet count syndrome (n=20; 21.1%). These were followed by cases of postpartum bleeding (n=18; 18.9%). Maternal mortality occurred in 10 (10.5%) patients, representing Group 2. The amount of haemorrhage and blood transfused were significantly higher in the group. Maternal mortality cases had also significantly longer duration of intensive care unit admission. Conclusion: Early diagnosis and immediate management of the complications noted by the study can be the most important measures to prevent the occurrence of mortality. (author)

  16. Train-the-trainer intervention to increase nursing teamwork and decrease missed nursing care in acute care patient units.

    Science.gov (United States)

    Kalisch, Beatrice J; Xie, Boqin; Ronis, David L

    2013-01-01

    Teamwork is essential for patient safety and results in less missed nursing care. The aim of this study was to test the impact of a train-the-trainer intervention on the level of satisfaction with nursing teamwork and the amount of missed nursing care. This study used a quasiexperimental design with repeated measures taken at pretest, posttest, and 2 months after completion of the intervention. The sample for this study was the nursing staff on three medical-surgical units in three separate acute care hospitals (one unit in each hospital). Three nurses from each unit underwent a training program and then taught the skills and knowledge they acquired to the staff members on their units in three-hour-long sessions. The training involved staff role-playing scenarios based on teamwork problems that occur regularly on inpatient units in acute care hospitals followed by debriefing, which focused on teamwork behaviors (e.g., leadership, team orientation, backup, performance monitoring) and missed nursing care. Four measures were used to test the efficacy of this intervention: The Nursing Teamwork Survey, the MISSCARE Survey, and questions about the knowledge of and satisfaction with teamwork. Return rates for the surveys ranged from 73% to 84%. Follow-up tests individually comparing pretest, posttest, and delayed posttest were conducted within the mixed model and used the Bonferroni correction for multiple comparisons. Teamwork increased (F = 6.91, df = 259.01, p = .001) and missed care decreased (F = 3.59, df = 251.29, p = .03) over time. Nursing staff also reported a higher level of satisfaction with teamwork and an increase of teamwork knowledge after the intervention. The intervention tested in this study shows promise of being an effective and efficient approach to increase nursing teamwork and decrease missed nursing care.

  17. Patient versus health care provider perspectives on spirituality and spiritual care: the potential to miss the moment.

    Science.gov (United States)

    Selby, Debbie; Seccaraccia, Dori; Huth, Jim; Kurppa, Kristin; Fitch, Margaret

    2017-04-01

    Spirituality and spiritual care are well recognized as important facets of patient care, particularly in the palliative care population. Challenges remain, however, in the provision of such care. This study sought to compare patient and health care professional (HCP) views on spirituality/spiritual care, originally with a view to exploring a simple question(s) HCP's could use to identify spiritual distress, but evolved further to a comparison of how patients and HCPs were both concordant and discordant in their thoughts, and how this could lead to HCP's 'missing' opportunities to both identify spirituality/spiritual distress and to providing meaningful spiritual care. Patients (n=16) with advanced illnesses and HCP's (n=21) with experience providing care to those with advanced disease were interviewed using a semi-structured interview guide. Qualitative analysis distress and spiritual care, and screening for spiritual distress). Within each category there were areas of both concordance and discordance. Most notably, HCP's struggled to articulate definitions of spirituality whereas patients generally spoke with much more ease, giving rich examples. Equally, HCP's had difficulty relating stories of patients who had experienced spiritual distress while patients gave ready responses. Key areas where HCP's and patients differed were identified and set up the strong possibility for an HCP to 'miss the moment' in providing spiritual care. These key misses include the perception that spiritual care is simply not something they can provide, the challenge in defining/ recognizing spirituality (as HCP and patient definitions were often very different), and the focus on spiritual care, even for those interested in providing, as 'task oriented' often with emphasis on meaning making or finding purpose, whereas patients much more commonly described spiritual care as listening deeply, being present and helping them live in the moment. Several discrepancies in perception of

  18. «Would a doctor really endeavour to refuse a patient his cognac?!»--doctors' prescription practices in the prohibition era 1916-1926.

    Science.gov (United States)

    Hem, Per Eivind; Hem, Erlend

    2012-12-11

    In Norway, all sales of distilled spirits were prohibited from 1916 to 1926 and fortified wine was also banned from 1917 to 1923, a period of history called The Prohibition. During this time, the doctors served as gatekeepers who regulated the population's access to alcohol, since a prescription was the only legal way of obtaining fortified wine and distilled spirits. Many have claimed that the doctors failed in this role and undermined Norwegian prohibition policy. KNOWLEDGE BASE: The article is based on a review of articles on the alcohol issue published in the Journal of the Norwegian Medical Association. Many doctors were of the opinion that alcohol had beneficial health effects, for prevention and alleviation as well as to provide a cure. Moreover, few doctors were temperance advocates and many of them were opposed to the prohibition, including the Director of Health. Over time, many doctors prescribed large amounts of spirits and fortified wine. However, there were few real whisky doctors. The medical community was strongly in favour of rationing, i.e. letting people acquire a certain amount of alcohol without any medical supervision, but this proposal never gained political acceptance. The doctors had a certain responsibility for this erosion of the prohibition, and thereby also for its final demise. The whisky doctors were a threat to the profession's reputation, and the most unscrupulous were excluded from the Norwegian Medical Association. The main responsibility for the situation with regard to prescriptions, however, fell on the health authorities and politicians, who delayed the introduction of effective regulations for far too long.

  19. Imaging for metastatic disease in patients with newly diagnosed breast cancer: are doctor's perceptions in keeping with the guidelines?

    Science.gov (United States)

    Simos, Demetrios; Hutton, Brian; Graham, Ian D; Arnaout, Angel; Caudrelier, Jean-Michel; Clemons, Mark

    2015-02-01

    Despite multiple guidelines advocating against routine radiological evaluation for metastases in women with early stage breast cancer, imaging is still frequently overused. The objective of this study was to assess doctor's views on imaging guidelines, and an attempt to establish why personal and local clinical practice patterns regarding imaging may differ from current guidelines. Canadian doctors who treat breast cancer were invited by email to complete an online survey developed by members of the research team. Responses were received from 173 physicians (26% response rate). Most (82%) indicated awareness of at least one published imaging guideline. Sixty per cent indicated that they had read the recommendations of the 2012 American Society of Clinical Oncology 'Top 5' list for choosing wisely in oncology imaging and, of those, 81% agreed with it. However, most indicated that this recommendation has not influenced them to order less imaging. Over 95% of doctors identified suspicious history, physical examination findings and inflammatory breast cancer as important factors for performing imaging. The majority did not feel that patient demand, fear of litigation or ease of access to imaging influenced their ordering for imaging. The majority of breast cancer doctors are aware of and generally agree that guidelines pertaining to staging imaging for early breast cancer are reflective of evidence. Despite this, adherence is variable and factors such as local practice patterns and disease biology may play a role. Alternative strategies, beyond simply publishing recommendations, are therefore required if there is to be a sustained change in doctor behaviour. © 2014 John Wiley & Sons, Ltd.

  20. [The importance of the doctor-patient communication in the care of somatizing patients].

    Science.gov (United States)

    Stauder, Adrienne; Eörsi, Dániel; Pilling, János

    2016-04-24

    The term "somatization" refers to the manifestation of multiple somatic complaints not explained by organic changes. According to the literature, 15-25 percent of all medical visits are related to somatization. As medical training does not put enough emphasis on the evaluation of the possible psychological background of certain somatic symptoms, physicians may feel powerless and make unjustified diagnostic and therapeutic efforts. The patients may also feel helpless and frustrated, their anxiety and the intensity of their complaints may increase. As stress is an important factor in the somatization process, stress reduction and improvement of coping are key elements of the treatment guidelines for chronic diseases. Evidence based interventions range from short counselling and medication to cognitive and behavioral psychotherapy. Reattribution, a short (10-30 minutes) structured intervention that can be implemented in primary or secondary care, in certain cases can result in significant decrease in somatic symptoms and anxiety.

  1. Doctoral surplus?

    Science.gov (United States)

    Universities in the United States are producing about 25% more doctorates in science and engineering than the U.S. economy can absorb, according to a new study by the Rand Corporation and Stanford University's Institute for Higher Education Research. The study looked at 13 science and engineering fields, covering 210 doctorate-granting institutions and more than 1,000 educational institutions that employ people with doctorates. The study was done by Stanford Professor William Massy and Charles Goldman of Rand, with graduate students Marc Chun and Beryle Hsiao.The researchers found that supply and demand do not work in the usual way to regulate the employment market for doctoral candidates. In labor markets, when job opportunities decrease, fewer people usually seek to enter the field. In the case of Ph.D.s, however, the researchers found that neither departments nor prospective doctoral students take close accounting of the doctorate employment gap.

  2. Decayed, Missing, and Filled Teeth Index and Periodontal Health in Osteoporotic Patients Affected by BRONJ: An Observational Study

    Directory of Open Access Journals (Sweden)

    Giacomo Oteri

    2013-01-01

    Full Text Available The aim of this paper is to describe the incidence of decayed, missing, and filled teeth (DMFT and periodontal disease in 32 osteoporotic patients affected by bisphosphonate-related osteonecrosis of the jaw (BRONJ. Moreover, an investigation between the obtained data and 20 patients treated with bisphosphonate drugs and with no evidence of ONJ has been performed. Osteonecrosis of the jaws is a rare complication in a subset of patients receiving bisphosphonate drugs. Based on a growing number of case reports and institutional reviews, this kind of therapy can cause exposed and necrotic bone specifically in the jawbones. From April 2009 to June 2012, 32 osteoporotic patients treated with oral or intravenous (I.V. bisphosphonates have been recorded. The patients’ oral health has been compared with 20 bisphosphonates patients with no ONJ. The incidence of decayed, missing, and filled teeth (DMFT and periodontal disease was recorded in all patients and student’s t-test was applied for comparing the two investigated groups data. Data demonstrated how the poor dental hygiene and periodontal disease of the BRONJ patients’ are connected with the occurrence of jawbone necrosis.

  3. Talking to Your Doctor

    Science.gov (United States)

    ... Vision Education Program Hispanic/Latino Program Vision and Aging Program African American Program ... Talking to Your Doctor Today, patients take an active role in their health care. You and your ...

  4. Current status of online rating of Australian doctors.

    Science.gov (United States)

    Atkinson, Sean

    2014-01-01

    Online rating of patient satisfaction of their doctor is increasingly common worldwide. This study of 4157 ratings of Australian doctors found patients were extremely satisfied with their doctor. However, this result was limited by a low prevalence of rated doctors and low numbers of ratings per doctor. Further studies are needed to determine how online rating will affect future practice for all doctors.

  5. Evaluating the impact of patients' online access to doctors' visit notes: designing and executing the OpenNotes project

    Directory of Open Access Journals (Sweden)

    Leveille Suzanne G

    2012-04-01

    Full Text Available Abstract Background Providers and policymakers are pursuing strategies to increase patient engagement in health care. Increasingly, online sections of medical records are viewable by patients though seldom are clinicians' visit notes included. We designed a one-year multi-site trial of online patient accessible office visit notes, OpenNotes. We hypothesized that patients and primary care physicians (PCPs would want it to continue and that OpenNotes would not lead to significant disruptions to doctors' practices. Methods/Design Using a mixed methods approach, we designed a quasi-experimental study in 3 diverse healthcare systems in Boston, Pennsylvania, and Seattle. Two sites had existing patient internet portals; the third used an experimental portal. We targeted 3 key areas where we hypothesized the greatest impacts: beliefs and attitudes about OpenNotes, use of the patient internet portals, and patient-doctor communication. PCPs in the 3 sites were invited to participate in the intervention. Patients who were registered portal users of participating PCPs were given access to their PCPs' visit notes for one year. PCPs who declined participation in the intervention and their patients served as the comparison groups for the study. We applied the RE-AIM framework to our design in order to capture as comprehensive a picture as possible of the impact of OpenNotes. We developed pre- and post-intervention surveys for online administration addressing attitudes and experiences based on interviews and focus groups with patients and doctors. In addition, we tracked use of the internet portals before and during the intervention. Results PCP participation varied from 19% to 87% across the 3 sites; a total of 114 PCPs enrolled in the intervention with their 22,000 patients who were registered portal users. Approximately 40% of intervention and non-intervention patients at the 3 sites responded to the online survey, yielding a total of approximately 38

  6. Should doctors strike?

    Science.gov (United States)

    Park, John J; Murray, Scott A

    2014-05-01

    Last year in June, British doctors went on strike for the first time since 1975. Amidst a global economic downturn and with many health systems struggling with reduced finances, around the world the issue of public health workers going on strike is a very real one. Almost all doctors will agree that we should always follow the law, but often the law is unclear or does not cover a particular case. Here we must appeal to ethical discussion. The General Medical Council, in its key guidance document for practising doctors, Good Medical Practice, claims that 'Good doctors make the care of their patients their first concern'. Is this true? And if so, how is this relevant to the issue of striking? One year on since the events, we carefully reflect and argue whether it was right for doctors to pursue strike action, and call for greater discussion of ethical issues such as the recent strikes, particularly among younger members of the profession.

  7. Application of 3D Printing in the Surgical Planning of Trimalleolar Fracture and Doctor-Patient Communication

    Directory of Open Access Journals (Sweden)

    Long Yang

    2016-01-01

    Full Text Available To evaluate the effect of 3D printing in treating trimalleolar fractures and its roles in physician-patient communication, thirty patients with trimalleolar fractures were randomly divided into the 3D printing assisted-design operation group (Group A and the no-3D printing assisted-design group (Group B. In Group A, 3D printing was used by the surgeons to produce a prototype of the actual fracture to guide the surgical treatment. All patients underwent open reduction and internal fixation. A questionnaire was designed for doctors and patients to verify the verisimilitude and effectiveness of the 3D-printed prototype. Meanwhile, the operation time and the intraoperative blood loss were compared between the two groups. The fracture prototypes were accurately printed, and the average overall score of the verisimilitude and effectiveness of the 3D-printed prototypes was relatively high. Both the operation time and the intraoperative blood loss in Group A were less than those in Group B (P<0.05. Patient satisfaction using the 3D-printed prototype and the communication score were 9.3±0.6 points. A 3D-printed prototype can faithfully reflect the anatomy of the fracture site; it can effectively help the doctors plan the operation and represent an effective tool for physician-patient communication.

  8. Dominance Relations in the Light of Repairmechanisms in Family-doctor-Patient and Hospital Teacher-Student Encounters

    Directory of Open Access Journals (Sweden)

    Kránicz Rita

    2013-04-01

    Full Text Available Introduction: Repair mechanisms, both marked and unmarked, are present in institutional interactions including family doctor-patient and hospital teacher-student encounters. While in most of the cases unmarked repair is carried out by the dominant partner, sometimes marked repair mechanisms are initiated by the client. The present study was undertaken to throw light upon these marked repairs. The aim of the study is to compare two interactions, the first is between a GP and a patient and the second is between a hospital teacher and a student.

  9. Go green! Reusing brain monitoring data containing missing values: a feasibility study with traumatic brain injury patients.

    Science.gov (United States)

    Feng, Mengling; Loy, Liang Yu; Zhang, Feng; Zhang, Zhuo; Vellaisamy, Kuralmani; Chin, Pei Loon; Guan, Cuntai; Shen, Liang; King, Nicolas K K; Lee, Kah Keow; Ang, Beng Ti

    2012-01-01

    Despite the wealth of information carried, periodic brain monitoring data are often incomplete with a significant amount of missing values. Incomplete monitoring data are usually discarded to ensure purity of data. However, this approach leads to the loss of statistical power, potentially biased study and a great waste of resources. Thus, we propose to reuse incomplete brain monitoring data by imputing the missing values - a green solution! To support our proposal, we have conducted a feasibility study to investigate the reusability of incomplete brain monitoring data based on the estimated imputation error. Seventy-seven patients, who underwent invasive monitoring of ICP, MAP, PbtO (2) and brain temperature (BTemp) for more than 24 consecutive hours and were connected to a bedside computerized system, were selected for the study. In the feasibility study, the imputation error is experimentally assessed with simulated missing values and 17 state-of-the-art predictive methods. A framework is developed for neuroclinicians and neurosurgeons to determine the best re-usage strategy and predictive methods based on our feasibility study. The monitoring data of MAP and BTemp are more reliable for reuse than ICP and PbtO (2); and, for ICP and PbtO (2) data, a more cautious re-usage strategy should be employed. We also observe that, for the scenarios tested, the lazy learning method, K-STAR, and the tree-based method, M5P, are consistently 2 of the best among the 17 predictive methods investigated in this study.

  10. The proximal fibula should be examined in all patients with ankle injury: a case series of missed maisonneuve fractures.

    Science.gov (United States)

    Taweel, Nicholas R; Raikin, Steven M; Karanjia, Homyar N; Ahmad, Jamal

    2013-02-01

    The Maisonneuve fracture is a spiral fracture of the proximal third of the fibula. It occurs from violent twisting of the ankle that characteristically causes ligament damage and severe instability. Most patients complain of significant ankle pain but very little pain over the fracture. The clinical and radiographic examination is usually directed to the ankle region; and the proximal fibula is often ignored. The authors intend to show the ease of missing the proximal fibular fracture when the clinical examination is directed to the ankle region. They discuss the importance of palpating the proximal fibula and ordering appropriate radiographs. The authors report on 5 patients who presented to the Emergency Department, where the Maisonneuve fracture was missed despite having ankle radiographs taken. All patients required open reduction and internal fixation. The Maisonneuve fracture injury pattern causes untoward consequences if not promptly recognized and treated. To avoid misdiagnosis, the proximal fibula should be examined in all patients with ankle injury. Copyright © 2013 Elsevier Inc. All rights reserved.

  11. Virtually he@lthy: the impact of internet use on disease experience and the doctor-patient relationship.

    Science.gov (United States)

    Broom, Alex

    2005-03-01

    In the current study, the author explores the complex effects and contradictory roles of the Internet as a source of empowerment and control, and as a site of "risk management." Drawing on a study of the Internet usage of Australian men with prostate cancer, the author investigates how access to information and online support affects men's experiences of disease and, in particular, the possible implications of Internet-informed patients for the doctor-patient relationship. The data reveal that accessing information and/or support online can have a profound effect on men's experiences of prostate cancer, providing a method of taking some control over their disease and limiting inhibitions experienced in face-to-face encounters. However, it is also clear that some medical specialists view Internet-informed patients as a challenge to their power within medical encounters and, as a result, employ disciplinary strategies that reinforce traditional patient roles and alienate patients who use the Internet.

  12. Using a Treat-to-Target Management Strategy to Improve the Doctor-Patient Relationship in Inflammatory Bowel Disease.

    Science.gov (United States)

    Rubin, David T; Krugliak Cleveland, Noa

    2015-09-01

    The doctor-patient relationship (DPR) in inflammatory bowel disease (IBD) has been facing new challenges, in part due to the substantial progress in medical and surgical management and also due to the rapid expansion of patient access to medical information. Not surprisingly, the complexity of IBD care and heterogeneity of the disease types may lead to conflict between a physician's therapeutic recommendations and the patient's wishes. In this commentary, we propose that the so-called "treat-to-target" approach of objective targets of disease control and serial adjustments to therapies can also strengthen the DPR in IBD by enabling defined trials of alternative approaches, followed by a more objective assessment and reconsideration of treatments. We contend that such respect for patient autonomy and the use of objective markers of disease activity improves the DPR by fostering trust and both engaging and empowering patients and physicians with the information necessary to make shared decisions about therapies.

  13. Doctors as patients: postal survey examining consultants and general practitioners adherence to guidelines.

    Science.gov (United States)

    Forsythe, M; Calnan, M; Wall, B

    1999-09-04

    To examine the adherence by senior NHS medical staff to the BMA guidelines on the ethical responsibilities of doctors towards themselves and their families. Postal semistructured questionnaire. Four randomly selected NHS trusts and three local medical committees in South Thames region. Consultants and principals in general practice. Personal use of health services. The response rate was 64% (724) for general practitioners and 72% (427) for consultants after three mailings. Most (1106, 96%) respondents were registered with a general practitioner, although little use was made of their services. 159 (26%) general practitioners were registered with a general practitioner in their own practice and 80 (11%) admitted to looking after members of their family. 73 (24%) consultants would never see their general practitioner before obtaining consultant advice. Most consultants and general practitioners admitted to prescribing for themselves and their family. Responses to vignettes for different health problems indicated a general reluctance to take time off, but there were differences between consultants and general practitioners and by sex. Views on improvements needed included the possibility of a "doctor's doctor," access to out of area secondary care, an occupational health service for general practitioners, and regular health check ups. The guidelines are largely not being followed, perhaps because of the difficulties of obtaining access to general practitioners outside working hours. The occupational health service should be expanded and a general practitioner service for NHS staff piloted.

  14. Language spoken at home and the association between ethnicity and doctor-patient communication in primary care: analysis of survey data for South Asian and White British patients.

    Science.gov (United States)

    Brodie, Kara; Abel, Gary; Burt, Jenni

    2016-03-03

    To investigate if language spoken at home mediates the relationship between ethnicity and doctor-patient communication for South Asian and White British patients. We conducted secondary analysis of patient experience survey data collected from 5870 patients across 25 English general practices. Mixed effect linear regression estimated the difference in composite general practitioner-patient communication scores between White British and South Asian patients, controlling for practice, patient demographics and patient language. There was strong evidence of an association between doctor-patient communication scores and ethnicity. South Asian patients reported scores averaging 3.0 percentage points lower (scale of 0-100) than White British patients (95% CI -4.9 to -1.1, p=0.002). This difference reduced to 1.4 points (95% CI -3.1 to 0.4) after accounting for speaking a non-English language at home; respondents who spoke a non-English language at home reported lower scores than English-speakers (adjusted difference 3.3 points, 95% CI -6.4 to -0.2). South Asian patients rate communication lower than White British patients within the same practices and with similar demographics. Our analysis further shows that this disparity is largely mediated by language. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  15. Spin doctoring

    OpenAIRE

    Vozková, Markéta

    2011-01-01

    1 ABSTRACT The aim of this text is to provide an analysis of the phenomenon of spin doctoring in the Euro-Atlantic area. Spin doctors are educated people in the fields of semiotics, cultural studies, public relations, political communication and especially familiar with the infrastructure and the functioning of the media industry. Critical reflection of manipulative communication techniques puts spin phenomenon in historical perspective and traces its practical use in today's social communica...

  16. Missing Value Imputation Improves Mortality Risk Prediction Following Cardiac Surgery: An Investigation of an Australian Patient Cohort.

    Science.gov (United States)

    Karim, Md Nazmul; Reid, Christopher M; Tran, Lavinia; Cochrane, Andrew; Billah, Baki

    2017-03-01

    The aim of this study was to evaluate the impact of missing values on the prediction performance of the model predicting 30-day mortality following cardiac surgery as an example. Information from 83,309 eligible patients, who underwent cardiac surgery, recorded in the Australia and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) database registry between 2001 and 2014, was used. An existing 30-day mortality risk prediction model developed from ANZSCTS database was re-estimated using the complete cases (CC) analysis and using multiple imputation (MI) analysis. Agreement between the risks generated by the CC and MI analysis approaches was assessed by the Bland-Altman method. Performances of the two models were compared. One or more missing predictor variables were present in 15.8% of the patients in the dataset. The Bland-Altman plot demonstrated significant disagreement between the risk scores (prisk of mortality. Compared to CC analysis, MI analysis resulted in an average of 8.5% decrease in standard error, a measure of uncertainty. The MI model provided better prediction of mortality risk (observed: 2.69%; MI: 2.63% versus CC: 2.37%, Pvalues improved the 30-day mortality risk prediction following cardiac surgery. Copyright © 2016 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  17. Bilateral Intraosseous Migration of Mandibular Second Premolars in a Patient with Nine Missing Teeth

    Directory of Open Access Journals (Sweden)

    H. Shahoon

    2010-03-01

    Full Text Available Intraosseous migration is an unusual developmental dental anomaly, which demonstrates horizontal movement of unerupted teeth only affecting the permanent dentition of the lower jaw. Mandibular second premolar is the most common impacted tooth after the thirdmolars and maxillary canines. Distal migration of the second premolar is rare and early loss of the permanent first molar is one of the most important predisposing factors of intrabony migration of this tooth. Bilateral migration of the mandibular premolars is veryrare compared to unilateral migration. Hereby, we present an 18-year-old man with bilateral intrabony migration of the mandibular second premolars to the mandibular angle (at the inferior and buccal side of the mandibular canal in the presence of first molars. Thepatient also had nine congenitally missing teeth without any systemic complication or abnormality in the skeleton. The teeth were surgically extracted. The clinical and diagnostic features and treatment of this case are discussed.

  18. Focused sonography of the heart, lungs, and deep veins identifies missed life-threatening conditions in admitted patients with acute respiratory symptoms

    DEFF Research Database (Denmark)

    Laursen, Christian B; Sloth, Erik; Lambrechtsen, Jess

    2014-01-01

    Patients with acute respiratory symptoms still remain a diagnostic challenge. The aim of the study was to evaluate whether focused sonography could potentially diagnose life-threatening conditions missed at the primary assessment in a patient population consisting of admitted patients with acute ...

  19. Don't LOL at virtual visits. Technology is allowing more doctors and patients to consult via e-mail, and insurance companies are reimbursing for it.

    Science.gov (United States)

    Robeznieks, Andis

    2007-10-15

    In today's "I-gotta-know-now" society, many patients turn to e-mail to contact doctors on matters, as opposed to waiting for an in-person office visit. Now, some insurers are actually reimbursing doctors for their electronic time, which is also known as a "virtual visit." Internist Paul Tang, left, doesn't consider the practice mainstream yet. "No one is reimbursing us," he says.

  20. Doctor-patient relationship and quality of life in Irritable Bowel Syndrome: an exploratory study of the potential mediating role of illness perceptions and acceptance.

    Science.gov (United States)

    Hulme, Katrin; Chilcot, Joseph; Smith, Michael A

    2017-12-20

    Irritable Bowel Syndrome (IBS) is a functional gastrointestinal disorder characterised by unpredictable bowel symptoms. These can be difficult to manage, consequently impacting quality of life (QoL). In addition, a strained doctor-patient relationship is independently reported in the qualitative literature. Given the doctor is often the first port of call for people with IBS, a difficult relationship may influence subsequent IBS management. Research suggests illness perceptions are important in determining IBS outcomes in therapy; however, their association with doctor-patient relationship and QoL is yet to be investigated. This exploratory study aimed to investigate the association between these constructs in IBS, as well as potential mediation by illness perceptions. Online questionnaires measuring doctor-patient relationship, illness perceptions, acceptance and QoL, were completed by 167 participants who reported an IBS diagnosis (144 female, mean age = 44.22 years, SD = 15.91 years). Bootstrapped pathway analysis was used to model the relationship and mediation effects. There was a significant positive correlation between patient-doctor relationship and QoL, r = .258, n = 167, p = .001. There was a significant indirect effect between doctor-patient relationship and QoL through illness coherence and acceptance (bootstrapped estimate = .058, 95%CI Lower-Upper = .02, .095, p = .002). No other indirect effects were observed in combination with good fit indices for the other illness perceptions. Findings suggest a doctor-patient relationship which fosters mutual understanding and helps patients make sense of symptoms, increases their ability to manage their IBS in a psychologically flexible manner, subsequently helping them maintain their QoL.

  1. Who's the doctor? Patients' perceptions of the role of the breast radiologist: a lesson for all radiologists.

    Science.gov (United States)

    O'Mahony, N; McCarthy, E; McDermott, R; O'Keeffe, S

    2012-12-01

    The aim of this study was to explore patients' perceptions of the role of the radiologist in their care. The questionnaire used was designed in conjunction with a psychologist who had an interest in oncology, and piloted. The final questionnaires were distributed to patients attending the breast clinic at St James's Hospital, Dublin, Ireland, from 1 March to 1 July 2011. Patients requiring imaging (mammography and/or ultrasound) were asked to complete the same questionnaire again after imaging procedures were performed. Paired t-tests were used to assess for changes in parameters, including ranking of members of the breast care team in order of perceived importance and levels of anxiety pre and post consultation with the radiologist. 306 patients were recruited. 76% of patients thought that radiologists were radiographers and only 14% knew that radiologists were medical doctors. Nearly 40% of patients did not consider that radiologists had a role to play in their care. There was no statistically significant difference in the ranking of team members pre and post consultation. There was a significant improvement in patient anxiety levels after consultation with the breast radiologist, which is likely to be due to the patient learning the outcome of tests performed. There is a lack of awareness amongst patients and amongst our colleagues in paramedical disciplines regarding the roles and responsibilities of the modern radiologist. Radiology must act to increase public awareness so that future changes in the health service will reflect the scope and importance of the speciality.

  2. Awareness of doctors of health care and possible therapy methods for alcohol and drug dependant patients in Latvia

    Directory of Open Access Journals (Sweden)

    Dave V.

    2012-10-01

    Full Text Available Aim is to investigate the knowledge of Latvian doctors about addiction treatment and healthcare possibilities in Latvia, to compare which methods are the best known to physicians, and which are offered to addicted patients. Work material and methods. Questionnaire was developed by researchers themselves, it contains 14 questions (about demographical data, treatment methods and their application. 250 questionnaires were distributed, 158 (63, 2% were received. Results. Average age of participants – 43.7 years. 31,0% of respondents are psychiatrists, 13,3% – addiction specialists, 34,8% – other specialists (general practitioners, internists, health care doctors, neurologists and others, 12,0% – psychotherapists, 4,4% – surgeons, 1,9% – dentists and 1,9% – paediatricians. The best known were detoxification (98,2% and suggestion (892% methods. The least known methods for drug addicts were substitution therapy (73,4% and rehabilitation communities (73,4%. The most recommended treatment method was Minnesota programme – 108 (68,4% and detoxification 99 (62,7%, the least recommended – substitution therapy – 29 (18,5%. Conclusions. 17,1% of respondents do not meet patients with addiction problems, but 20,3% of respondents don’t recommend any of treatment methods. Although 73%-98% of respondents have information about treatment methods, only 18%-68% of respondents offer them.

  3. [Murder of the doctor].

    Science.gov (United States)

    Lorettu, Liliana; Falchi, Lorenzo; Nivoli, Fabrizia L; Milia, Paolo; Nivoli, Giancarlo; Nivoli, Alessandra M

    2015-01-01

    To examine possible risk factors for the doctor to be killed by the patient in the clinical practice by examining a series of murders that involved physicians. This aim has been achieved through a retrospective review on clinical cases of doctors killed by patients within the period between 1988 and 2013, in Italy. In this period 18 Italian doctors have been killed in the workplace, with a rate of 0.3/100,000. In 7 cases, the murder resulted in the context of doctor-dissatisfaction; in 7 cases the murder was committed by a psychiatric patient; 1 case in the context of a stalking; 3 cases occurred in a workplace which was not safe enough. Four categories of at-risk contexts have been identified. One category includes a murder in the context of a doctor-dissatisfaction, perceived by patient. The second category concerns murders committed by patients suffering from mental illness. A third category includes homicides in a workplace which is not safe. The last category comprises the murder in the context of stalking. These categories identify specific dangerous situations for physicians, in which are highlighted elements that have played a crucial role in the murder and for which special precautions are suggested preventive.

  4. The effectiveness of SMS Reminders and the impact of patient characteristics on missed appointments in a public dental outpatient clinic

    Directory of Open Access Journals (Sweden)

    Emilia Bellucci

    2017-03-01

    Full Text Available This paper reports on the Failure To Attend (FTA rate of appointments as well as patients following the implementation of SMS reminders in a public dental outpatient service.  Given the ineffectiveness of the intervention and a highly representative patient’s profile, this paper identifies the demographic characteristics of patients who miss all of their appointments.  Data on appointment attendance, patient demographics and dental service type was collected over a time period of 46 consecutive months.  Using descriptive and inferential statistics (chi-square, two sample tests and Marascuilo procedure we found the SMS intervention was ineffective in reducing the FTA rates. Further, patients associated with high rates of non-attendance exhibited one or more of the following characteristics: male; age 26 – 44; non-concession card holders; a person of Indigenous, local, Asian or African descent, and of refugee status, persons living in low socio-economic areas; and appointments in General Care and Student Clinics. Whilst the literature overwhelmingly attributes SMS reminders to improving the attendance rate of patients in outpatient clinics, our contradictory findings suggest a more targeted approach in settings whose patients exhibit strong characteristics associated with non-attendance.

  5. [Internet use by primary care and hospital doctors: perception of how it influences their relationships with patients].

    Science.gov (United States)

    Mira Solves, José Joaquín; Llinás Santacreu, Gilberto; Lorenzo Martínez, Susana; Aibar Remón, Carlos

    2009-06-01

    To compare Internet use among physicians working in primary health care and hospitals and their perception of the influence this has on patient-doctor relationships. Observational descriptive study based on survey. 7 public hospitals (H) and 8 primary health care centres (PH) from Alicante, Madrid, Saragossa and Huesca. 685 physicians. 49.3% PH, 55.9% male, mean age: 43.2 years. MAIN ITEMS: How and for what is the Internet used on duty, advantages and disadvantages of Internet for medical-patient relationships. Hospital MDs spend more time on the Internet (padvantage of education resources (pInternet leads to interaction with patients. Only 14% of the MDs had not received any questions regarding Internet information; 27.6% recommend websites to their patients; 30.8% considered that Internet use complicates medical-patient relationships. Its main advantage (42.2%) is support in getting to know the disease; 20.5% considers that it improves patient autonomy; 30.9% thinks that it undermines physician credibility. Hospital MDs use the Internet more intensively. Both groups have the same opinion on the advantages of the Web resources for medical-patient relationships.

  6. Will Medical Technology Deskill Doctors?

    Science.gov (United States)

    Lu, Jingyan

    2016-01-01

    This paper discusses the impact of medical technology on health care in light of the fact that doctors are becoming more reliant on technology for obtaining patient information, making diagnoses and in carrying out treatments. Evidence has shown that technology can negatively affect doctor-patient communications, physical examination skills, and…

  7. Outpatient-based pneumococcal vaccine campaign and survey of perceptions about pneumococcal vaccination in patients and doctors.

    Science.gov (United States)

    Song, Joon Young; Cheong, Hee Jin; Heo, Jung Yeon; Noh, Ji Yun; Seo, Yu Bin; Kim, In Seon; Choi, Won Suk; Kim, Woo Joo

    2013-03-01

    Despite the ready availability of pneumococcal vaccine, vaccination rates are quite low in South Korea. This study was designed to assess perceptions and awareness about pneumococcal vaccines among subjects at risk and find strategies to increases vaccine coverage rates. A cross sectional, community-based survey was conducted to assess perceptions about the pneumococcal vaccine at a local public health center. In a tertiary hospital, an outpatient- based pneumococcal vaccine campaign was carried out for the elderly and individuals with chronic co-morbidities from May to July of 2007. Based on the survey, only 7.6% were ever informed about pneumococcal vaccination. The coverage rates of the pneumococcal vaccine before and after the hospital campaign showed an increased annual rate from 3.39% to 5.91%. The most common reason for vaccination was "doctor's advice" (53.3%). As for the reasons for not receiving vaccination, about 75% of high risk patients were not aware of the pneumococcal vaccine, which was the most important barrier to vaccination. Negative clinician's attitude was the second most common cause of non-vaccination. Annual outpatient-based campaigns early in the influenza season may improve pneumococcal vaccine coverage rates. Doctor's advice was the most important encouraging factor for vaccination.

  8. The influence of medical students' and doctors' attachment style and emotional intelligence on their patient-provider communication.

    Science.gov (United States)

    Cherry, Mary Gemma; Fletcher, Ian; O'Sullivan, Helen

    2013-11-01

    Attachment style and emotional intelligence (EI) have been highlighted as potential factors influencing the variation in medical students' and doctors' patient-provider communication (PPC), particularly in relation to emotive issues. The objective of this review is to systematically review and synthesise the published literature relating to the influence of medical students' and/or doctors' attachment style and EI on their PPC. Electronic and hand searches were conducted to identify all published literature relating to the aim of the review. Data were narratively synthesised. 1597 studies were identified. 14 were included in the review, of which 5 assessed the influence of attachment style and 9 assessed the influence of EI on PPC. No studies assessed the impact of both attachment style and EI on PPC. Whilst tentative links were found between both PPC and both attachment style and EI, heterogeneity in study design, predictor variables and outcome measures made drawing conclusions difficult. More research is needed to assess the influence of both attachment style and EI on PPC. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  9. Surveying the attitudes of transsexual patients referring to Tehran Institute of Psychiatry toward doctors' empathy, Iran, 2011-2012.

    Science.gov (United States)

    Ahmadi Jazi, Ghazaleh; Eftekhar, Mehrdad; Mobasher, Pezhman; Saeedi Tehrani, Saeedeh; Ahmadi, Khosro; Rastgouy Fahim, Maria

    2015-01-01

    Physicians' knowledge of therapy and counseling stands among the most important issues in the viewpoints of clients who refer to psychiatric centers. Transsexual patients are very important in this regard. The goal of this research is to study their attitude toward doctors' empathy. A group of transsexual patients who referred to the Tehran Institute of Psychiatry, Iran, answered the Jefferson Scale of Empathy. The relationship of the patients' age, gender, education level, and lifestyle with their attitude was measured. This study was conducted on 40 patients, including 16 women (40%) and 24 men (60%). In terms of education, 8 patients had a degree below high school diploma (20%), 9 had high school diploma (22.5%), and 23 patients were university students or of higher education level (57.5%). Among these patients, 6 were unemployed (15%), 10 were students (25%), and the rest were employed. Moreover, 8 participants lived alone (20%), 5 lived with their friends (12.5%), and 27 lived with their family (67.5%). Gender had no influence on the average score of the questionnaires, yet level of education had some influence. Lifestyle also had a significant influence on the patients' attitude. On the other hand, patients whose problems began before the age of 12 had lower score than others. Experienced psychologists in referential centers can express greater levels of empathy to specific diseases and this trend is very effective on the patients' cooperation level. In order to create an effective relationship between physicians and patients, the efficiency of the health system and increasing satisfaction of specific patients should be considered.

  10. Impact of the Diabetes Inpatient Care and Education (DICE) project and the DICE Care Pathway on patient outcomes and trainee doctor's knowledge and confidence.

    Science.gov (United States)

    Rajendran, R; Kerry, C; Round, R-M; Barker, S; Scott, A; Rayman, G

    2015-07-01

    To evaluate the impact of the Diabetes Inpatient Care and Education project and a comprehensive diabetes care pathway, the Diabetes Inpatient Care and Education Care Pathway, on patient outcomes and on the knowledge and confidence of trainee doctors. The effect on patient outcomes was evaluated by comparing the National Diabetes Inpatient Audit data before (2012) and after (2013) implementing the Diabetes Inpatient Care and Education project. The impact on trainee doctors was evaluated using the Modified Kirkpatrick model. Just before the project began and again 3 months later, trainee doctors were surveyed to assess their knowledge and confidence in inpatient diabetes care. Patient harm was found to have been reduced significantly when National Diabetes Inpatient Audit data for 2012 and 2013 were compared. Severe hypoglycaemia decreased from 15.4 to 9.7%, medication errors from 56.9 to 21.1% and insulin errors from 31 to 7%. Across the 96 trainee doctors surveyed, the mean (sd) knowledge and confidence scores increased significantly (P Education project and the Diabetes Inpatient Care and Education Care Pathway improved patient outcomes and the knowledge and confidence of trainee doctors in this hospital. The impact of a similar project in other hospitals needs to be evaluated. © 2015 The Authors. Diabetic Medicine © 2015 Diabetes UK.

  11. Strategies to avoid a missed diagnosis of co-occurring concussion in post-acute patients having a spinal cord injury

    Directory of Open Access Journals (Sweden)

    David S Kushner

    2015-01-01

    Full Text Available Research scientists and clinicians should be aware that missed diagnoses of mild-moderate traumatic brain injuries in post-acute patients having spinal cord injuries may approach 60-74% with certain risk factors, potentially causing clinical consequences for patients, and confounding the results of clinical research studies. Factors leading to a missed diagnosis may include acute trauma-related life-threatening issues, sedation/intubation, subtle neuropathology on neuroimaging, failure to collect Glasgow Coma Scale scores or duration of posttraumatic amnesia, or lack of validity of this information, and overlap in neuro-cognitive symptoms with emotional responses to spinal cord injuries. Strategies for avoiding a missed diagnosis of mild-moderate traumatic brain injuries in patients having a spinal cord injuries are highlighted in this perspective.

  12. Inhaled medication for asthma management: evaluation of how asthma patients, medical students, and doctors use the different devices

    Directory of Open Access Journals (Sweden)

    Muniz Janaína Barbosa

    2003-01-01

    Full Text Available Asthma results from a combination of three essential features: airflow obstruction, hyperresponsiveness of airways to endogenous or exogenous stimuli and inflammation. Inadequacy of the techniques to use different inhalation devices is one of the causes of therapeutic failure. The main purpose of this study was to evaluate how 20 medical students, 36 resident physicians of Internal Medicine/Pediatrics, and 40 asthma patients used three devices for inhalation therapy containing placebo. All patients were followed at the Pulmonary Outpatient Service of Botucatu Medical School and had been using inhaled medication for at least six months. The following devices were evaluated: metered dose inhalers (MDI, dry powder inhalers (DPI, and MDI attached to a spacer device. A single observer applied a protocol containing the main steps necessary to obtain a good inhaler technique to follow and grade the use of different devices. Health care professionals tested all three devices and patients tested only the device being used on their management. MDI was the device best known by doctors and patients. MDI use was associated with errors related to the coordination between inspiration and device activation. Failure to exhale completely before inhalation of the powder was the most frequent error observed with DPI use. In summary, patients did not receive precise instruction on how to use inhaled medication and health care professionals were not well prepared to adequately teach their patients.

  13. Inadequate knowledge of immunization guidelines: a missed opportunity for preventing infection in immunocompromised IBD patients.

    Science.gov (United States)

    Yeung, James H; Goodman, Karen J; Fedorak, Richard N

    2012-01-01

    Immunosuppressive agents, used commonly to treat inflammatory bowel disease (IBD), are associated with an increased risk of infections, including those preventable by immunization. This study aimed to describe physician and patient values and knowledge regarding immunization and immunization histories. In all, 167 IBD patients and 43 gastroenterologists completed mail-out questionnaires. Patients were asked 15 questions about their immunization histories and attitudes towards immunization. Gastroenterologists were asked nine questions about immunization for the immunocompromised host. The questionnaire return rate was 45.7% (43/94) for gastroenterologists and 25.2% (167/661) for patients. Only 14.3% (6/42) of gastroenterologists reported taking an immunization history from most or all of their patients. Only 5.4% (9/167) of patients recalled being asked by their gastroenterologist whether their immunizations were up to date, and just 0.6% (1/164) recalled being asked for a detailed immunization history. Overall, 21.7% (35/161) of patients had refused to be immunized in the past; 18.6% (8/43) of gastroenterologists did not know if up-to-date immunizations were important prior to starting immunosuppressive therapy. Of note, 23.1% (9/39) of gastroenterologists and 46.7% (35/161) of patients did not know whether live vaccines should be avoided by those in the immunosuppressed state, and 42.9% (18/43) of gastroenterologists acknowledged they did not know which specific immunizations should be avoided for immunosuppressed patients. Gastroenterologists have limited knowledge of their IBD patients' immunization status and rarely take an adequate immunization history. Substantial proportions of IBD patients and gastroenterologists lack adequate knowledge of established immunization guidelines prior to initiation of immunosuppressive therapy. Copyright © 2011 Crohn's & Crohn's & Colitis Foundation of America, Inc.

  14. Illness cognitions, doctor-patient communication and prescription adherence among first diagnosed hypertensive patients from a rural teaching hospital in South Africa

    Directory of Open Access Journals (Sweden)

    K Peltzer

    2003-11-01

    Full Text Available This study examines the relationship between illness cognitions, doctor-patient communication and the use of prescribed medication among patients first diagnosed with hypertension in the outpatient department of a rural South African teaching hospital. Opsomming Hierdie studie ondersoek die verwantskap tussen siekte-kognisies, dokter-pasiënt kommunikasie en die gebruik van voorskrifmedisyne onder pasiënte wat die eerste keer met hipertensie gediagnoseer is, in die buitepasiëntafdeling van ‘n landelike Suid-Afrikaanse opleidingshospitaal. *Please note: This is a reduced version of the abstract. Please refer to PDF for full text.

  15. Doctor Down

    Directory of Open Access Journals (Sweden)

    N.V. Nagornaya

    2013-09-01

    Full Text Available The article presents the biographical data of John Langdon Down, his invaluable contribution to the development of rehabilitation programs for children with Down syndrome. The basis of these programs was the socialization of people with intellectual disabilities. In doctor Down’s rehabilitation center there were used methods, including health care, education, physical education, the formation of correct behavior.

  16. The Missing Link between Faces and Names: Evidence from Alzheimer's Disease Patients

    Science.gov (United States)

    Calabria, Marco; Sabio, Alicia; Martin, Clara; Hernandez, Mireia; Juncadella, Montserrat; Gascon-Bayarri, Jordi; Rene, Ramon; Ortiz-Gil, Jordi; Ugas, Lidia; Costa, Albert

    2012-01-01

    Retrieval of proper names is a cause of concern and complaint among elderly adults and it is an early symptom of patients suffering from neurodegenerative diseases such as Alzheimer's disease (AD). While it is well established that AD patients have deficits of proper name retrieval, the nature of such impairment is not yet fully understood.…

  17. Missing the boat: odds for the patients who leave ED without being seen

    Directory of Open Access Journals (Sweden)

    Fayyaz Jabeen

    2013-01-01

    Full Text Available Abstract Background A patient left without being seen is a well-recognized indicator of Emergency Department overcrowding. The aim of this study was to define the characteristics of LWBS patients, their rates and associated factors from a tertiary care hospital of Pakistan. Methods A retrospective patient record review was undertaken. All patients presenting to the Aga Khan University Hospital, Karachi, between April and December of the year 2010, were included in the study. Information was collected on age, sex, presenting complaints, ED capacity, month, time, shift, day of the week, and waiting times in the ED. A basic descriptive analysis was made and the rates of LWBS patients were determined among the patient subgroups. Logistic regression analysis was used to assess the risk factors associated with a patient not being seen in the ED. Results A total of 38,762 patients visited ED during the study period. Among them 5,086 (13% patients left without being seen. Percentage of leaving was highest in the night shift (20%. The percentage was twice as high when the ED was on diversion (19.8% compared to regular periods of operation (9.8%. Mean waiting time before leaving the ED in pediatric patients was 154 minutes while for adults it was 171 minutes. More than 32% of patients had waited for more than 180 minutes before they left without being seen, compared to the patients who were seen in ED. Important predictors for LWBS included; Triage category P4 i.e. walk –in-patients had an OR of 13.62(8.72-21.3, Diversion status, OR 1.49(1.26-1.76, night shift , OR 2.44(1.95-3.05 and Pediatric age, OR 0.57(0.48-0.66. Conclusions Our study elucidates the LWBS population characteristics and identifies the risk factors for this phenomenon. Targeted interventions should be planned and implemented to decrease the waiting time and alternate services should be provided for high-risk patients (for LWBS to minimize their number.

  18. Patients with ulcerative colitis miss more days of work than the general population, even following colectomy.

    Science.gov (United States)

    Neovius, Martin; Arkema, Elizabeth V; Blomqvist, Paul; Ekbom, Anders; Smedby, Karin E

    2013-03-01

    It is unclear whether colectomy restores the ability of patients with ulcerative colitis (UC) to work to precolectomy levels. We estimated the burden of sick leave and disability pension in a population-based cohort of patients with UC and the effects of colectomy. We performed a register-based cohort study using the Swedish National Patient Register and identified working-age patients with UC in 2005 (n = 19,714) and patients who underwent colectomies between 1998 and 2002 (n = 807). Sick leave and disability pension data were retrieved from Statistics Sweden (1995-2005). Data from each patient in the study were compared with those from 5 age-, sex-, education-, and county-matched individuals from the general population. In 2005, 15% of patients with prevalent UC received a disability pension, compared with 11% of the general population, and 21% vs 13% had ≥1 sick leave episode (P work days lost was 0 in both groups, but patients with UC had higher mean (65 vs 45 days; difference, 20; 95% confidence interval [CI], 18-22 days) and 75th percentile work days lost (37 vs 0 days; difference, 37; 95% CI, 36-38 days). Among patients who underwent colectomies, annual days lost increased from a mean of 40 (median, 0) days 3 years before surgery to 141 (median, 99) days during the year of surgery (P work at all compared with 7.2% of the general population (risk difference, 5.2%; 95% CI, 2.7%-7.7%) and compared with 5.9% 3 years before colectomy (P work days than the general population in Sweden. Although most patients had no registered work loss 3 years after colectomy, work loss was not restored to presurgery or general population levels in the group that underwent colectomy during several years of follow-up. Copyright © 2013 AGA Institute. Published by Elsevier Inc. All rights reserved.

  19. Gingival Recession in a Child-Patient; Easily Missed Etiologies: Case Report with Video

    Science.gov (United States)

    Nwhator, SO

    2014-01-01

    Gingival recession is commonly associated with plaque-induced inflammation and calculus. A high frenal attachment is more important in gingival recession in the child-patient. A healthy child-patient with impeccable oral hygiene presented with localized gingival recession without plaque-induced inflammation which led to the exploration of other possible etiologies. Multiple factors appeared to be acting in consonance (Concomitant multiple etiologies [CME]). The factors were a high frenal attachment, traumatic overbite and bruxism induced by premature tooth contacts. Pedodontists and periodontists should rule out CME in cases of gingival recession in the child-patient. PMID:25031899

  20. Awareness, attitudes, need and demand on replacement of missing teeth among a group of partially dentate patients attending a University Dental Hospital.

    Science.gov (United States)

    Jayasinghe, Rasika Manori; Perera, Janana; Jayasinghe, Vajira; Thilakumara, Indika P; Rasnayaka, Sumudu; Shiraz, Muhammad Hanafi Muhammad; Ranabahu, Indra; Kularatna, Sanjeewa

    2017-07-27

    Our objective was to assess awareness, attitudes, need and demand on replacement of missing teeth according to edentulous space, age, gender, ethnicity, educational level and socio-economical status of the patient. 76.2% of the study group was opined that the missing teeth should be replaced by prosthetic means. Majority were keen in getting them replaced mainly for the comfort in mastication. Although 77.9 and 32.9% were aware of the removable prostheses and implants respectively, only 25.2% knew about tooth supported bridges as an option of replacement of missing teeth. Participants' awareness on tooth and implant supported prostheses is at a higher level. Participants' opinion on need of regular dental visit was statistically significant when gender, ethnicity and education level were considered. The highest demand for replacement of missing teeth was observed in Kennedy class I and II situations in both upper and lower arches. Demand for fixed prostheses was significantly highest in Kennedy class II in upper and lower arches. In conclusion, although removable prosthodontic options are known to most of the patients, their awareness on tooth and implant supported prostheses is also at a higher level. The highest demand for replacement of missing teeth is by patients with Kennedy class I and II situations whereas Kennedy class II being the category with highest demand for fixed prostheses. We recommend that the location of missing teeth to be considered as a priority when educating patients on the most appropriate prosthetic treatment options. Dentists' involvement in educating patients on prosthetic options needs to be improved.

  1. Near miss sudden cardiac death on a young patient with repaired atrioventricular septal defect.

    Science.gov (United States)

    Papadopoulou, Sofia A; Dimopoulos, Konstantinos; Gatzoulis, Michael A

    2008-11-28

    Patients with congenital heart disease often face the prospect of long-term haemodynamic or arrhythmic complications for which lifelong follow-up in specialist adult congenital heart disease (ACHD) centres is required. We describe the case of a 25-year-old man with repaired atrioventricular septal defect who was referred to our centre after a ventricular fibrillation arrest. Serial echocardiograms in previous years had shown progressive severe left ventricular outflow obstruction, but the patient had not been operated on as he was deemed asymptomatic and reluctant to consider surgery. Management and criteria for further intervention in ACHD patients often differ from those of patients with acquired heart disease and reliance on symptoms alone is not good practice and may prove catastrophic.

  2. 'That's the doctor's job': Overcoming patient reluctance to be involved in medical decision making.

    Science.gov (United States)

    Blumenthal-Barby, J S

    2017-01-01

    To review the barriers to patient engagement and techniques to increase patients' engagement in their medical decision-making and care. Barriers exist to patient involvement in their decision-making and care. Individual barriers include education, language, and culture/attitudes (e.g., deference to physicians). Contextual barriers include time (lack of) and timing (e.g., lag between test results being available and patient encounter). Clinicians should gauge patients' interest in being involved and their level of current knowledge about their condition and options. Framing information in multiple ways and modalities can enhance understanding, which can empower patients to become more engaged. Tools such as decision aids or audio recording of conversations can help patients remember important information, a requirement for meaningful engagement. Clinicians and researchers should work to create social norms and prompts around patients asking questions and expressing their values. Telehealth and electronic platforms are promising modalities for allowing patients to ask questions on in a non-intimidating atmosphere. Researchers and clinicians should be motivated to find ways to engage patients on the ethical imperative that many patients prefer to be more engaged in some way, shape, or form; patients have better experiences when they are engaged, and engagement improves health outcomes. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  3. Perspectives of Patients, Doctors and Medical Students at a Public University Hospital in Rio de Janeiro Regarding Tuberculosis and Therapeutic Adherence.

    Science.gov (United States)

    de Andrade, Elizabeth da Trindade; Hennington, Élida Azevedo; Siqueira, Hélio Ribeiro de; Rolla, Valeria Cavalcanti; Mannarino, Celina

    2015-01-01

    The World Health Organization (WHO) identifies 8.7 million new cases of tuberculosis (TB) annually around the world. The unfavorable outcomes of TB treatment prevent the achievement of the WHO's cure target. To evaluate existing intersections in the conceptions relative to the knowledge of TB, the experience of the illness and the treatment. Doctors, medical students and patients were selected from a public university in Rio de Janeiro, Brazil, from 2011 to 2013. The data were obtained by semi-structured individual and focus group interviews, participant observation and a field journal. The inclusion of patients was interrupted due to saturation, and the inclusion of doctors and medical students stopped due to exhaustion. The theoretical background included symbolic Interactionism, and the analysis used rounded Theory. The analysis prioritized the actions/interactions axis. Twenty-three patients with pulmonary TB, seven doctors and 15 medical students were included. In the interviews, themes such as stigma, self-segregation, and difficulties in assistance emerged, in addition to defense mechanisms such as denial, rationalization, isolation and other mental mechanisms, including guilt, accountability and concealment of the disease. Aspects related to the assistance strategy, the social support network, bonding with the healthcare staff and the doctor-patient relationship were highlighted as adherence enablers. Doctors and students recommended an expansion of the theoretical and practical instruction on TB during medical students' education. The existence of health programs and policies was mentioned as a potential enabler of adherence. The main concepts identified were the stigma, self-segregation, guilt, responsibility, concealment and emotional repercussions. In relation to the facilitation of therapeutic adherence, the concepts identified were the bonds with healthcare staff, the doctor-patient relationship, assistance and educational health strategies.

  4. Perspectives of Patients, Doctors and Medical Students at a Public University Hospital in Rio de Janeiro Regarding Tuberculosis and Therapeutic Adherence

    Science.gov (United States)

    de Andrade, Elizabeth da Trindade; Hennington, Élida Azevedo; de Siqueira, Hélio Ribeiro; Rolla, Valeria Cavalcanti; Mannarino, Celina

    2015-01-01

    Introduction The World Health Organization (WHO) identifies 8.7 million new cases of tuberculosis (TB) annually around the world. The unfavorable outcomes of TB treatment prevent the achievement of the WHO’s cure target. Goal To evaluate existing intersections in the conceptions relative to the knowledge of TB, the experience of the illness and the treatment. Methods Doctors, medical students and patients were selected from a public university in Rio de Janeiro, Brazil, from 2011 to 2013. The data were obtained by semi-structured individual and focus group interviews, participant observation and a field journal. The inclusion of patients was interrupted due to saturation, and the inclusion of doctors and medical students stopped due to exhaustion. The theoretical background included symbolic Interactionism, and the analysis used rounded Theory. The analysis prioritized the actions/interactions axis. Results Twenty-three patients with pulmonary TB, seven doctors and 15 medical students were included. In the interviews, themes such as stigma, self-segregation, and difficulties in assistance emerged, in addition to defense mechanisms such as denial, rationalization, isolation and other mental mechanisms, including guilt, accountability and concealment of the disease. Aspects related to the assistance strategy, the social support network, bonding with the healthcare staff and the doctor-patient relationship were highlighted as adherence enablers. Doctors and students recommended an expansion of the theoretical and practical instruction on TB during medical students’ education. The existence of health programs and policies was mentioned as a potential enabler of adherence. Conclusion The main concepts identified were the stigma, self-segregation, guilt, responsibility, concealment and emotional repercussions. In relation to the facilitation of therapeutic adherence, the concepts identified were the bonds with healthcare staff, the doctor-patient relationship

  5. Questions to Ask Your Doctor

    Science.gov (United States)

    ... Rockville, MD. http://www.ahrq.gov/patients-consumers/patient-involvement/ask-your-doctor/index.html Back to top Accessibility Disclaimers EEO Electronic Policies FOIA HHS Digital Strategy HHS Nondiscrimination Notice ...

  6. Personal and professional challenges in the management of deliberate self-poisoning patients in rural Sri Lanka: a qualitative study of rural hospital doctors' experiences and perceptions

    Directory of Open Access Journals (Sweden)

    Buckley Nick A

    2008-10-01

    Full Text Available Abstract Background Deliberate self-poisoning is a major public heath issue in developing countries. In rural Sri Lanka deliberate self-poisoning is one of the leading causes of hospital death. The majority of patients with poisoning present to rural hospitals for initial treatment that are staffed by non-specialist and often relatively junior doctors. The treatment of self-poisoning patients poses numerous clinical challenges and further difficulties are experienced if patients are uncooperative and aggressive, intoxicated with alcohol or suffering mental illness. Previous research in developed countries has examined self-poisoning patients and their treatment but little is know about self-poisoning patient care in the context of rural health provision in developing countries. This study provides the first focused exploration of the experiences and perceptions of primary care rural hospital doctors in Sri Lanka toward the treatment of self-poisoning patients. Methods Semi-structured in-depth interviews were conducted with fifteen doctors from rural hospitals in the North Central Province, Sri Lanka. All interviews were recorded and transcribed and subject to thematic analysis. Results Participating doctors did perceive that treating self-poisoning patients in a primary care rural hospital as potentially confidence-building. However, resource issues such as the lack of medication, equipment and staffing were seen as important challenges to treating self-poisoning patients. Other challenges identified included disparity with community and other staff members regarding expectations of care, a sense of professional isolation and a lack of continuing education programs. Conclusion Addressing professional isolation through educational and trainee programs for doctors and reducing the variance in expectations between professional groups and the community has the potential to improve delivery of care for self-poisoning patients.

  7. [Successful patient-activated help call for a doctor during in-hospital stay].

    Science.gov (United States)

    Hansen, Mette Mejlby; Hasselkvist, Birgith; Thordal, Sofie; Riiskjær, Erik; Kelsen, Jens

    2014-09-29

    Department of Medicine, Randers Regional Hospital, conducted a study of patient-activated help call, involving 1,050 patients with nearly 3,700 days in-hospital stay. Patients were encou-raged to bypass traditional clinical hierarchy of communication when they felt, that their concern was not met by the staff. Three help calls were related to the management of pain. In two cases it resulted in a surgical procedure. A survey including 104 patients revealed that one third reported that patient safety was improved by the initiative and nearly three quarters re-ported that they would be willing to activate the call.

  8. Is prolactin the missing link in adipose tissue dysfunction of polycystic ovary syndrome patients?

    Science.gov (United States)

    Albu, Alice; Florea, Suzana; Fica, Simona

    2016-01-01

    The aims of the study were to evaluate whether adiposity was among the determinants of circulating prolactin levels and to determine whether serum prolactin independently predicted metabolic abnormalities in patients with polycystic ovary syndrome (PCOS). A total of 322 PCOS patients with normal serum prolactin levels were recruited between January 2007 and January 2014. Anthropometric, metabolic, and hormonal parameters were measured in all of the patients. HOMA-IR was calculated as an index of insulin resistance. Serum prolactin was negatively correlated with age (p prolactin after adjustment for age, leptin, and anthropometrical adiposity parameters. Of the adiposity parameters, only WHR and VAI were independent predictors of serum prolactin after adjustment for adiponectin. Circulating prolactin was also negatively correlated with fasting glycemia (only in patients with normal glucose metabolism, p = 0.037) and was inversely correlated with the presence of metabolic syndrome (p prolactin level was related to adipose tissue quantity and function, and adiponectin was a possible mediator of this relationship. Low serum prolactin levels were associated with an unfavorable metabolic profile, but this association seemed to be due to the complex interplay among prolactin, adiposity, and insulin resistance rather than to a direct metabolic effect of prolactin.

  9. Should sputum-negative presumptive TB patients be actively followed to identify missing cases in India?

    Science.gov (United States)

    Waikar, S; Pathak, A; Ghule, V; Kapoor, A; Sagili, K; Babu, E R; Chadha, S

    2017-12-21

    Setting: Sputum smear microscopy, the primary diagnostic tool used for diagnosis of tuberculosis (TB) in India's Revised National TB Control Programme (RNTCP), has low sensitivity, resulting in a significant number of TB cases reported as sputum-negative. As the revised guidelines pose challenges in implementation, sputum-negative presumptive TB (SNPT) patients are subjected to 2 weeks of antibiotics, followed by chest X-ray (CXR), resulting in significant loss to care among these cases. Objective: To determine whether reducing delays in CXR would yield additional TB cases and reduce initial loss to follow-up for diagnosis among SNPT cases. Methods: In an ongoing intervention in five districts of Maharashtra, SNPT patients were offered upfront CXR. Results: Of 119 male and 116 female SNPT patients with a mean age of 45 years who were tested by CXR, 32 (14%) were reported with CXR suggestive of TB. Administering upfront CXR in SNPT patients yielded twice as many additional cases, doubling the proportion of cases detected among all those tested as against administering CXR 2 weeks after smear examination. Conclusion: Our interventional study showed that the yield of TB cases was significantly greater when upfront CXR examination was undertaken without waiting for a 2-week antibiotic trial.

  10. Missing link in community psychiatry: When a patient with schizophrenia was expelled from her home

    Directory of Open Access Journals (Sweden)

    I-Ming Chen

    2015-06-01

    Full Text Available Treatment and disposition of homeless patients with schizophrenia represent a great challenge in clinical practice. We report a case of this special population, and discuss the development of homelessness, the difficulty in disposition, their utilization of health services, and possible applications of mandatory community treatment in this group of patients. A 51-year-old homeless female was brought to an emergency department for left femur fracture caused by an assault. She was diagnosed with schizophrenia about 20 years ago but received little help from mental health services over the decades. During hospitalization, her psychotic symptoms were only partially responsive to treatment. Her family refused to handle caretaking duties. The social welfare system was mobilized for long-term disposition. Homeless patients with schizophrenia are characterized by family disruption, poor adherence to health care, and multiple emergency visits and hospitalization. We hope this article can provide information about the current mental health policy to medical personnel. It is possible that earlier intervention and better outcome can be achieved by utilizing mandatory community treatment in the future, as well as preventing patients with schizophrenia from losing shelters.

  11. Physicians' communication styles as correlates of elderly cancer patients' satisfaction with their doctors.

    Science.gov (United States)

    Finkelstein, A; Carmel, S; Bachner, Y G

    2017-01-01

    Physician-patient communication style is of utmost importance to patients with life-threatening diseases. This study identifies the most desired physician communication style by older cancer patients; and examines which of the studied communication styles significantly explains cancer patients' satisfaction with family physicians. A total of 200 older cancer patients, with average age of 75 years, participated in the study, yielding a response rate of 42%. Prospective respondents were randomly selected from the list of cancer patients in the central geographical district of Israel's second largest Health Maintenance Organization fund. Respondents rated their satisfaction with physicians as relatively high. All three communication styles studied were found to be associated with patient's satisfaction. Associations were found between self-rated health, time since the diagnosis of cancer and satisfaction. Women were less satisfied than men with their physicians. Two variables emerged as significant predictors of satisfaction: the physician's caring communication style and patient's gender. Intervention programmes should focus on elevating physicians' awareness of the importance of their communication with cancer patients in general, and of the caring communication style in particular. © 2015 John Wiley & Sons Ltd.

  12. Doctoral Education

    DEFF Research Database (Denmark)

    Ridder, Hanne Mette Ochsner

    2015-01-01

    Doctoral education covers the “third cycle” of degrees following the bachelor’s and the master’s degree. The education of researchers is necessary for developing music therapy as a scientific discipline and calls for a certain research culture that not only brings knowledge on research, but invol......, multicultural identity and the ongoing and emerging needs of a discipline. The book is an unparalleled resource for academic advisors, prospective and current educators, clinical supervisors, clinicians and students of music therapy.......Doctoral education covers the “third cycle” of degrees following the bachelor’s and the master’s degree. The education of researchers is necessary for developing music therapy as a scientific discipline and calls for a certain research culture that not only brings knowledge on research...... with an integration of science and practice. This leads to a description of the principles of problem-based learning as a social constructive approach, problematization, self-directed learning and learning community. The chapter is concluded with an example of a model of doctoral education, the Aalborg model, where...

  13. Near-misses are an opportunity to improve patient safety: adapting strategies of high reliability organizations to healthcare.

    Science.gov (United States)

    Van Spall, Harriette; Kassam, Alisha; Tollefson, Travis T

    2015-08-01

    Near-miss investigations in high reliability organizations (HROs) aim to mitigate risk and improve system safety. Healthcare settings have a higher rate of near-misses and subsequent adverse events than most high-risk industries, but near-misses are not systematically reported or analyzed. In this review, we will describe the strategies for near-miss analysis that have facilitated a culture of safety and continuous quality improvement in HROs. Near-miss analysis is routine and systematic in HROs such as aviation. Strategies implemented in aviation include the Commercial Aviation Safety Team, which undertakes systematic analyses of near-misses, so that findings can be incorporated into Standard Operating Procedures (SOPs). Other strategies resulting from incident analyses include Crew Resource Management (CRM) for enhanced communication, situational awareness training, adoption of checklists during operations, and built-in redundancy within systems. Health care organizations should consider near-misses as opportunities for quality improvement. The systematic reporting and analysis of near-misses, commonplace in HROs, can be adapted to health care settings to prevent adverse events and improve clinical outcomes.

  14. Providing protection for doctors.

    Science.gov (United States)

    Hegan, T

    2003-03-01

    Over the last decade the number of negligence cases brought against doctors, dentists and other healthcare professional has increased significantly in many countries around the world. In addition, the proliferation of the pathways of accountability in many countries means that doctors are feeling undervalued and vulnerable and are therefore seeking assistance and protection more than ever. The effect of a claim or complaint on a doctor can be devastating both personally and professionally. The relationship with the patient is damaged and an increase in defensive practice ultimately causes an increase in healthcare costs. Patient expectations have increased. Patients are more knowledgeable than they were five years ago and the demands on the professions are increasing daily. Unfortunately because of the long delays that are seen between an incident and a claim it is very difficult to predict what reserves are required in the future. We have seen a number of organisations pull out of the business over the last year and it highlights the importance of having an understanding of the needs of the professions and the ability to track trends in litigation in order to set appropriate subscription rates. Doctors and other healthcare professionals require more than just financial protection. They need support from their colleagues and assistance from experienced lawyers in order to help restore their confidence and ensure that they can continue to practice for the benefit of their patients in the future.

  15. What is effective doctor-patient communication? Review of the evidence.

    NARCIS (Netherlands)

    Makoul, G.; Dulmen, S. van

    2016-01-01

    Over the past 50 years, a confluence of research evidence and teaching practice has positioned effective communication as the linchpin of doctor–patient relationships, highlighting the impact on patient outcomes such as information recall, adherence to treatment plans and likelihood to sue for

  16. Current evidence on physical therapy in patients with adhesive capsulitis: what are we missing?

    Science.gov (United States)

    Struyf, Filip; Meeus, Mira

    2014-05-01

    Adhesive capsulitis is, in most cases, a self-limiting condition of poorly understood etiology that results in shoulder pain and large mobility deficits. The socio-economic burden will increase as with continuous aging of our population. In addition, both prevalence and incidence figures of adhesive capsulitis are increasing. No literature overview solely focuses on the physiotherapeutic options in patients with adhesive capsulitis and their scientific evidence. Moreover, although some physiotherapeutic interventions show evidence regarding reducing pain or increasing mobility, there is little evidence to suggest that the disease prognosis is affected and this raises the need for new, innovative research in the area of adhesive capsulitis and its treatment. By presenting its current evidence, we hope to retrieve several gaps in the present management of adhesive capsulitis by physiotherapists and provide us with new insights for improving the physiotherapists' policy in treating adhesive capsulitis patients, e.g., continuously increasing nociceptive impulse activity, as in early stages of adhesive capsulitis, could lead to peripheral and subsequently long-lasting central sensitization, as well as to an increased activity of the sympathetic nervous system. But up to now the involvement of central sensitization in adhesive capsulitis has not been studied yet and remains speculative. Finally, when selecting a physical treatment method for adhesive capsulitis, it is extremely important to consider the patient's symptoms, stage of the condition, and recognition of different patterns of motion loss. Guidelines for clinical assessment will be presented in this scoping review.

  17. Patch testing with a new fragrance mix detects additional patients sensitive to perfumes and missed by the current fragrance mix.

    Science.gov (United States)

    Frosch, Peter J; Pirker, Claudia; Rastogi, Suresh C; Andersen, Klaus E; Bruze, Magnus; Svedman, Cecilia; Goossens, An; White, Ian R; Uter, Wolfgang; Arnau, Elena Giménez; Lepoittevin, Jean-Pierre; Menné, Torkil; Johansen, Jeanne Duus

    2005-04-01

    The currently used 8% fragrance mix (FM I) does not identify all patients with a positive history of adverse reactions to fragrances. A new FM II with 6 frequently used chemicals was evaluated in 1701 consecutive patients patch tested in 6 dermatological centres in Europe. FM II was tested in 3 concentrations - 28% FM II contained 5% hydroxyisohexyl 3-cyclohexene carboxaldehyde (Lyral), 2% citral, 5% farnesol, 5% coumarin, 1% citronellol and 10%alpha-hexyl-cinnamic aldehyde; in 14% FM II, the single constituents' concentration was lowered to 50% and in 2.8% FM II to 10%. Each patient was classified regarding a history of adverse reactions to fragrances: certain, probable, questionable, none. Positive reactions to FM I occurred in 6.5% of the patients. Positive reactions to FM II were dose-dependent and increased from 1.3% (2.8% FM II), through 2.9% (14% FM II) to 4.1% (28% FM II). Reactions classified as doubtful or irritant varied considerably between the 6 centres, with a mean value of 7.2% for FM I and means ranging from 1.8% to 10.6% for FM II. 8.7% of the tested patients had a certain fragrance history. Of these, 25.2% were positive to FM I; reactivity to FM II was again dose-dependent and ranged from 8.1% to 17.6% in this subgroup. Comparing 2 groups of history - certain and none - values for sensitivity and specificity were calculated: sensitivity: FM I, 25.2%; 2.8% FM II, 8.1%; 14% FM II, 13.5%; 28% FM II, 17.6%; specificity: FM I, 96.5%; 2.8% FM II, 99.5%; 14% FM II, 98.8%; 28% FM II, 98.1%. 31/70 patients (44.3%) positive to 28% FM II were negative to FM I, with 14% FM II this proportion being 16/50 (32%). In the group of patients with a certain history, a total of 7 patients were found reacting to FM II only. Conversely, in the group of patients without any fragrance history, there were significantly more positive reactions to FM I than to any concentration of FM II. In conclusion, the new FM II detects additional patients sensitive to fragrances missed

  18. Efficacy of muscle exercise in patients with muscular dystrophy: a systematic review showing a missed opportunity to improve outcomes.

    Directory of Open Access Journals (Sweden)

    Silvia Gianola

    Full Text Available BACKGROUND: Although muscular dystrophy causes muscle weakness and muscle loss, the role of exercise in the management of this disease remains controversial. OBJECTIVE: The purpose of this systematic review is to evaluate the role of exercise interventions on muscle strength in patients with muscular dystrophy. METHODS: We performed systematic electronic searches in Medline, Embase, Web of Science, Scopus and Pedro as well as a list of reference literature. We included trials assessing muscle exercise in patients with muscular dystrophy. Two reviewers independently abstracted data and appraised risk of bias. RESULTS: We identified five small (two controlled and three randomized clinical trials comprising 242 patients and two ongoing randomized controlled trials. We were able to perform two meta-analyses. We found an absence of evidence for a difference in muscle strength (MD 4.18, 95% CIs - 2.03 to 10.39; p = 0.91 and in endurance (MD -0.53, 95% CIs -1.11 to 0.05; p = 0.26. In both, the direction of effects favored muscle exercise. CONCLUSIONS: The first included trial about the efficacy of muscular exercise was published in 1978. Even though some benefits of muscle exercise were consistently reported across studies, the benefits might be due to the small size of studies and other biases. Detrimental effects are still possible. After several decades of research, doctors cannot give advice and patients are, thus, denied basic information. A multi-center randomized trial investigating the strength of muscles, fatigue, and functional limitations is needed.

  19. Agency doctorates

    International Nuclear Information System (INIS)

    1970-01-01

    Staff members of the Agency working at the Seibersdorf laboratory are continuing to achieve high academic distinction. Two more - both Austrian - have now been awarded the degree of Doctor of Agriculture. Joachim Kramer, who is 26, graduated from the Hochschule fur Bodenkultur in 1967 with the degree of Diplom-Ingenieur and then started work in the plant breeding and genetics section of the laboratory under the direction of Dr. Knut Mikaelsen. The results of the research work he carried out were accepted as the subject of a thesis for which he has now been granted his doctorate. The doctoral promotion took place on 30 June, at a ceremony attended by Dr. Andre Finkelstein, Deputy Director General for Research and Isotopes. The subject of Dr. Kramer's thesis was a comprehensive study of the mutagenic effects of fast neutrons and gamma rays, and the influence of various modifying factors such as water content, oxygen and metabolic state of seeds at the time of irradiation. This work has contributed significantly to the understanding of the mechanisms by which these two types of ionizing radiation produce mutations in seeds. The knowledge gained will be of great importance in the efficient use of ionizing radiation in practical plant breeding. Paul Wassermann, who is 33 years old, joined the Agency in 1965. He, too, graduated from the Hochschule fur Bodenkultur as Diplom-Ingenieur in agriculture, having graduated with honours previously from the agricultural secondary school at Raumberg, Austria, in 1958. Dr. Wassermann's own words may be used to explain how he came to gain his doctorate. 'In October, 1966, I completed my studies at the Hochschule,' he writes. 'I was employed at the Agency laboratories in Seibersdorf, working in the plant and soils group. Encouraged by the interesting research which was performed there, a thesis entitled 'the Fate of Nitrogen in Submerged Rice Soils' was started, which finally led to the doctor's degree in Agriculture in June this year

  20. Patient-specific reconstruction plates are the missing link in computer-assisted mandibular reconstruction: A showcase for technical description.

    Science.gov (United States)

    Cornelius, Carl-Peter; Smolka, Wenko; Giessler, Goetz A; Wilde, Frank; Probst, Florian A

    2015-06-01

    Preoperative planning of mandibular reconstruction has moved from mechanical simulation by dental model casts or stereolithographic models into an almost completely virtual environment. CAD/CAM applications allow a high level of accuracy by providing a custom template-assisted contouring approach for bone flaps. However, the clinical accuracy of CAD reconstruction is limited by the use of prebent reconstruction plates, an analogue step in an otherwise digital workstream. In this paper the integration of computerized, numerically-controlled (CNC) milled, patient-specific mandibular plates (PSMP) within the virtual workflow of computer-assisted mandibular free fibula flap reconstruction is illustrated in a clinical case. Intraoperatively, the bone segments as well as the plate arms showed a very good fit. Postoperative CT imaging demonstrated close approximation of the PSMP and fibular segments, and good alignment of native mandible and fibular segments and intersegmentally. Over a follow-up period of 12 months, there was an uneventful course of healing with good bony consolidation. The virtual design and automated fabrication of patient-specific mandibular reconstruction plates provide the missing link in the virtual workflow of computer-assisted mandibular free fibula flap reconstruction. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  1. Interdisciplinary treatment of a patient with bilateral cleft lip and palate and congenitally missing and transposed teeth.

    Science.gov (United States)

    Germec-Cakan, Derya; Canter, Halil Ibrahim; Cakan, Umut; Demir, Becen

    2014-03-01

    The comprehensive treatment of a patient with cleft lip and palate requires an interdisciplinary approach for functional and esthetic outcomes. A 20-year-old woman with bilateral cleft lip and palate had a chief complaint of unesthetic appearance of her teeth and the presence of oronasal fistulae. Her clinical and radiographic evaluation showed a dolichofacial growth pattern, a Class II skeletal relationship with retroclined maxillary central incisors, 5 mm of negative overjet, maxillary constriction, maxillary and mandibular crowding, congenitally missing maxillary right incisors and left lateral incisor, and a transposed maxillary left canine. Her treatment plan included the extraction of 3 premolars, maxillary expansion, segmental maxillary osteotomy, repair of the oronasal fistulae, rhinoplasty, periodontal surgery, and prosthodontic rehabilitation. To obtain a better occlusion and reduce the dimensions of the fistulae, orthognathic surgery comprising linear and rotational movements of the maxillary segments (premaxilla, right and left maxillary alveolar segments) in all 3 axes was planned by performing 3-dimensional virtual surgery on 3-dimensional computerized tomography. At the end of the interdisciplinary treatment, a functional occlusion, a harmonious profile, and patient satisfaction were achieved. Posttreatment records after 1 year showed stable results. Copyright © 2014 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.

  2. Missed Opportunities in the Patient-Focused Drug Development Public Meeting and Scientific Workshop on Female Sexual Dysfunction Held at the FDA, October 2014

    NARCIS (Netherlands)

    Tiefer, Leonore; Laan, Ellen; Basson, Rosemary

    2015-01-01

    There were numerous missed opportunities at the October 2014 U.S. Food and Drug Administration (FDA) meeting on female sexual dysfunction (FSD). They included opportunities to hear from a diverse range of patients and to engage in evidence-based discussions of unmet medical needs, diagnostic

  3. Comparison of Doctors' and Breast Cancer Patients' Perceptions of Docetaxel, Epirubicin, and Cyclophosphamide (TEC) Toxicity.

    Science.gov (United States)

    Bayo, Juan; Prieto, Blanca; Rivera, Francisco

    2016-05-01

    In Spain, around 26,000 cases of breast cancer are diagnosed each year, representing nearly 30% of all cancers in women. The aim this study was to compare the perceptions of nonhematologic toxicities after administration of a docetaxel, epirubicin, and cyclophosphamide (TEC) regimen between breast cancer patients and oncologists. Furthermore, the relationship between such adverse events and quality of life (QOL) was evaluated. Cross-sectional study carried out among 92 breast cancer patients who received TEC as neoadjuvant or adjuvant treatment. The main nonhematologic toxicities experienced by breast cancer patients treated with the TEC regimen were asthenia, nausea, dysgeusia, arthralgia, headache, and myalgia. Patients were less likely to be affected by vomiting and peripheral neuropathy. Oncologists seemed to show greater interest in toxicities, such as asthenia, nausea, and diarrhea. Vomiting was the toxicity with the most substantial degree of agreement between oncologist and patient. Toxicities with greater disagreement were dysgeusia, arthralgia, myalgia, asthenia, and headache. Asthenia, dysgeusia, loss of appetite, skin allergies, peripheral edema, abdominal pain, and myalgia were found to significantly affect the QOL. Tolerability and QOL were more favorable in patients treated with pegfilgrastim compared with filgrastim. Oncologists tend to underestimate toxicities experienced by breast cancer patients treated with the TEC regimen. The establishment of a protocol to record these toxicities may reduce that problem. © 2016 Wiley Periodicals, Inc.

  4. Avoiding the term 'obesity': an experimental study of the impact of doctors' language on patients' beliefs.

    Science.gov (United States)

    Tailor, Anisha; Ogden, Jane

    2009-08-01

    GPs sometimes use euphemisms rather than medical terms. The present study aimed to explore the relative impact of using the term 'obese' compared to GPs' preferred euphemism on patients' beliefs about the problem. A cross sectional survey followed by an experimental study was used with two conditions: the term 'obese' versus the GPs' preferred euphemism. In the cross sectional survey, GPs' (n=19) described their preferred use of term. In the experimental study, patients (n=449) from one General Practice in West London then completed a set of ratings about their beliefs following a vignette using either the term 'obese' or the GPs' preferred euphemism. The first stage of the study showed that GPs avoided using the term 'obese' and preferred to use a euphemism. The most commonly used euphemism was 'your weight may be damaging your health'. The second stage showed that the term 'obese' made patients believe that the problem had more serious consequences and made them feel more anxious and upset than when the same symptoms were labelled using the euphemism. When analysed according to the patient's own BMI, however, the results showed that the term 'obese' had a greater emotional impact than the euphemism only on patients who were not obese; obese patients found the euphemism more upsetting. GPs avoid using the term 'obese' for fear of upsetting patients. This term, whilst making the problem appear more serious is only more upsetting for non-obese patients. GPs choice of term therefore needs to reflect whether they want the patients to be upset or whether they want them to accept the seriousness of their problem.

  5. What happens when patients can see their doctors' note? - the Open Notes movement

    OpenAIRE

    Mende, Susan

    2017-01-01

    Introduction:  The Open Notes movement represents a culture change, enabling patients’ access to their providers’ notes, thereby increasing transparency and patient engagement.Policy context, objective and highlights:  OpenNotes involves allowing patients on-line or hard copy access to their providers’ notes. The one-year initial pilot began in 2010 with twenty thousand patients and one hundred primary care physicians at three medical centers in the United States.  The pilot’s evaluation foun...

  6. Doctor-patient relationships in general practice--a different model.

    Science.gov (United States)

    Kushner, T

    1981-09-01

    Philosophical concerns cannot be excluded from even a cursory examination of the physician-patient relationship. Two possible alternatives for determining what this relationship entails are the teleological (outcome) approach vs the deontological (process) one. Traditionally, this relationship has been structured around the 'clinical model' which views the physician-patient relationship in teleological terms. Data on the actual content of general medical practice indicate the advisability of reassessing this relationship, and suggest that the 'clinical model' may be too limiting, and that a more appropriate basis for the physician-patient relationship is one described in this paper as the 'relational model'.

  7. Burnout syndrome among non-consultant hospital doctors in Ireland: relationship with self-reported patient care.

    Science.gov (United States)

    Sulaiman, Che Fatehah Che; Henn, Patrick; Smith, Simon; O'Tuathaigh, Colm M P

    2017-10-01

    Intensive workload and limited training opportunities for Irish non-consultant hospital doctors (NCHDs) has a negative effect on their health and well-being, and can result in burnout. Burnout affects physician performance and can lead to medical errors. This study examined the prevalence of burnout syndrome among Irish NCHDs and its association with self-reported medical error and poor quality of patient care. A cross-sectional quantitative survey-based design. All teaching hospitals affiliated with University College Cork. NCHDs of all grades and specialties. The following instruments were completed by all participants: Maslach Burnout Inventory-Human Service Survey (MBI-HSS), assessing three categories of burnout syndrome: Emotional exhaustion (EE), Personal Achievement (PA) and Depersonalization (DP); questions related to self-reported medical errors/poor patient care quality and socio-demographic information. Self-reported measures of burnout and poor quality of patient care. Prevalence of burnout among physicians (n = 265) was 26.4%. There was a significant gender difference for EE and DP, but none for PA. A positive weak correlation was observed between EE and DP with medical error or poor patient care. A negative association was reported between PA and medical error and reduced quality of patient care. Burnout is prevalent among NCHDs in Ireland. Burnout syndrome is associated with self-reported medical error and quality of care in this sample population. Measures need to be taken to address this issue, with a view to protecting health of NCHDs and maintaining quality of patient care. © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  8. Interactive "Video Doctor" counseling reduces drug and sexual risk behaviors among HIV-positive patients in diverse outpatient settings.

    Directory of Open Access Journals (Sweden)

    Paul Gilbert

    2008-04-01

    Full Text Available Reducing substance use and unprotected sex by HIV-positive persons improves individual health status while decreasing the risk of HIV transmission. Despite recommendations that health care providers screen and counsel their HIV-positive patients for ongoing behavioral risks, it is unknown how to best provide "prevention with positives" in clinical settings. Positive Choice, an interactive, patient-tailored computer program, was developed in the United States to improve clinic-based assessment and counseling for risky behaviors.We conducted a parallel groups randomized controlled trial (December 2003-September 2006 at 5 San Francisco area outpatient HIV clinics. Eligible patients (HIV-positive English-speaking adults completed an in-depth computerized risk assessment. Participants reporting substance use or sexual risks (n = 476 were randomized in stratified blocks. The intervention group received tailored risk-reduction counseling from a "Video Doctor" via laptop computer and a printed Educational Worksheet; providers received a Cueing Sheet on reported risks. Compared with control, fewer intervention participants reported continuing illicit drug use (RR 0.81, 95% CI: 0.689, 0.957, p = 0.014 at 3 months; and RR 0.65, 95% CI: 0.540, 0.785, p<0.001 at 6 months and unprotected sex (RR 0.88, 95% CI: 0.773, 0.993, p = 0.039 at 3 months; and RR 0.80, 95% CI: 0.686, 0.941, p = 0.007 at 6 months. Intervention participants reported fewer mean days of ongoing illicit drug use (-4.0 days vs. -1.3 days, p = 0.346, at 3 months; and -4.7 days vs. -0.7 days, p = 0.130, at 6 months than did controls, and had fewer casual sex partners at (-2.3 vs. -1.4, p = 0.461, at 3 months; and -2.7 vs. -0.6, p = 0.042, at 6 months.The Positive Choice intervention achieved significant cessation of illicit drug use and unprotected sex at the group-level, and modest individual-level reductions in days of ongoing drug use and number of casual sex partners compared with the

  9. A high-definition fiber tracking report for patients with traumatic brain injury and their doctors.

    Science.gov (United States)

    Chmura, Jon; Presson, Nora; Benso, Steven; Puccio, Ava M; Fissel, Katherine; Hachey, Rebecca; Braun, Emily; Okonkwo, David O; Schneider, Walter

    2015-03-01

    We have developed a tablet-based application, the High-Definition Fiber Tracking Report App, to enable clinicians and patients in research studies to see and understand damage from Traumatic Brain Injury (TBI) by viewing 2-dimensional and 3-dimensional images of their brain, with a focus on white matter tracts with quantitative metrics. The goal is to visualize white matter fiber tract injury like bone fractures; that is, to make the "invisible wounds of TBI" understandable for patients. Using mobile computing technology (iPad), imaging data for individual patients can be downloaded remotely within hours of a magnetic resonance imaging brain scan. Clinicians and patients can view the data in the form of images of each tract, rotating animations of the tracts, 3-dimensional models, and graphics. A growing number of tracts can be examined for asymmetry, gaps in streamline coverage, reduced arborization (branching), streamline volume, and standard quantitative metrics (e.g., Fractional Anisotropy (FA)). Novice users can learn to effectively navigate and interact with the application (explain the figures and graphs representing normal and injured brain tracts) within 15 minutes of simple orientation with high accuracy (96%). The architecture supports extensive graphics, configurable reports, provides an easy-to-use, attractive interface with a smooth user experience, and allows for securely serving cases from a database. Patients and clinicians have described the application as providing dramatic benefits in understanding their TBI and improving their lives. Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.

  10. [Motivational interviewing use for promoting health behavior: an approach of doctor/patient relationship].

    Science.gov (United States)

    Benarous, X; Legrand, C; Consoli, S M

    2014-05-01

    Many situations in common medical practice, especially in chronic diseases, require patients to be mobilized for health behavior decisions: for daily intake of an antihypertensive drug, performing a mammography for cancer screening, as well as adopting new diet habits in diabetes. Ability to initiate a health behavior depends on several parameters. Some of them are related to the patient, his personality, his illness and treatment's perception; others directly rely on the physician, his attitude and his communication style during the visit, independently of patient's level of resistance to change. Motivational interviewing (MI) is a communication technique, first developed for patients presenting a substance abuse disorder, to explore their ambivalence, overcome their resistances and give them the willingness of a better self-care. Its general principles and basic techniques can be applied by every practitioner and deserve to be better known, given that scientific literature provides evidence for generalizing it in a variety of medical conditions, in structured patient education programs as well as in usual follow-up, for which time is generally restricted. This article provides an overview of MI recent applications and argues for its diffusion in everyday medical practice. Copyright © 2013. Published by Elsevier SAS.

  11. Feto-maternal outcomes in obstetric patients with near miss morbidity: an audit of obstetric high dependency unit.

    Science.gov (United States)

    Murki, Anuradha; Dhope, Sheetal; Kamineni, Vasundhara

    2017-03-01

    To evaluate and compare the feto-maternal outcomes of pregnant women with potentially life-threatening complications (PLTC) and near miss events admitted to the obstetric high dependency units (OHDU). Pregnant women with PLTC admitted to the OHDU were enrolled. Feto-maternal outcomes, need for NICU admission and neonatal mortality, were compared between women without near miss events (controls) and those with near miss events. Of the 1505 admissions to the obstetric department during the study period, 1127 delivered at our hospital. Among the deliveries 125 (11%) women were admitted to the OHDU and 19 (15%) of them were referred to the intensive care unit (ICU) of the hospital. The incidence of near miss morbidity (n = 46) was 37% among the mothers admitted to OHDU and 4.1% among the deliveries. The outcomes were similar in both groups for mean birth weight (among live births), neonatal death and still birth or intra-uterine deaths. The mean duration of ICU stay, proportion of ICU admission, and the mean duration of hospital stay were significantly higher for women with near miss events. In the presence of standardized OHDU and an ICU, the feto-maternal outcomes of women with PLTC and near miss event are similar to those without near miss events.

  12. Professionalism for future humanistic doctors

    Directory of Open Access Journals (Sweden)

    SEDIGHEH EBRAHIMI

    2013-07-01

    Full Text Available Dear editor Clinical environments encounter is an important part of studying medicine (1. Patient contact as an integral part of medical education occurs in various formats in the clinical settings (2, 3. During clinical training, medical students may experience high levels of stress, and some may not deal with it well. The abruptness of students’ transition to the clinical setting generated positive and negative emotions. Due to being a novice, they did not receive adequate training on how to get emotionally prepared for meeting seriously ill people. In such circumstances, the shortage of training will have predictably crucial consequences. Early clinical contact has been suggested to reduce these stresses and help the students adapt effectively to changes in the hospital climate (2. Patient contact creates an environment where each student appreciates cultural diversity and reinforces the development of clinical professional interpersonal skills through social, emotional and cognitive experiences (4, 5. It encourages validating of the relationship between patients and doctors and allows students to experience a more personal relationship with patients and nurture the ability to empathize with them, providing considerable benefits for trainees and patients. In this way, the social emotions that students experience when empathizing with a patient represent a uniquely human achievement. By internalizing their subjective interpretations of patient’s beliefs and feelings, the student’s body, brain and mind come together to produce cognition and emotion . They construct culturally relevant knowledge and make decisions about how to act and think about the patient’s problems as if they were their own. On the other hand, patient interaction in undergraduate education offers students a valuable early insight into the day-to-day role of a doctor and the patients’ perspective on specific conditions. Early experience provides a greater knowledge

  13. The medical consultation viewed as a value chain: a neurobehavioral approach to emotion regulation in doctor-patient interaction.

    Science.gov (United States)

    Finset, Arnstein; Mjaaland, Trond A

    2009-03-01

    To present a model of the medical consultation as a value chain, and to apply a neurobehavioral perspective to analyze each element in the chain with relevance for emotion regulation. Current knowledge on four elements in medical consultations and neuroscientific evidence on corresponding basic processes are selectively reviewed. The four elements of communication behaviours presented as steps in a value chain model are: (1) establishing rapport, (2) patient disclosure of emotional cues and concerns, (3) the doctor's expression of empathy, and (4) positive reappraisal of concerns. The metaphor of the value chain, with emphasis on goal orientation, helps to understand the impact of each communicative element on the outcome of the consultation. Added value at each step is proposed in terms of effects on outcome indicators; in this case patients affect regulation. Neurobehavioral mechanisms are suggested to explain the association between communication behaviour and affect regulation outcome. The value chain metaphor and the emphasis on behaviour-outcome-mechanisms associations may be of interest as conceptualizations for communications skills training.

  14. Introduction and Assessment of a Blended-Learning Model to Teach Patient Assessment in a Doctor of Pharmacy Program.

    Science.gov (United States)

    Prescott, William Allan; Woodruff, Ashley; Prescott, Gina M; Albanese, Nicole; Bernhardi, Christian; Doloresco, Fred

    2016-12-25

    Objective. To integrate a blended-learning model into a two-course patient assessment sequence in a doctor of pharmacy (PharmD) program and to assess the academic performance and perceptions of enrolled students. Design. A blended-learning model consisting of a flipped classroom format was integrated into a patient assessment (PA) course sequence. Course grades of students in the blended-learning (intervention) and traditional-classroom (control) groups were compared. A survey was administered to assess student perceptions. Assessment. The mean numeric grades of students in the intervention group were higher than those of students in the traditional group (PA1 course: 92.2±3.1 vs 90.0±4.3; and PA2 course: 90.3±4.9 vs 85.8±4.2). Eighty-six percent of the students in the intervention group agreed that the instructional methodologies used in this course facilitated understanding of the material. Conclusion. The blended-learning model was associated with improved academic performance and was well-received by students.

  15. A scale assessing doctor-patient communication in a context of acute conditions based on a systematic review.

    Directory of Open Access Journals (Sweden)

    Mélanie Sustersic

    Full Text Available There is no validated generic tool to measure Doctor-Patient-Communication (DPC in a context of acute conditions.To create and validate such a scale in a real population.We performed a systematic review of validated DPC scales available in English. From these, using a theoretical model based on a multidisciplinary approach, we selected pertinent items that met the inclusion criteria and included them in a simple questionnaire. This tool based on a synthesis of the literature was then validated in a prospective study in two hospital emergency departments.We found 22 pertinent questionnaires and scoring systems. From these, we extracted items and built a scale based on 15 questions with graded responses (Likert from 1 to 4. The mean time for questionnaire completion was 3 minutes. We included 189 adults and adolescents in the study and analyzed complete responses to the questionnaire by 149 patients, gathered over the phone one week after their consultation. The scale had high internal consistency (Cronbach's alpha = 0.89 and good external validity. Two questions were removed due to redundancy giving a scale based on 13 questions.We have created an easy-to-use and validated generic questionnaire to assess DPC in a context of acute conditions, usable both in clinical research and in routine practice.

  16. A scale assessing doctor-patient communication in a context of acute conditions based on a systematic review

    Science.gov (United States)

    Gauchet, Aurélie; Foote, Alison; Vermorel, Céline; Bosson, Jean-Luc

    2018-01-01

    Background There is no validated generic tool to measure Doctor-Patient-Communication (DPC) in a context of acute conditions. Objective To create and validate such a scale in a real population. Materials and method We performed a systematic review of validated DPC scales available in English. From these, using a theoretical model based on a multidisciplinary approach, we selected pertinent items that met the inclusion criteria and included them in a simple questionnaire. This tool based on a synthesis of the literature was then validated in a prospective study in two hospital emergency departments. Results We found 22 pertinent questionnaires and scoring systems. From these, we extracted items and built a scale based on 15 questions with graded responses (Likert from 1 to 4). The mean time for questionnaire completion was 3 minutes. We included 189 adults and adolescents in the study and analyzed complete responses to the questionnaire by 149 patients, gathered over the phone one week after their consultation. The scale had high internal consistency (Cronbach’s alpha = 0.89) and good external validity. Two questions were removed due to redundancy giving a scale based on 13 questions. Conclusions We have created an easy-to-use and validated generic questionnaire to assess DPC in a context of acute conditions, usable both in clinical research and in routine practice. PMID:29466407

  17. Delayed diagnosis of severe tuberculous spondylodiscitis in an asylum seeker; patient or doctors delay?

    DEFF Research Database (Denmark)

    Kristensen, Kristina Langholz; Podlekareva, Daria; Ravn, Pernille

    2017-01-01

    The still increasing global migration affects the epidemiology of tuberculosis (TB) in European countries. We present the case of an asylum seeker from a TB high-endemic country, who presented with severe TB spondylodiscitis and need for emergency surgery. The patient had a history of recurrent...

  18. Appendectomy during the third trimester of pregnancy in a 27-year old patient: case report of a "near miss" complication

    Directory of Open Access Journals (Sweden)

    Holzer Thomas

    2011-05-01

    Full Text Available Abstract The management of acute appendicitis during pregnancy is not fully established, especially regarding the choice between open and laparoscopic surgery during the third trimester. We report herein the case of a major uterine variecele hemorrhage during a laparoscopic appendectomy in a 27-year old pregnant patient at 33 weeks of amenorrhea. After conversion to a Pfannenstiel incision, the baby was delivered, the bleeding stopped and the appendectomy completed. While both mother and child fully recovered, this «near miss» complication underlines the challenges linked to the management of acute appendicitis during pregnancy. Based on a literature review, we propose an algorithm favoring the laparoscopic approach during the first and second trimesters, and the open approach during the third trimester (especially after the 26th week of amenorrhea. In case of unclear pre-operative diagnosis, a laparoscopy should be conducted even during the third trimester with a Mc Burney conversion when the diagnosis of appendicitis is confirmed.

  19. Intolerance and Violence Against Doctors.

    Science.gov (United States)

    Singh, Meharban

    2017-10-01

    Intolerance and grouse against doctors is a global phenomenon but India seems to lead the world in violence against doctors. According to World Health Organization, about 8-38% healthcare workers suffer physical violence at some point in their careers. Many more are verbally abused or threatened. Public is almost behaving like health sector terrorists. The spate of increasing attacks on doctors by damaging their property and causing physical injury is not acceptable by any civilized society. The public is becoming increasingly intolerant to a large number of social issues because of poor governance and vote bank politics. There is a need to arrest the development of further distrust between doctors and their patients/relatives, otherwise it will compromise all achievements of medical science and adversely affect healing capabilities of doctors. Rude and aggressive behavior of the patients or their family members, and arrogant and lackadaisical approach of the doctor, adversely affects the doctor-patient relationship and the outcome of the patient. The doctors, hospital administration and government must exercise "zero tolerance" with respect to acts of violence against healthcare professionals. It is possible to reduce the incidence of intolerance against doctors but difficult to eliminate it completely. The healthcare providers should demonstrate greater compassion and empathy with improved communication skills. The hospitals must have adequate infrastructure, facilities and staff to handle emergencies without delay and with due confidence and skills. The security of healthcare providers, especially in sensitive areas, should be improved by having adequate number of security guards, frisking facilities, extensive CCTV network and availability of "Quick response team" to handle unruly mob. In case of any grievances for alleged mismanagement, the public should handle the situation in a civilized manner and seek redressal through Medical Protection Act and legal

  20. Placebo and the New Physiology of the Doctor-Patient Relationship

    OpenAIRE

    Benedetti, Fabrizio

    2013-01-01

    Modern medicine has progressed in parallel with the advancement of biochemistry, anatomy, and physiology. By using the tools of modern medicine, the physician today can treat and prevent a number of diseases through pharmacology, genetics, and physical interventions. Besides this materia medica, the patient's mind, cognitions, and emotions play a central part as well in any therapeutic outcome, as investigated by disciplines such as psychoneuroendocrinoimmunology. This review describes recent...

  1. Direct-to-consumer advertising: public perceptions of its effects on health behaviors, health care, and the doctor-patient relationship.

    Science.gov (United States)

    Murray, Elizabeth; Lo, Bernard; Pollack, Lance; Donelan, Karen; Lee, Ken

    2004-01-01

    To determine public perceptions of the effect of direct-to-consumer advertising (DTCA) of prescription medications on health behaviors, health care utilization, the doctor-patient relationship, and the association between socioeconomic status and these effects. Cross-sectional survey of randomly selected, nationally representative sample of the US public using computer-assisted telephone interviewing. numbers and proportions of respondents in the past 12 months who, as a result of DTCA, requested preventive care or scheduled a physician visit; were diagnosed with condition mentioned in advertisement; disclosed health concerns to a doctor; felt enhanced confidence or sense of control; perceived an effect on the doctor-patient relationship; requested a test, medication change, or specialist referral; or manifested serious dissatisfaction after a visit to a doctor. As a result of DTCA, 14% of respondents disclosed health concerns to a physician, 6% requested preventive care, 5% felt more in control during a physician visit; 5% made requests for a test, medication change, or specialist referral, and 3% received the requested intervention. One percent of patients reported negative outcomes, including worsened treatment, serious dissatisfaction with the visit, or that the physician acted challenged. Effects of DTCA were greater for respondents with low socioeconomic status. DTCA has positive and negative effects on health behaviors, health service utilization, and the doctor-patient relationship that are greatest on people of low socioeconomic status. The benefits of DTCA in terms of encouraging hard-to-reach sections of the population to seek preventive care must be balanced against increased health care costs caused by clinically inappropriate requests generated by DTCA.

  2. Use of non-vitamin, non-mineral (NVNM) supplements by hospitalized internal medicine patients and doctor-patient communication.

    Science.gov (United States)

    Samuels, Noah; Zisk-Rony, Rachel Y; Zevin, Shoshana; Becker, Evy L; Yinnon, Amos M; Oberbaum, Menachem

    2012-12-01

    To study non-vitamin, non-mineral (NVNM) supplements use and disclosure of among hospitalized internal medicine patients. A convenience sample of patients completed an interviewer-administered questionnaire examining use of and perceptions regarding NVNM supplements, and disclosure to medical personnel. 280 patients were interviewed (54% female), 15.4% reporting NVNM supplement use. This practice was more prevalent among female patients (p=0.045), more educated (pinternal medicine patients. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  3. A "tale of two countries": Narratives of hearts, patients and doctors in the Spanish press.

    Science.gov (United States)

    Danet, Alina; Medina-Doménech, Rosa M

    2015-08-01

    In this article we explore how the Spanish written press--ABC, La Vanguardia, and Blanco y Negro--and the official newsreel No-Do, created and disseminated a narrative about heart transplantations at the end of the 1960s. We consider how Franco's regime used Christiaan Barnard's heart transplants to legitimize the Spanish dictatorship and as a means of signifying scientific progress, modernization and national pride. The Spanish press created the plot of the first transplantations like that of a television series, presenting daily installments on the patients' progress, dramatizing the stories and ensuring the public's emotional attachment. The three main characters in the story: donors, patients and surgeons, formed a symbolic, indivisible narrative triangle endowed with singular meaning. This Spanish narrative of organ transplant technology was deployed through what we have called "a tale of two countries", that, emulating the South African's success, constructed in Martínez-Bordiú, Franco's son-in-law, a home-grown, masculine scientific personality capable of performing heart surgery and endorsing Franco's investment in scientific modernization. © The Author(s) 2013.

  4. Imputation by the mean score should be avoided when validating a Patient Reported Outcomes questionnaire by a Rasch model in presence of informative missing data

    LENUS (Irish Health Repository)

    Hardouin, Jean-Benoit

    2011-07-14

    Abstract Background Nowadays, more and more clinical scales consisting in responses given by the patients to some items (Patient Reported Outcomes - PRO), are validated with models based on Item Response Theory, and more specifically, with a Rasch model. In the validation sample, presence of missing data is frequent. The aim of this paper is to compare sixteen methods for handling the missing data (mainly based on simple imputation) in the context of psychometric validation of PRO by a Rasch model. The main indexes used for validation by a Rasch model are compared. Methods A simulation study was performed allowing to consider several cases, notably the possibility for the missing values to be informative or not and the rate of missing data. Results Several imputations methods produce bias on psychometrical indexes (generally, the imputation methods artificially improve the psychometric qualities of the scale). In particular, this is the case with the method based on the Personal Mean Score (PMS) which is the most commonly used imputation method in practice. Conclusions Several imputation methods should be avoided, in particular PMS imputation. From a general point of view, it is important to use an imputation method that considers both the ability of the patient (measured for example by his\\/her score), and the difficulty of the item (measured for example by its rate of favourable responses). Another recommendation is to always consider the addition of a random process in the imputation method, because such a process allows reducing the bias. Last, the analysis realized without imputation of the missing data (available case analyses) is an interesting alternative to the simple imputation in this context.

  5. Hard Internet Truths: 34,748 Online Reviews Reveal What Patients Really Want from Doctors.

    Science.gov (United States)

    King, Ron Harman; Stanley, Jonathan; Baum, Neil

    2016-01-01

    For all of us living in the Internet age, it's hard to underestimate the power of online reviews. Before booking a reservation at a new hotel or restaurant, who doesn't consult websites such as TripAdvisor and Open Table? Who would gamble $100 on a dinner out or $200 on a hotel stay before first seeing what other diners and patrons had to say about their experiences? Patients who are looking for a healthcare provider are no different than those customers looking for a restaurant or a hotel; they want opinions from others who have previously availed themselves of that restaurant or hotel. This article addresses the importance of online reputation management and offers ideas and suggestions for healthcare providers to control and protect their online reputations.

  6. Prospective Validation of the Decalogue, a Set of Doctor-Patient Communication Recommendations to Improve Patient Illness Experience and Mood States within a Hospital Cardiologic Ambulatory Setting

    Directory of Open Access Journals (Sweden)

    Piercarlo Ballo

    2017-01-01

    Full Text Available Strategies to improve doctor-patient communication may have a beneficial impact on patient’s illness experience and mood, with potential favorable clinical effects. We prospectively tested the psychometric and clinical validity of the Decalogue, a tool utilizing 10 communication recommendations for patients and physicians. The Decalogue was administered to 100 consecutive patients referred for a cardiologic consultation, whereas 49 patients served as controls. The POMS-2 questionnaire was used to measure the total mood disturbance at the end of the consultation. Structural equation modeling showed high internal consistency (Cronbach alpha 0.93, good test-retest reproducibility, and high validity of the psychometric construct (all > 0.80, suggesting a positive effect on patients’ illness experience. The total mood disturbance was lower in the patients exposed to the Decalogue as compared to the controls (1.4±12.1 versus 14.8±27.6, p=0.0010. In an additional questionnaire, patients in the Decalogue group showed a trend towards a better understanding of their state of health (p=0.07. In a cardiologic ambulatory setting, the Decalogue shows good validity and reliability as a tool to improve patients’ illness experience and could have a favorable impact on mood states. These effects might potentially improve patient engagement in care and adherence to therapy, as well as clinical outcome.

  7. Patients' blood pressure control and doctors' adherence to hypertension clinical practice guideline in managing patients at health clinics in Kuala Muda district, Kedah.

    Science.gov (United States)

    Teoh, S H; Razlina, A R; Norwati, D; Siti Suhaila, M Y

    2017-02-01

    blood pressure (bP) control among Malaysian is poor and doctor's adherence to clinical practice guideline (cPG) has been a well-known factor that may improve it. this study was designed to evaluate patients' bP control, doctors' adherence to the latest hypertension cPG and their association. Factors associated with bP control and cPG adherence was also examined. A cross-sectional study was conducted in Kuala Muda district's health clinics. 331 medical records were selected using stratified random sampling and standard proforma was used for data collection. the latest edition of the Malaysian cPG on hypertension was employed to define related variables. A total of 160 patients (48.3%) had controlled bP and it was significantly associated with patients' age (adjusted Odds ratio, aOr= 1.03, 95% cI: 1.004, 1.05, p= 0.016) and systolic bP at presentation (aOr= 0.95, 95% cI: 0.93, 0.96, p< 0.001). About 60.7% of the medical records showed doctor's good level of cPG adherence. this adherence has significant association with presence of chronic kidney disease (aOr= 0.51, 95% cI: 0.31, 0.85, p= 0.007) and cardiovascular disease (aOr= 2.68, 95% cI: 1.04, 6.95, p= 0.030) in the patients and physicians' treatment intensification (aOr= 2.00, 95% cI: 1.26, 3.19, p= 0.009). However, no association was found between bP control and cPG adherence. Hypertension control in this study was poor and the prevalence of physicians with good level of cPG adherence was slightly above average. these findings are important for relevant stakeholders to strategise an action plan to improve hypertension management outcome.

  8. Impact of Scientific Versus Emotional Wording of Patient Questions on Doctor-Patient Communication in an Internet Forum: A Randomized Controlled Experiment with Medical Students.

    Science.gov (United States)

    Bientzle, Martina; Griewatz, Jan; Kimmerle, Joachim; Küppers, Julia; Cress, Ulrike; Lammerding-Koeppel, Maria

    2015-11-25

    Medical expert forums on the Internet play an increasing role in patient counseling. Therefore, it is important to understand how doctor-patient communication is influenced in such forums both by features of the patients or advice seekers, as expressed in their forum queries, and by characteristics of the medical experts involved. In this experimental study, we aimed to examine in what way (1) the particular wording of patient queries and (2) medical experts' therapeutic health concepts (for example, beliefs around adhering to a distinctly scientific understanding of diagnosis and treatment and a clear focus on evidence-based medicine) impact communication behavior of the medical experts in an Internet forum. Advanced medical students (in their ninth semester of medical training) were recruited as participants. Participation in the online forum was part of a communication training embedded in a gynecology course. We first measured their biomedical therapeutic health concept (hereinafter called "biomedical concept"). Then they participated in an online forum where they answered fictitious patient queries about mammography screening that either included scientific or emotional wording in a between-group design. We analyzed participants' replies with regard to the following dimensions: their use of scientific or emotional wording, the amount of communicated information, and their attempt to build a positive doctor-patient relationship. This study was carried out with 117 medical students (73 women, 41 men, 3 did not indicate their sex). We found evidence that both the wording of patient queries and the participants' biomedical concept influenced participants' response behavior. They answered emotional patient queries in a more emotional way (mean 0.92, SD 1.02) than scientific patient queries (mean 0.26, SD 0.55; t74=3.48, PCommunication training for medical experts could aim to address this issue of recognizing patients' communication styles and needs in certain

  9. An assessment of clinical pathways and missed opportunities for the diagnosis of nodular melanoma versus superficial spreading melanoma.

    Science.gov (United States)

    Cicchiello, Mark; Lin, Matthew J; Pan, Yan; McLean, Catriona; Kelly, John W

    2016-05-01

    Missed opportunities in the diagnosis of nodular melanoma (NM) carry high prognostic penalties due to the rapid rate of NM growth. To date, an assessment of the pathways to diagnosis of NM versus superficial spreading melanoma (SSM) specifically comparing numbers of opportunities missed to undertake biopsy has not been performed. A retrospective questionnaire of 120 patients (60 NM patients, age and sex matched to 60 SSM patients) from the Victorian Melanoma Service (VMS) database was undertaken to assess pathways to diagnosis. The numbers of opportunities missed to undertake a biopsy and doctor behaviour at such encounters were recorded. Diagnostic delay (overall, patient's and doctor's delay) in terms of time was assessed. Significant differences in opportunities missed to make a diagnosis of NM compared to SSM were found. In all, 43% of NM were biopsied at a first encounter compared to 70% of SSM. All SSM were diagnosed within three reviews. Overall, 33% of NM required at least three and up six reviews until biopsy. Patients with NM were more likely than those with SSM to be reassured that their lesions were benign. No significant differences in terms of time delay to diagnosis between NM and SSM were found. NM contributes disproportionately to melanoma mortality in Australia. Addressing earlier diagnosis of NM with renewed focus may make the biggest impact on the overall mortality of melanoma. The message that a period of observation is not appropriate for patients re-presenting with lesions of concern must be more effectively communicated. © 2015 The Australasian College of Dermatologists.

  10. Barriers for an effective communication around clinical decision making: an analysis of the gaps between doctors' and patients' point of view.

    Science.gov (United States)

    Mira, José Joaquín; Guilabert, Mercedes; Pérez-Jover, Virtudes; Lorenzo, Susana

    2014-12-01

    There are doubts on whether patients feel that they have sufficient information for actively participating in clinical decisions. To describe the type of information that patients receive. To determine whether patients consider this information sufficient, and whether it contributes or not to improve clinical safety. To identify the barriers for patient participation in clinical decision making. Cross-sectional study with 764 patients and 327 physicians. Fourteen health centres belonging to three primary care districts and three hospitals in Spain. Just 35.1% (268) (95% CI 32.2, 39.1%) of patients preferred to have the last word in clinical decisions. Age (39 vs. 62%, P communication by the patients. Only 19.6% (64) (95% CI 15.4, 24.2%) of doctors considered that they could intervene to involve patients in the decisions. The majority of patients prefer the decisions to be made by their doctor, especially those with more severe illnesses, and older patients. Patients are not normally informed about medication interactions, precautions and foreseeable complications. The information provided by general practitioners does not seem to contribute enough to the patient involvement in clinical safety. © 2012 John Wiley & Sons Ltd.

  11. Why do patients visit their doctors? Assessing the most prevalent conditions in a defined US population

    Science.gov (United States)

    St. Sauver, Jennifer L.; Warner, David O.; Yawn, Barbara P.; Jacobson, Debra J.; Mc Gree, Michaela E.; Pankratz, Joshua J.; Melton, L. Joseph; Roger, Véronique L.; Ebbert, Jon O.; Rocca, Walter A.

    2013-01-01

    Objective To describe the prevalence of non-acute conditions among patients seeking healthcare in a defined US population, emphasizing age, sex, and ethnic differences. Methods The Rochester Epidemiology Project (REP) records-linkage system was used to identify all residents of Olmsted County, MN on April 1, 2009 (n=142,377). We then electronically extracted all International Classification of Diseases, ninth revision (ICD-9) codes received by these subjects from any health care provider between January 1, 2005 and December 31, 2009. We grouped ICD-9 codes into Clinical Classification Codes (CCCs), and then into 47 broader disease groups associated with health-related quality of life. Age- and sex-specific prevalence was estimated by dividing the number of individuals within each group by the corresponding age- and sex-specific population. People with multiple codes within a group were counted only once. Results We included a total of 142,377 subjects (53% women). Skin disorders (42.7%), osteoarthritis and joint disorders (33.6%), back problems (23.9%), disorders of lipid metabolism (22.4%), and upper respiratory disease (22.1%; excluding asthma) were the most prevalent disease groups in this population. Eight of the 10 most prevalent disease groups were more common in women; however, disorders of lipid metabolism and hypertension were more common in men. Additionally, the prevalence of seven of these 10 groups increased with advancing age. Prevalence varied also across whites, blacks, and Asians. Conclusion Our findings suggest areas for focused research that may lead to better care delivery and improved population health. PMID:23274019

  12. A marketing clinical doctorate programs.

    Science.gov (United States)

    Montoya, Isaac D; Kimball, Olive M

    2007-01-01

    Over the past decade, clinical doctorate programs in health disciplines have proliferated amid both support and controversy among educators, professional organizations, practitioners, administrators, and third-party payers. Supporters argue that the explosion of new knowledge and increasing sophistication of technology have created a need for advanced practice models to enhance patient care and safety and to reduce costs. Critics argue that necessary technological advances can be incorporated into existing programs and believe that clinical doctorates will increase health care costs, not reduce them. Despite the controversy, many health disciplines have advanced the clinical doctorate (the most recent is the doctor of nursing practice in 2004), with some professions mandating the doctorate as the entry-level degree (i.e., psychology, pharmacy, audiology, and so on). One aspect of the introduction of clinical doctoral degrees has been largely overlooked, and that is the marketing aspect. Because of marketing considerations, some clinical doctorates have been more successfully implemented and accepted than others. Marketing is composed of variables commonly known as "the four P's of marketing": product, price, promotion, and place. This report explores these four P's within the context of clinical doctorates in the health disciplines.

  13. Study Of Physician And Patient Communication Identifies Missed Opportunities To Help Reduce Patients' Out-Of-Pocket Spending.

    Science.gov (United States)

    Ubel, Peter A; Zhang, Cecilia J; Hesson, Ashley; Davis, J Kelly; Kirby, Christine; Barnett, Jamison; Hunter, Wynn G

    2016-04-01

    Some experts contend that requiring patients to pay out of pocket for a portion of their care will bring consumer discipline to health care markets. But are physicians prepared to help patients factor out-of-pocket expenses into medical decisions? In this qualitative study of audiorecorded clinical encounters, we identified physician behaviors that stand in the way of helping patients navigate out-of-pocket spending. Some behaviors reflected a failure to fully engage with patients' financial concerns, from never acknowledging such concerns to dismissing them too quickly. Other behaviors reflected a failure to resolve uncertainty about out-of-pocket expenses or reliance on temporary solutions without making long-term plans to reduce spending. Many of these failures resulted from systemic barriers to health care spending conversations, such as a lack of price transparency. For consumer health care markets to work as intended, physicians need to be prepared to help patients navigate out-of-pocket expenses when financial concerns arise during clinical encounters. Project HOPE—The People-to-People Health Foundation, Inc.

  14. Interdisciplinary approach for increasing the vertical dimension of occlusion in an adult patient with several missing teeth.

    Science.gov (United States)

    Uribe, Flavio; Janakiraman, Nandakumar; Nanda, Ravindra

    2013-06-01

    This case report describes the interdisciplinary treatment of a 39-year-old man with several missing teeth (including both maxillary lateral incisors), Class II malocclusion, deep overbite, and significant mandibular midline deviation. The treatment plan included placement of endosseous dental implants early in the orthodontic treatment to increase the vertical dimension of the occlusion for deepbite correction, canine substitution for the missing lateral incisors, and distalization of the mandibular right buccal segment with the aid of a temporary anchorage device. Copyright © 2013 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.

  15. Talking to Your Doctor

    Medline Plus

    Full Text Available ... communication. Remember that nurses and pharmacists are also good sources of information. How to Talk to your Doctor Talking With Your Doctor , NIH News in Health Español Talking to Your Doctor , National Eye Institute ( ...

  16. Developing skilled doctor-patient communication in the workplace: a qualitative study of the experiences of trainees and clinical supervisors.

    Science.gov (United States)

    Giroldi, Esther; Veldhuijzen, Wemke; Geelen, Kristel; Muris, Jean; Bareman, Frits; Bueving, Herman; van der Weijden, Trudy; van der Vleuten, Cees

    2017-12-01

    To inform the development of recommendations to facilitate learning of skilled doctor-patient communication in the workplace, this qualitative study explores experiences of trainees and supervisors regarding how trainees learn communication and how supervisors support trainees' learning in the workplace. We conducted a qualitative study in a general practice training setting, triangulating various sources of data to obtain a rich understanding of trainees and supervisors' experiences: three focus group discussions, five discussions during training sessions and five individual interviews. Thematic network analysis was performed during an iterative process of data collection and analysis. We identified a communication learning cycle consisting of six phases: impactful experience, change in frame of reference, identification of communication strategies, experimentation with strategies, evaluation of strategies and incorporation into personal repertoire. Supervisors supported trainees throughout this process by creating challenges, confronting trainees with their behaviour and helping them reflect on its underlying mechanisms, exploring and demonstrating communication strategies, giving concrete practice assignments, creating safety, exploring the effect of strategies and facilitating repeated practice and reflection. Based on the experiences of trainees and supervisors, we conclude that skilled communication involves the development of a personal communication repertoire from which learners are able to apply strategies that fit the context and their personal style. After further validation of our findings, it may be recommended to give learners concrete examples, opportunities for repeated practise and reflection on personal frames of reference and the effect of strategies, as well as space for authenticity and flexibility. In the workplace, the clinical supervisor is able to facilitate all these essential conditions to support his/her trainee in becoming a skilled

  17. The comparison of cardiovascular risk scores using two methods of substituting missing risk factor data in patient medical records

    Directory of Open Access Journals (Sweden)

    Andrew Dalton

    2011-07-01

    Conclusions A simple method of substituting missing risk factor data can produce reliable estimates of CVD risk scores. Targeted screening for high CVD risk, using pre-existing electronic medical record data, does not require multiple imputation methods in risk estimation.

  18. What are the communication skills and needs of doctors when communicating a poor prognosis to patients and their families? A qualitative study from South Africa.

    Science.gov (United States)

    Ganca, L L; Gwyther, L; Harding, R; Meiring, M

    2016-08-09

    Thousands of South Africans are diagnosed with life-threatening illness every year. Research shows that, globally, of the 20 million people who need palliative care at the end of life every year, <10% receive it. To explore communication skills and practices of medical practitioners when conveying a poor prognosis to patients and families, and to identify their communication skills, needs and understanding of palliative care. This was an exploratory qualitative study of practising doctors, using a grounded theory approach. The study was conducted at a government-funded public hospital in Cape Town, South Africa, which is a referral centre for various illnesses including cancer. Face-to-face, one-on-one interviews using a semistructured interview guide were conducted, using audio recording. The emerging theory from this study is that doctors who understand the principles of palliative care and who have an established working relationship with a palliative care team feel supported and express low levels of emotional anxiety when conveying a poor prognosis. Having hospital-based palliative care teams in all public hospitals will provide support for patients and doctors handling difficult conversations. All healthcare professionals should be trained in palliative care so as to effectively communicate with patients and their families concerns related to poor prognosis. Communication, loss and grief issues should be part of the curriculum in all disciplines and throughout training in medical school.

  19. Reinventing The Doctor

    Directory of Open Access Journals (Sweden)

    Moyez Jiwa

    2011-07-01

    Full Text Available There has been a seismic shift in the lives of people because of technology. People are far better informed than they were in the 1980s and 1990s. Much of this information is available through the media but even more is available and archived on the internet. The forces pushing the internet into health and health care are strong and unstoppable, ensuring that the internet and the choices it offers must be part of the design of our future health care system. We are no longer content to wait in queues as we live at a faster pace than earlier generations — we don’t not have time to wait for appointments months, weeks or even days in advance. The internet offers the prospect of online consultations in the comfort of your own home. The physical examination will change as new devices are developed to allow the necessary sounds and signals emitted by our malfunctioning bodies to be recorded, interpreted and captured at a remote location. Meanwhile, for those who prefer to see a health care practitioner in person the options to consult practitioners other than doctors who can advise on our health is expanding. The reality is we can’t afford to train or pay for all the doctors we need under the current “doctor-knows-best” system of health care. Patients no longer believe the rhetoric and are already voting with their feet. Pharmacists, nurses and other allied health professionals are beginning to play a much greater role in offering relief from symptoms and monitoring of chronic diseases. Of course, the doctor of the future will still need to offer face-to-face consultations to some people most of the time or most people some of the time. The social role doctors play will continue to be important as humans will always need other humans to personally respond to their distress. As doctors reinvent themselves, the internet and the value of time with patients will be the driving forces that move us into a more sustainable future in health care.

  20. Patients as teachers: a randomised controlled trial on the use of personal stories of harm to raise awareness of patient safety for doctors in training.

    Science.gov (United States)

    Jha, Vikram; Buckley, Hannah; Gabe, Rhian; Kanaan, Mona; Lawton, Rebecca; Melville, Colin; Quinton, Naomi; Symons, Jools; Thompson, Zoe; Watt, Ian; Wright, John

    2015-01-01

    Patient safety training often provides learners with a health professional's perspective rather than the patient's. Personal narratives of health-related harm allow patients to share their stories with health professionals to influence clinical behaviour by rousing emotions and improving attitudes to safety. This study measured the impact of patient narratives used to train junior doctors in patient safety. An open, multi-centre, two-arm, parallel design randomised controlled trial was conducted in the North Yorkshire East Coast Foundation School (NYECFS). The intervention consisted of 1-h-long patient narratives followed by discussion. The control arm received conventional faculty-delivered teaching. The Attitude to Patient Safety Questionnaire (APSQ) and the Positive and Negative Affect Schedule (PANAS) were used to measure the impact of the intervention. 142 trainees received the intervention; 141 the control teaching. There was no evidence of a difference in post-intervention APSQ scores between the groups. There was a statistically significant difference in the underlying distribution of both post PA (positive affect) and post NA (negative affect) scores between the groups on the PANAS (ppatients with experiences of safety incidents in training has an ideological appeal and seems an obvious choice in designing safety interventions. On the basis of our primary outcome measure, we were unable to demonstrate effectiveness of the intervention in changing general attitudes to safety compared to control. While the intervention may impact on emotional engagement and learning about communication, we remain uncertain whether this will translate into improved behaviours in the clinical context or indeed if there are any negative effects. Grant reference no. RP-PG-0108-10049. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  1. Attitudes and concerns of doctors and nurses about using a translation application for in-hospital brief interactions with Korean patients

    Directory of Open Access Journals (Sweden)

    Karen Jean Day

    2017-10-01

    Full Text Available Background: New Zealand is becoming more ethnically diverse, with rising numbers of people with limited English language proficiency. Consequently, hospital interactions are increasing where patients have insufficient English to communicate adequately with doctors or nurses for appropriate, effective, and safe care. Translation technology is rapidly evolving, but evidence is limited regarding its usefulness to clinicians. Objective: To examine the acceptability to doctors and nurses of a translation application (app used on a tablet, in brief interactions with Korean patients. Method: An app was developed to facilitate brief conversations between patients and clinicians as part of clinical care. We used the Technology Acceptance Model 2 to develop semi-structured interview questions for 15 junior and senior doctors and nurses in an urban hospital. Participants used the app to interact with the interviewer as part of a scenario. The interviews were analysed thematically. Results: The app was easy to use, learn to use, and to memorise for future use. It was considered useful for everyday brief interactions, urgent situations where there is no time to call an interpreter, and after hours, to augment the work of interpreters. Subject to perceived usefulness, there appears to be little need for social normalisation of a translation app, other than management support for the costs, maintenance, and implementation of the app for everyday use.   Conclusion: Guidelines are required for the use of a translation app by doctors and nurses to augment the interpreter role. A larger study and future research on the patient’s perspective are required.

  2. Management of Congenitally Missing Lateral Incisor

    Directory of Open Access Journals (Sweden)

    Nidhi Kedia

    2011-01-01

    Full Text Available Multiple treatment options are available to patients who have congenitally missing teeth. Management options for the treatment of missing teeth can include the following: (1 Orthodontic space closure and adjacent tooth substitution, (2 autotransplantation, (3 prosthetic replacement with resin-bonded fixed partial dentures, conventional fixed partial dentures and single-tooth implants. In this case report, treatment of a patient with congenitally missing maxillary right lateral incisor will be presented.

  3. General beliefs about medicines among doctors and nurses in out-patient care: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Hedenrud Tove

    2009-05-01

    Full Text Available Abstract Background Doctors and nurses are two natural partners in the healthcare team, but they usually differ in their perspectives on how to work for increased health. These professions may also have different beliefs about medicines, a factor important for adherence to medicines. The aim was to explore general beliefs about medicines among doctors and nurses. Methods Questionnaires were sent to 306 private practitioners (PPs, 298 general practitioners (GPs and 303 nurses in the county of Västra Götaland, Sweden. The questionnaire included sociodemographic questions and the general part of the Beliefs about Medicines Questionnaire (BMQ, which measures the beliefs people have about medicines in general. General beliefs about medicines in relation to background variables were explored with independent t-tests and ANOVA analyses. Differences between occupations and influences of interaction variables were analysed with multiple linear regression models for general beliefs about medicines. Results The data collection resulted in 616 questionnaires (62.1% PPs; 61.6% GPs; 80.5% nurses. The majority of the PPs and 40% of the GPs were male but most of the nurses were female. The GPs' mean age was 47 years, PPs' 60 years and nurses' 52 years. Few nurses originated from non-Nordic countries while 15% of the PPs and 25% of the GPs did. Nurses saw medicines as more harmful and less beneficial than did PPs and GPs. These differences could not be explained by the included interaction variables. GPs with a Nordic background saw medicines as more beneficial and less harmful than did GPs with a non-Nordic background. Furthermore, GPs of non-Nordic origin were most likely to believe that medicines were overprescribed by doctors. Conclusion Doctors were more positive about medicines than nurses. The differences in beliefs about medicines found between doctors and nurses could not be explained by any of the included interaction variables. These differences in

  4. AUSTRALIAN COMPETITION AND CONSUMER COMMISSION v ACN 117 372 915: SHOULD CONSUMER LAW REGULATE DOCTOR-PATIENT RELATIONS IN A CORPORATISED HEALTH CARE SYSTEM?

    Science.gov (United States)

    Wallace, Jessica; Pyman, Ella; Faunce, Thomas

    2015-09-01

    In April 2015, North J of the Federal Court of Australia made a finding of unconscionable conduct against Advanced Medical Institute, a promoter and provider of erectile dysfunction treatment, in a case concerning unfair contract terms (Australian Competition and Consumer Commission vACN 117 372 915 Pty Ltd (in liq) (formerly Advanced Medical Institute Pty Ltd) [2015] FCA 368). The contract required a minimum 12-month commitment, with costs exceeding treatments available from general practitioners, and made refunds available only after all possible treatment plans were exhausted which included penile injections. This column analyses that case, particularly in respect to the consumer law standards of practice under which it was litigated. Those standards refer to patients as "consumers" yet North J made extensive reference to the Good Medical Practice: A Code of Conduct for Doctors in Australia, a text which refers to "patients", as evidence of what constitutes appropriate professional conduct or practice for the health profession. This column considers whether legislative and judicial categorisation of patients (a class of people presumptively suffering, sick and vulnerable) as "consumers" undermines the formal and informal protections accorded to patients under normative systems of medical ethics such as those represented by the Code. The case, it is argued, also illuminates the contemporary tensions between the ethical, legal and human rights standards required of doctors in their treatment of patients and the commercial interests of businesses.

  5. Identifying Factors and Root Causes Associated With Near-Miss or Safety Incidents in Patients Treated With Radiotherapy: A Case-Control Analysis.

    Science.gov (United States)

    Judy, Gregory D; Mosaly, Prithima R; Mazur, Lukasz M; Tracton, Gregg; Marks, Lawrence B; Chera, Bhishamjit S

    2017-08-01

    To identify factors associated with a near-miss or safety incident (NMSI) in patients undergoing radiotherapy and identify common root causes of NMSIs and their relationship with incident severity. We retrospectively studied NMSIs filed between October 2014 and April 2016. We extracted patient-, treatment-, and disease-specific data from patients with an NMSI (n = 200; incident group) and a similar group of control patients (n = 200) matched in time, without an NMSI. A root cause and incident severity were determined for each NMSI. Univariable and multivariable analyses were performed to determine which specific factors were contributing to NMSIs. Multivariable logistic regression was used to determine root causes of NMSIs and their relationship with incident severity. NMSIs were associated with the following factors: head and neck sites (odds ratio [OR], 5.2; P = .01), image-guided intensity-modulated radiotherapy (OR, 3; P = .009), daily imaging (OR, 7; P importance of a strong reporting system to support a safety culture.

  6. [Goya and doctors].

    Science.gov (United States)

    Vargas-Origel, Arturo

    2009-01-01

    This is a brief analysis of the different diseases the Spanish painter Goya suffered, particularly the one that caused his deafness. We also discussed the probable relationship the artist had with his physicians throughout his life, and how this relationship is portrayed in four of his works, with such variety of feelings that go from indifference, satire and mockery to gratefulness and full recognition to the medical profession. This last point is exemplified in a self-portrait of the sick artist being assisted by Dr. Eugenio Garcia Arrieta which was his personal doctor during that time. This work is considered a representation of an adequate patient-physician relationship.

  7. Coaching doctoral students

    DEFF Research Database (Denmark)

    Godskesen, Mirjam Irene; Kobayashi, Sofie

    2016-01-01

    In this paper we focus on individual coaching carried out by an external coach as a new pedagogical element that can impact doctoral students’ sense of progress in doctoral education. The study used a mixed methods approach in that we draw on quantitative and qualitative data from the evaluation...... of a project on coaching doctoral students. We explore how coaching can contribute to the doctoral students’ development of a broad set of personal competences and suggest that coaching could work as a means to engender self-management and improve relational competences. The analysis of the participants’ self......-reported gains from coaching show that doctoral students experience coaching as an effective method to support the doctoral study process. This study also provides preliminary empirical evidence that coaching of doctoral students can facilitate the doctoral study process so that the doctoral students experience...

  8. Pay for performance of Estonian family doctors and impact of different practice- and patient-related characteristics on a good outcome: A quantitative assessment.

    Science.gov (United States)

    Merilind, Eero; Salupere, Rauno; Västra, Katrin; Kalda, Ruth

    2016-01-01

    Several practice- and patient-related characteristics are reported to have an influence on a good quality outcome. Estonia started the pay-for-performance (P4P) system for family doctors (FDs) in 2006. Every year the number of FDs participating in P4P has increased, but only half of the FDs achieved good outcome. The aim of this study was to find out which practice- and patient-related characteristics could have an impact on a good outcome. The study was conducted using the database from the Estonian Health Insurance Fund. All working FDs were divided into two groups (with "good" and "poor" outcomes) according their achievements in P4P. We chose characteristics which described structure (practice list size, number of doctors, composition of FDs list: age, number of chronically ill patients) during the observation period 2006-2012. During the observation period 2006-2012, the number of FDs with a good outcome in P4P increased from 6% (2006) to 53% (2012). The high number of FDs in primary care teams, longer experience of participation in P4P and the smaller number of patients on FDs' lists all have an impact on a good outcome. The number of chronically ill patients in FDs lists has no significant effect on an outcome, but P4P increases the number of disease-diagnosed patients. Different practice and patient-related characteristics have an impact on a good outcome. As workload increases, smaller lists of FDs patients or increased staff levels are needed in order to maintain a good outcome. Copyright © 2016 The Lithuanian University of Health Sciences. Production and hosting by Elsevier Urban & Partner Sp. z o.o. All rights reserved.

  9. Doctoral Women: Managing Emotions, Managing Doctoral Studies

    Science.gov (United States)

    Aitchison, Claire; Mowbray, Susan

    2013-01-01

    This paper explores the experiences of women doctoral students and the role of emotion during doctoral candidature. The paper draws on the concept of emotional labour to examine the two sites of emotional investment students experienced and managed during their studies: writing and family relationships. Emotion is perceived by many dominant…

  10. Summative assessment of undergraduates' communication competence in challenging doctor-patient encounters. Evaluation of the Düsseldorf CoMeD-OSCE.

    Science.gov (United States)

    Mortsiefer, Achim; Immecke, Janine; Rotthoff, Thomas; Karger, André; Schmelzer, Regine; Raski, Bianca; Schmitten, Jürgen In der; Altiner, Attila; Pentzek, Michael

    2014-06-01

    To evaluate the summative assessment (OSCE) of a communication training programme for dealing with challenging doctor-patient encounters in the 4th study year. Our OSCE consists of 4 stations (breaking bad news, guilt and shame, aggressive patients, shared decision making), using a 4-item global rating (GR) instrument. We calculated reliability coefficients for different levels, discriminability of single items and interrater reliability. Validity was estimated by gender differences and accordance between GR and a checklist. In a pooled sample of 456 students in 3 OSCEs over 3 terms, total reliability was α=0.64, reliability coefficients for single stations were >0.80, and discriminability in 3 of 4 stations was within the range of 0.4-0.7. Except for one station, interrater reliability was moderate to strong. Reliability on item level was poor and pointed to some problems with the use of the GR. The application of the GR on regular undergraduate medical education shows moderate reliability in need of improvement and some traits of validity. Ongoing development and evaluation is needed with particular regard to the training of the examiners. Our CoMeD-OSCE proved suitable for the summative assessment of communication skills in challenging doctor-patient encounters. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  11. Use of Information and Communication Technologies in Clinical Practice Related to the Treatment of Pain. Influence on the Professional Activity and the Doctor-Patient Relationship.

    Science.gov (United States)

    Fernandez, Jorge Muriel; Cenador, Maria Begoña García; Manuel López Millan, J; Méndez, Juan Antonio Juanes; Ledesma, María José Sánchez

    2017-05-01

    The increasing relevance of Information and Communication Technologies (ICTs) in medical care is indisputable. This evidence makes it necessary to start studies that analyse the scope these new forms of access to information and understanding of medicine have on the professional activity of the physician, on the attitude and on the knowledge of patients or, on the doctor-patient relationship. The purpose of this study is to explore some of these aspects in a group of physicians whose clinical activity is related to one of the greatest social impact health problems which is the treatment of chronic pain. Starting with the completion of a questionnaire, in the study group it is observed that the interaction between social structure, increase of information flows and ICTs generate transformations in social practices and behaviour of the actors of the health system. Internet is confirmed as an information space on the subject, but is shown as an underutilized space of interaction between the doctor and his patient.

  12. Sexual harassment in the physician-patient interaction: analysis of charges against doctors in the state of São Paulo

    Directory of Open Access Journals (Sweden)

    Claudio Cohen

    2009-11-01

    Full Text Available OBJECTIVE: This research intends to discuss sexual harassment within the doctor-patient relationship based on four parameters: doctor's characteristics, accuser's characteristics, accusation characteristics, and the evaluation by the Medicine Council of São Paulo. METHOD: It is a descriptive, quantitative approach using a retrospective documental analysis. Studied subjects were doctors who were allegedly engaged in sexual harassment. This analysis considered all accusations made from January 2000 to December 2005 (n=150. RESULTS: For this type of sexual abuse, there was a prevalence of male professionals (96.6% who committed abuse against female patients (90.3% during adulthood (77.7%. The mean age of the accused was 46.87 years, ranging from 30-76 years, concentrated between 46-75 years. The intrinsic difficulty of understanding sexual harassment by a professional constrained ethical evaluation of the cases, with 24.1% of the cases being considered proceeding charges by the professional council. When the cases were recognized as proceeding, they were either filed (88.2% or were considered to be ethical infringement (11.8% becoming Professional Ethical Process (PEP. In the majority of proceeding cases (87%, there was a Police Occurrence Report enclosed. DISCUSSION AND CONCLUSION: The incidence of sexual abuse by professionals was independent of education, as the accused professionals came from a large variety of medical colleges, without significant differences related to institution. The predominance of accusations against older professionals may occur due to the frail personality structure that allows professional acting out. Objective evidence is very important in ethical evaluations compared to psychological and subjective evidence.

  13. URGENT NEED OF A DOCTOR

    CERN Multimedia

    Medical Service

    2001-01-01

    IN URGENT NEED OF A DOCTOR GENEVA EMERGENCY SERVICES GENEVA AND VAUD 144 FIRE BRIGAD 118 POLICE 117 CERN FIREMEN 767-44-44 ANTI-POISONS CENTRE Open 24h/24h 01-251-51-51 Patient not fit to be moved, call family doctor, or: GP AT HOME, open 24h/24h 748-49-50 Association Of Geneva Doctors Emergency Doctors at home 07h-23h 322 20 20 Patient fit to be moved: HOPITAL CANTONAL CENTRAL 24 Micheli-du-Crest 372-33-11 ou 382-33-11 EMERGENCIES 382-33-11 ou 372-33-11 CHILDREN'S HOSPITAL 6 rue Willy-Donzé 372-33-11 MATERNITY 32 bvd.de la Cluse 382-68-16 ou 382-33-11 OPHTHALMOLOGY 22 Alcide Jentzer 382-33-11 ou 372-33-11 MEDICAL CENTRE CORNAVIN 1-3 rue du Jura 345 45 50 HOPITAL DE LA TOUR Meyrin EMERGENCIES 719-61-11 URGENCES PEDIATRIQUES 719-61-00 LA TOUR MEDICAL CENTRE 719-74-00 European EmergencyCall 112 FRANCE EMERGENCY SERVICES 15 FIRE BRIGADE 18 POLICE 17 CERN FIREMEN AT HOME 00-41-22-767-44-44 ANTI-POISONS CENTRE Open 24h/24h 04-72-11-69-11 All doctors will...

  14. Choosing a Family Doctor

    Science.gov (United States)

    ... and Birth Control Sex and Sexuality Birth Control Family Health Infants and Toddlers Kids and Teens Pregnancy ... Home Prevention and Wellness Staying Healthy Choosing a Family Doctor Choosing a Family Doctor Share Print What ...

  15. Occlusal rehabilitation in patients with congenitally missing teeth-dental implants, conventional prosthetics, tooth autotransplants, and preservation of deciduous teeth-a systematic review.

    Science.gov (United States)

    Terheyden, Hendrik; Wüsthoff, Falk

    2015-12-01

    Implant patients with congenitally missing teeth share some common charateristics and deserve special attention. The PICO question was "In patients with congenitally missing teeth, does an early occlusal rehabilitation with dental implants in comparison to tooth autotransplants, conventional prosthetics on teeth or preservation of deciduous teeth have better general outcomes in terms of survival, success and better patient centered outcomes in terms of quality of life, self-esteem, satisfaction, chewing function?" After electronic database search, a total of 63 relevant studies were eligible, of which 42 qualified for numerical data synthesis, 26 being retrospective studies. A data synthesis was performed by weighted means for survival/success/annual failure rates. The mean survival of implants was 95.3 % (prosthesis survival 97.8 %), autotransplants 94.4 %, deciduous teeth 89.6 %, and conventional prostheses 60.2 %. The implant survival in children, adolescents, and adults was 72.4, 93.0, and 97.4 %. Annual failure rates of implants 3.317 %, autotransplants 1.061 %, deciduous teeth 0.908 %, and conventional prostheses 5.144 % indicated better results for natural teeth and more maintenance needs for the both prosthetic treatments. The mean OHIP score was 27.8 at baseline and a mean improvement of 14.9 score points was reported after implant prosthetics. The mean satisfaction rates were 93.4 (implants), 76.6 (conventional prostheses), 72.0 (autotransplants), and 65.5 % (orthodontic space closure). In synopsis of general and patient-centered outcomes, implants yielded the best results, however, not in children prosthetics had lower survival/success rates than the other options. Due to heterogeneity and low number of studies, patient-reported outcomes in this review have to be interpreted with caution.

  16. Is preoperative MRCP necessary for patients with gallstones? An analysis of the factors related to missed diagnosis of choledocholithiasis by preoperative ultrasound.

    Science.gov (United States)

    Qiu, Yan; Yang, Zhengpeng; Li, Zhituo; Zhang, Weihui; Xue, Dongbo

    2015-11-14

    The diagnosis of associated choledocholithiasis prior to cholecystectomy for patients with gallstones is important for the surgical decision and treatment efficacy. However, whether ultrasound is sufficient for preoperative diagnosis of choledocholithiasis remains controversial, with different opinions on whether routine magnetic resonance cholangiopancreatography (MRCP) is needed to detect the possible presence of common bile duct (CBD) stones. In this study, a total of 413 patients with gallstones who were admitted to the Department of General Surgery of the First Affiliated Hospital of Harbin Medical University in China for a period of 3 years and underwent both ultrasound and MRCP examinations were retrospectively analysed. After reviewing and screening these cases according to the literature, 11 indicators including gender, age, alanine aminotransferase, aspartate aminotransferase, total bilirubin, direct bilirubin, indirect bilirubin, alkaline phosphatase, γ-aminotransferase, CBD diameter, and concurrent acute cholecystitis were selected and comparatively analysed. Among the 413 patients, a total of 109 cases showed concurrent gallstones and choledocholithiasis, accounting for 26.39 % of all cases. Among them, 60 cases of choledocholithiasis were revealed by ultrasound examination, accounting for 55.05 %, while 49 cases of choledocholithiasis were not detected by ultrasound examination but were confirmed by MRCP instead (the missed diagnosis rate of ultrasound was 44.95 %). The results of statistical analysis suggested that alanine aminotransferase, acute cholecystitis, and CBD diameter were the three most relevant factors for missed diagnosis by ultrasound. The accuracy of preoperative ultrasonography for the diagnosis of associated CBD stones for patients with gallstones is not high. However, elevated alanine aminotransferase, concurrent acute cholecystitis, and CBD diameter were identified as key factors that may affect the accuracy of the diagnosis. Thus

  17. Miss Lora juveelikauplus = Miss Lora jewellery store

    Index Scriptorium Estoniae

    2009-01-01

    Narvas Fama kaubanduskeskuses (Tallinna mnt. 19c) asuva juveelikaupluse Miss Lora sisekujundusest. Sisearhitektid Annes Arro ja Hanna Karits. Poe sisu - vitriinkapid, vaip, valgustid - on valmistatud eritellimusel. Sisearhitektide tähtsamate tööde loetelu

  18. Changing doctors' behaviours: an educational program to disseminate a new clinical pathway for the hospital management of hip fractures in elderly patients in the Lazio Region, Italy.

    Science.gov (United States)

    Ciaschi, Alma; Caprara, Andrea; Gillespie, Francesca; Furnari, Giacomo; Mamede, Sílvia

    2011-08-01

    Concerns with patient safety have increased interest in approaches to improving doctors' performance, yet dissemination of clinical guidelines and conventional continuing medical education have often failed. This study investigated the effects of an educational program based on reflection upon experience on the quality of care for patients with hip fracture in Lazio, Italy. Five hospitals participated. The study consisted of the development of a clinical pathway, a preparatory phase and the educational intervention itself, which comprised a course followed by monthly audits with reflection on practice, guided by analysis of patients' charts. Data on the quality of care for patients with hip fracture were collected from the routine information system for the period before and after the intervention. There was a significant increase in the proportion of patients who underwent surgery within 48 hours of admission (from 7% in 2006 to 26.4% in 2007) and a significant reduction in the average length of hospital stay (from 18.8 to 16.4 days). Some process indicators of quality of care were high after the intervention, though non-recommended practices were still routinely used (e.g. urinary catheterization in 72.2% of patients). There were differences in the changes when comparing hospitals. An educational intervention that combined the dissemination of a clinical pathway with external auditing geared to reflection upon practice was effective in promoting changes in doctors' behaviours. The persistence of non-recommended practices and the variation among hospitals indicate that multiple factors influence performance and affect the effectiveness of interventions. © 2010 Blackwell Publishing Ltd.

  19. Principled Missing Data Treatments.

    Science.gov (United States)

    Lang, Kyle M; Little, Todd D

    2018-04-01

    We review a number of issues regarding missing data treatments for intervention and prevention researchers. Many of the common missing data practices in prevention research are still, unfortunately, ill-advised (e.g., use of listwise and pairwise deletion, insufficient use of auxiliary variables). Our goal is to promote better practice in the handling of missing data. We review the current state of missing data methodology and recent missing data reporting in prevention research. We describe antiquated, ad hoc missing data treatments and discuss their limitations. We discuss two modern, principled missing data treatments: multiple imputation and full information maximum likelihood, and we offer practical tips on how to best employ these methods in prevention research. The principled missing data treatments that we discuss are couched in terms of how they improve causal and statistical inference in the prevention sciences. Our recommendations are firmly grounded in missing data theory and well-validated statistical principles for handling the missing data issues that are ubiquitous in biosocial and prevention research. We augment our broad survey of missing data analysis with references to more exhaustive resources.

  20. Aspects of Spirituality in Medical Doctors and Their Relation to Specific Views of Illness and Dealing with Their Patients' Individual Situation

    Directory of Open Access Journals (Sweden)

    Arndt Büssing

    2013-01-01

    Full Text Available We intended to analyse which aspects of spirituality are of relevance for medical doctors in a mostly secular society and how their spiritual/religious attitudes are related to specific views of illness, their dealing with patients' individual situation, and finally physicians' life satisfaction. Data from an anonymous survey enrolling 237 medical doctors from Germany (mean age 45.7 ± 9.6, 58% male, 42% female indicated that secular forms of spirituality scored highest, while specific religious orientation had the lowest scores. Physicians with a specific specialization in complementary/alternative medicine (CAM or anthroposophic medicine differed from their conventional counterparts with respect to specific aspects of spirituality; however, the specific views associated with these specialisations were only weakly to moderately correlated with physicians' view on the meaning of illness and how they assume that they would deal with their patients' individual situation. Of interest, the specific aspects of spirituality were negatively correlated with the view of “illness as a meaningless interruption” of life, indicating that physicians with a spiritual attitude would see illness also as a chance for an “individual development” and associated with a “biographical meaning” rather than just a “useless interruption” of life.

  1. Joint development of evidence-based medical record by doctors and patients through integrated Chinese and Western medicine on digestive system diseases.

    Science.gov (United States)

    Li, Bo; Gao, Hong-yang; Gao, Rui; Zhao, Ying-pan; Li, Qing-na; Zhao, Yang; Tang, Xu-dong; Shang, Hong-cai

    2016-02-01

    Building the clinical therapeutic evaluation system by combing the evaluation given by doctors and patients can form a more comprehensive and objective evaluation system. A literature search on the practice of evidence-based evaluation was conducted in key biomedical databases, i.e. PubMed, Excerpt Medica Database, China Biology Medicine disc and China National Knowledge Infrastructure. However, no relevant study on the subjects of interest was identified. Therefore, drawing on the principles of narrative medicine and expert opinion from systems of Chinese medicine and Western medicine, we propose to develop and pilot-test a novel evidence-based medical record format that captures the perspectives of both patients and doctors in a clinical trial. Further, we seek to evaluate a strategic therapeutic approach that integrates the wisdom of Chinese medicine with the scientific basis of Western medicine in the treatment of digestive system disorders. Evaluation of therapeutic efficacy of remedies under the system of Chinese medicine is an imperative ongoing research. The present study intends to identify a novel approach to assess the synergistic benefits achievable from an integrated therapeutic approach combining Chinese and Western system of medicine to treat digestive system disorders.

  2. Objectively Assessed Exercise Behavior in Chinese Patients with Early-Stage Cancer: A Predictor of Perceived Benefits, Communication with Doctors, Medical Coping Modes, Depression and Quality of Life.

    Science.gov (United States)

    Liu, Zhunzhun; Zhang, Lanfeng; Shi, Songsong; Xia, Wenkai

    2017-01-01

    This study sought to identify factors associated with objectively assessed exercise behavior in Chinese patients with early-stage cancer. Three hundred and fifty one cancer patients were recruited from the Affiliated Jiangyin Hospital of Southeast University Medical College and the Nantong Tumor Hospital. One-way ANOVA, Pearson Chi-square tests and regression analysis were employed to identify the correlations between physical exercise and the measured factors. The results showed that occupation type (χ2 = 14.065; p = 0.029), monthly individual monthly income level (χ2 = 24.795; p = 0.003), BMI (χ2 = 15.709; p = 0.015) and diagnosis (χ2 = 42.442; p exercise with different frequency per week. Differences in the frequency of exercise were associated with different degrees of reported Benefit Finding (BF) (F = 24.651; p exercise. Our results indicated that benefit finding, medical coping modes, communication with doctors, social support, depression and quality of life were significantly correlated with exercise. The variance in several psychosocial factors (benefit finding, medical coping modes, the communication with doctors, depression and quality of life) could be explained by exercise. Psychosocial factors should be addressed and examined over time when evaluating the effect of physical exercise that is prescribed as a clinically relevant treatment.

  3. Factors Affecting the Readiness of Medical Doctors and Patients with Chronic Conditions toward the Usage of Smartphones in the Saudi Arabian Healthcare Sector

    Directory of Open Access Journals (Sweden)

    Bassam M Al-Mahadeen

    2015-01-01

    Full Text Available Numerous studies have reported the rapid increase in the number of individuals who use smartphones. However, smartphones appear to be increasingly used by healthcare workers, particularly physicians and nurses. Therefore, this study aims to investigate the readiness of medical doctors and patients with chronic conditions in using and adopting smartphones for communication. This study employs the Technology Acceptance Model to examine the behavior of people in using smartphones from the perspectives of trust and rural areas. To realize our objective, we conducted a questionnaire survey that involved medical doctors and patients with chronic conditions. Our particular focus was Al Qunfudhah City in Saudi Arabia. More than 200 questionnaires were distributed to people belonging to different healthcare sectors in the rural areas of Al Qunfudhah City. Our aim was to include every possible scenario and to obtain excellent perspectives. The results that we eventually analyzed indicated that trust factor and rural areas significantly influence the readiness of people belonging to the healthcare sector toward using smartphones. The results of our study concur with the findings of other studies. Our results indicate that smartphones and other high-technology gadgets are now necessary and accepted devices in the different healthcare fields. However, further studies should explore the challenges and effects of smartphone use in the healthcare sector.

  4. Aspects of spirituality in medical doctors and their relation to specific views of illness and dealing with their patients' individual situation.

    Science.gov (United States)

    Büssing, Arndt; Hirdes, Almut Tabea; Baumann, Klaus; Hvidt, Niels Christian; Heusser, Peter

    2013-01-01

    We intended to analyse which aspects of spirituality are of relevance for medical doctors in a mostly secular society and how their spiritual/religious attitudes are related to specific views of illness, their dealing with patients' individual situation, and finally physicians' life satisfaction. Data from an anonymous survey enrolling 237 medical doctors from Germany (mean age 45.7 ± 9.6, 58% male, 42% female) indicated that secular forms of spirituality scored highest, while specific religious orientation had the lowest scores. Physicians with a specific specialization in complementary/alternative medicine (CAM) or anthroposophic medicine differed from their conventional counterparts with respect to specific aspects of spirituality; however, the specific views associated with these specialisations were only weakly to moderately correlated with physicians' view on the meaning of illness and how they assume that they would deal with their patients' individual situation. Of interest, the specific aspects of spirituality were negatively correlated with the view of "illness as a meaningless interruption" of life, indicating that physicians with a spiritual attitude would see illness also as a chance for an "individual development" and associated with a "biographical meaning" rather than just a "useless interruption" of life.

  5. Talking to Your Doctor

    Medline Plus

    Full Text Available ... to Your Doctor , National Eye Institute (NEI) Español Aging Planning Your Doctor Visit , NIHSeniorHealth.gov Videos: Talking ... A Guide for Older People , National Institute on Aging (NIA) Talking With Your Doctor Presentation Toolkit , National ...

  6. Learning curves, taking instructions, and patient safety: using a theoretical domains framework in an interview study to investigate prescribing errors among trainee doctors.

    Science.gov (United States)

    Duncan, Eilidh M; Francis, Jill J; Johnston, Marie; Davey, Peter; Maxwell, Simon; McKay, Gerard A; McLay, James; Ross, Sarah; Ryan, Cristín; Webb, David J; Bond, Christine

    2012-09-11

    Prescribing errors are a major source of morbidity and mortality and represent a significant patient safety concern. Evidence suggests that trainee doctors are responsible for most prescribing errors. Understanding the factors that influence prescribing behavior may lead to effective interventions to reduce errors. Existing investigations of prescribing errors have been based on Human Error Theory but not on other relevant behavioral theories. The aim of this study was to apply a broad theory-based approach using the Theoretical Domains Framework (TDF) to investigate prescribing in the hospital context among a sample of trainee doctors. Semistructured interviews, based on 12 theoretical domains, were conducted with 22 trainee doctors to explore views, opinions, and experiences of prescribing and prescribing errors. Content analysis was conducted, followed by applying relevance criteria and a novel stage of critical appraisal, to identify which theoretical domains could be targeted in interventions to improve prescribing. Seven theoretical domains met the criteria of relevance: "social professional role and identity," "environmental context and resources," "social influences," "knowledge," "skills," "memory, attention, and decision making," and "behavioral regulation." From critical appraisal of the interview data, "beliefs about consequences" and "beliefs about capabilities" were also identified as potentially important domains. Interrelationships between domains were evident. Additionally, the data supported theoretical elaboration of the domain behavioral regulation. In this investigation of hospital-based prescribing, participants' attributions about causes of errors were used to identify domains that could be targeted in interventions to improve prescribing. In a departure from previous TDF practice, critical appraisal was used to identify additional domains that should also be targeted, despite participants' perceptions that they were not relevant to

  7. Women who doctor shop for prescription drugs.

    Science.gov (United States)

    Worley, Julie; Thomas, Sandra P

    2014-04-01

    Doctor shopping is a term used to describe a form of diversion of prescription drugs when patients visit numerous prescribers to obtain controlled drugs for illicit use. Gender differences exist in regard to prescription drug abuse and methods of diversion. The purpose of this phenomenological study guided by the existential philosophy of Merleau-Ponty was to understand the lived experience of female doctor shoppers. Interviews were conducted with 14 women, which were recorded, transcribed, and analyzed. Included in the findings are figural aspects of the participants' experience of doctor shopping related to the existential grounds of world, time, body, and others. Four themes emerged from the data: (a) feeding the addiction, (b) networking with addicts, (c) playing the system, and (d) baiting the doctors. The findings suggest several measures that nurses can take to reduce the incidence of doctor shopping and to provide better care for female doctor shoppers.

  8. 'Covering doctors' standing in for unavailable colleagues: What is ...

    African Journals Online (AJOL)

    2018-01-19

    Jan 19, 2018 ... [1] In terms of contract, a doctor 'undertakes to treat a patient with the required skill and care, and a patient undertakes to pay their fees'.[1] Under the law of delict, once a doctor begins to provide care to a person or instructs other healthcare personnel on how to treat such a person, the doctor is regarded as ...

  9. The Evaluation of Saliva Flow Rate, pH, Buffer Capacity, Microbiological Content and Indice of Decayed, Missing and Filled Teeth in Behçet's Patients.

    Science.gov (United States)

    Erdem, Vildan; Yıldız, Mehmet; Erdem, Teoman

    2013-06-01

    Several lines of evidence indicate that oral microbial flora play a critical role in the pathogenesis of Behçet disease. Saliva flow rate, buffer capacity and microorganism content are very important in the maintenance of oral health. We aimed to evaluate saliva flow rate, pH, buffer capacity and Streptococcus mutans and Lactobacilli content along with the decayed, missing, and filled tooth index in Behçet's patients. Case-control study. Forty patients with active Behçet disease [female:male (F/M) 21/19, mean age 31.05±11.08 years] and forty healthy persons (F/M 21/19, mean age 31.03±9.14 years) were included in the study. The oral region was first examined, and the decayed, missing, and filled tooth index was calculated for each person. Stimulated saliva was collected and divided into two separate millimetric tubes to calculate the buffer capacity of the saliva, determine Streptococcus mutans and Lactobacilli levels and measure the pH of the saliva. A Caries Risk Test buffer strip was used to calculate the buffer capacity. Caries Risk Test bacterial kit was used to determine Streptococcus mutans and lactobacilli levels. A pH meter was used to measure the pH of the saliva. The mean saliva pH of the patients was higher than the controls (7.76±0.51, 7.18±0.46, respectively) (p0.05). We think that the maintenance of oral health by effective, regular tooth brushing, regular dental check-ups and dental treatment for Behçet patients is very important for the prevention and therapy of Behçet disease.

  10. The Evaluation of Saliva Flow Rate, pH, Buffer Capacity, Microbiological Content and Indice of Decayed, Missing and Filled Teeth in Behçet"s Patients

    Directory of Open Access Journals (Sweden)

    Vildan Erdem

    2013-06-01

    Full Text Available Background: Several lines of evidence indicate that oral microbial flora play a critical role in the pathogenesis of Behçet disease. Saliva flow rate, buffer capacity and microorganism content are very important in the maintenance of oral health. Aims: We aimed to evaluate saliva flow rate, pH, buffer capacity and Streptococcus mutans and Lactobacilli content along with the decayed, missing, and filled tooth index in Behçet’s patients. Study Design: Case-control study Methods: Forty patients with active Behçet disease [female:male (F/M 21/19, mean age 31.05±11.08 years] and forty healthy persons (F/M 21/19, mean age 31.03±9.14 years were included in the study. The oral region was first examined, and the decayed, missing, and filled tooth index was calculated for each person. Stimulated saliva was collected and divided into two separate millimetric tubes to calculate the buffer capacity of the saliva, determine Streptococcus mutans and Lactobacilli levels and measure the pH of the saliva. A Caries Risk Test buffer strip was used to calculate the buffer capacity. Caries Risk Test bacterial kit was used to determine Streptococcus mutans and lactobacilli levels. A pH meter was used to measure the pH of the saliva. Results: The mean saliva pH of the patients was higher than the controls (7.76±0.51, 7.18±0.46, respectively (p0.05. Conclusion: We think that the maintenance of oral health by effective, regular tooth brushing, regular dental check-ups and dental treatment for Behçet patients is very important for the prevention and therapy of Behçet disease.

  11. Burnout and Doctors: Prevalence, Prevention and Intervention

    Directory of Open Access Journals (Sweden)

    Shailesh Kumar

    2016-06-01

    Full Text Available Doctors are exposed to high levels of stress in the course of their profession and are particularly susceptible to experiencing burnout. Burnout has far-reaching implications on doctors; patients and the healthcare system. Doctors experiencing burnout are reported to be at a higher risk of making poor decisions; display hostile attitude toward patients; make more medical errors; and have difficult relationships with co-workers. Burnout among doctors also increases risk of depression; anxiety; sleep disturbances; fatigue; alcohol and drug misuse; marital dysfunction; premature retirement and perhaps most seriously suicide. Sources of stress in medical practice may range from the emotions arising in the context of patient care to the environment in which doctors practice. The extent of burnout may vary depending on the practice setting; speciality and changing work environment. Understanding dynamic risk factors associated with burnout may help us develop strategies for preventing and treating burnout. Some of these strategies will be reviewed in this paper.

  12. Burnout and Doctors: Prevalence, Prevention and Intervention.

    Science.gov (United States)

    Kumar, Shailesh

    2016-06-30

    Doctors are exposed to high levels of stress in the course of their profession and are particularly susceptible to experiencing burnout. Burnout has far-reaching implications on doctors; patients and the healthcare system. Doctors experiencing burnout are reported to be at a higher risk of making poor decisions; display hostile attitude toward patients; make more medical errors; and have difficult relationships with co-workers. Burnout among doctors also increases risk of depression; anxiety; sleep disturbances; fatigue; alcohol and drug misuse; marital dysfunction; premature retirement and perhaps most seriously suicide. Sources of stress in medical practice may range from the emotions arising in the context of patient care to the environment in which doctors practice. The extent of burnout may vary depending on the practice setting; speciality and changing work environment. Understanding dynamic risk factors associated with burnout may help us develop strategies for preventing and treating burnout. Some of these strategies will be reviewed in this paper.

  13. Multiple imputation: dealing with missing data.

    Science.gov (United States)

    de Goeij, Moniek C M; van Diepen, Merel; Jager, Kitty J; Tripepi, Giovanni; Zoccali, Carmine; Dekker, Friedo W

    2013-10-01

    In many fields, including the field of nephrology, missing data are unfortunately an unavoidable problem in clinical/epidemiological research. The most common methods for dealing with missing data are complete case analysis-excluding patients with missing data--mean substitution--replacing missing values of a variable with the average of known values for that variable-and last observation carried forward. However, these methods have severe drawbacks potentially resulting in biased estimates and/or standard errors. In recent years, a new method has arisen for dealing with missing data called multiple imputation. This method predicts missing values based on other data present in the same patient. This procedure is repeated several times, resulting in multiple imputed data sets. Thereafter, estimates and standard errors are calculated in each imputation set and pooled into one overall estimate and standard error. The main advantage of this method is that missing data uncertainty is taken into account. Another advantage is that the method of multiple imputation gives unbiased results when data are missing at random, which is the most common type of missing data in clinical practice, whereas conventional methods do not. However, the method of multiple imputation has scarcely been used in medical literature. We, therefore, encourage authors to do so in the future when possible.

  14. [Health behaviour of doctors].

    Science.gov (United States)

    Németh, Anikó

    2016-07-01

    Health behaviour involves maintaining, improving and restoration of health. The aim of the author was to assess correlations of health behaviour with age, gender, job type and overtime. A quantitative cross-sectional study was conducted using an online questionnaire (N = 186). Data were analyzed with chi-square, Kolmogorov-Smirnov, Mann-Whitney and Kruskal-Wallis tests. Doctors working in in-patient care drink more coffee (p = 0.034) and energy drinks (p = 0.018); they eat undisturbed only on weekends at home (p = 0.032). Men consume more alcohol (p = 0.003), red meats (pmeals (p = 0.018) and their daily fluid consumption exceeds 2 litres (p = 0.005); their body mass index values are higher compared to women (peat more hot meals (p = 0.005), and those under the age of 30 consume more crisps, fast food (p = 0.001) and energy drinks (p = 0.005), while they are more active (p = 0.010). Dietary habits of doctors are not ideal and their physical activity is diminished compared to international trends. Orv. Hetil., 2016, 157(30), 1198-1206.

  15. Missed Opportunities for HIV Diagnosis.

    Science.gov (United States)

    Downing, Asia; Garcia-Diaz, Julia B

    It has been previously shown that patients may present for multiple health issues in the years preceding their initial HIV diagnosis. This retrospective cohort study analyzed the data of patients with a new HIV diagnosis, at Ochsner Health System between January 1, 2011, and December 31, 2012. The primary end point was missed opportunities, the number of healthcare visits these patients made in the 2 years prior to being diagnosed with HIV. The 125 patients in the study cohort had 649 healthcare visits during which an HIV test was not performed. These missed opportunities are the key to capturing the undiagnosed and unaware HIV-positive individual. Primary care is an ideal setting to conduct HIV testing for those who have access to regular health care. However, nontraditional providers should also be encouraged to conduct HIV testing regardless of their ability to provide treatment because evidence shows that knowledge of the diagnosis may change behavior.

  16. How Healthcare Can Refocus on Its Super-Customers (Patients, n =1) and Customers (Doctors and Nurses) by Leveraging Lessons from Amazon, Uber, and Watson.

    Science.gov (United States)

    Kolker, Evelyne; Özdemir, Vural; Kolker, Eugene

    2016-06-01

    Healthcare is transforming with data-intensive omics technologies and Big Data. The "revolution" has already happened in technology, but the bottlenecks have shifted to the social domain: Who can be empowered by Big Data? Who are the users and customers? In this review and innovation field analysis, we introduce the idea of a "super-customer" versus "customer" and relate both to 21st century healthcare. A "super-customer" in healthcare is the patient, sample size of n = 1, while "customers" are the providers of healthcare (e.g., doctors and nurses). The super-customers have been patients, enabled by unprecedented social practices, such as the ability to track one's physical activities, personal genomics, patient advocacy for greater autonomy, and self-governance, to name but a few. In contrast, the originally intended customers-providers, doctors, and nurses-have relatively lagged behind. With patients as super-customers, there are valuable lessons to be learned from industry examples, such as Amazon and Uber. To offer superior quality service, healthcare organizations have to refocus on the needs, pains, and aspirations of their super-customers by enabling the customers. We propose a strategic solution to this end: the PPT-DAM (People-Process-Technology empowered by Data, Analytics, and Metrics) approach. When applied together with the classic Experiment-Execute-Evaluate iterative methodology, we suggest PPT-DAM is an extremely powerful approach to deliver quality health services to super-customers and customers. As an example, we describe the PPT-DAM implementation by the Benchmarking Improvement Program at the Seattle Children's Hospital. Finally, we forecast that cognitive systems in general and IBM Watson in particular, if properly implemented, can bring transformative and sustainable capabilities in healthcare far beyond the current ones.

  17. How stressful is doctor-patient communication? Physiological and psychological stress of medical students in simulated history taking and bad-news consultations.

    Science.gov (United States)

    Hulsman, Robert L; Pranger, Susan; Koot, Stephanie; Fabriek, Marcel; Karemaker, John M; Smets, Ellen M A

    2010-07-01

    Medical communication can be a stressful experience for both doctors and patients. In particular, inexperienced doctors facing the demanding task of a bad news consultation may experience high levels of distress. The aim of this exploratory study is to test students' differential cardiovascular reactivity to history taking and bad news consultations with a simulated patient, and to test the relation between the students' self-reported stressfulness of the consultation and their cardiovascular response. Fourth and fifth year medical students (n=20) conducted a history taking (HT) and a bad news (BN) consultation in a randomized order with a standardized patient. Heart rate (HR), mean arterial pressure (MAP), cardiac output (CO) and systemic vascular resistance (SVR) were assessed by way of the Finapres-technique in four conditions: rest, reading aloud, and during both consultations. Self-reported stress was assessed before and after each interview using the State and Trait Anxiety Inventory (STAI), and a visual analogue scale (VAS). Both HT and BN provoked more cardiovascular stress than reading. Bad-news provoked the highest HR and CO responses compared to all other conditions, and had a greater impact when it was the student's first consultation. The STAI and VAS data showed some correlations with the cardiovascular stress measures and a comparable but less significant pattern in stress response. The effect of order of the HT and BN consultations on the students' stress levels suggests an additional impact of novelty and habituation. Unfamiliarity with the patient may enhance the stressfulness of the task of breaking bad news. 2010 Elsevier B.V. All rights reserved.

  18. Gastric cancer missed at endoscopy | Gado | Alexandria Journal of ...

    African Journals Online (AJOL)

    with biopsies) is the gold standard for its diagnosis but missed oesophageal and gastric cancers are not infrequent in patients who have undergone previous endoscopy. Errors by the endoscopist account for the majority of these missed lesions.

  19. Do multimorbidity and deprivation influence patients' emotional expressions and doctors' responses in primary care consultations?--An exploratory study using multilevel analysis.

    Science.gov (United States)

    Zhou, Yuefang; Lundy, Jenna-Marie; Humphris, Gerry; Mercer, Stewart William

    2015-09-01

    To explore whether and how patient multimorbidity and socioeconomic deprivation might influence patients' emotional expression and doctors' responses in the general practice (GP) consultations. Video recordings of 107 consultations (eight GPs) were coded with the Verona Coding Definitions of Emotional Sequences (VR-CoDES). Multilevel logistic regressions modelled the probability of GP providing space response, considering patient multimorbidity, deprivation conditions and other contextual factors. Further multinomial regressions explored the possible impact of multimorbidity and deprivation on expression of and specific responses to patients' emotional distress. It was less likely for GPs to provide space as the consultation proceeded, controlling for multimorbidity and deprivation variables. Patients with multimorbidity were less likely to express emotional distress in an explicit form. GPs were more likely to provide acknowledgement to emotions expressed by patients from more deprived areas. Multimorbidity and deprivation may influence the dynamics of the GP consultations in specific ways. Rigorous methodologies using larger samples are required to explore further how these two variables relate to each other and influence cue expression, provider response and subsequent patient outcomes. Understanding how multimorbidity and deprivation impact on GP consultations may help inform future service improvement programmes. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  20. Atraumatic diplaced bilateral femoral neck fracture in a patient with hypophosphatemic rickets in postpartum period: A missed diagnosis

    Directory of Open Access Journals (Sweden)

    Erdal Uzun

    2016-01-01

    Conclusion: For patients with bone metabolic diseases and/or the patients in pregnancy and postpartum period, preventive measures should be increased to reduce the risk of pathologic fracture. Admitting to the hospital physicians must be more careful about detecting fractures in these patients.

  1. Susceptibility to hepatitis A in patients with chronic liver disease due to hepatitis C virus infection: missed opportunities for vaccination.

    Science.gov (United States)

    Shim, Michael; Khaykis, Inessa; Park, James; Bini, Edmund J

    2005-09-01

    Hepatitis A virus (HAV) superinfection is associated with a high risk of liver failure and death in patients with underlying chronic liver disease. Although HAV vaccination is recommended for all patients with chronic hepatitis C virus (HCV) infection, little is known about adherence to these recommendations in clinical practice. The aims of this study were to determine the frequency of HAV testing and vaccination among patients with chronic HCV infection. We conducted a retrospective cohort study of 1,193 patients diagnosed with chronic HCV infection over a 1-year period. During 1,646 person-years of follow-up, patients were seen by their primary care provider a median of 10.0 times (interquartile range, 4.0-20.0). HAV antibody testing was performed in 640 subjects (53.6%), and 317 (49.5%) of those tested were susceptible (HAV antibody negative). Only 94 of the 1,193 patients (7.9%) received the HAV vaccine, including 26.8% of the 317 susceptible patients, 0.9% of the 323 patients who were already immune to HAV, and 1.1% of the 553 subjects who were never tested. Among the 94 vaccinated patients, 45 received only one dose of the vaccine. Three of the unvaccinated patients developed acute HAV infection during follow-up, and 1 of them died of acute liver failure. In conclusion, despite published recommendations to vaccinate against HAV in patients with chronic HCV infection, we found that HAV testing and vaccination rates were low in clinical practice. Public health programs to increase awareness about HAV vaccination in patients with chronic liver disease are needed.

  2. What 'outliers' tell us about missed opportunities for tuberculosis control: a cross-sectional study of patients in Mumbai, India

    Directory of Open Access Journals (Sweden)

    Porter John DH

    2010-05-01

    Full Text Available Abstract Background India's Revised National Tuberculosis Control Programme (RNTCP is deemed highly successful in terms of detection and cure rates. However, some patients experience delays in accessing diagnosis and treatment. Patients falling between the 96th and 100th percentiles for these access indicators are often ignored as atypical 'outliers' when assessing programme performance. They may, however, provide clues to understanding why some patients never reach the programme. This paper examines the underlying vulnerabilities of patients with extreme values for delays in accessing the RNTCP in Mumbai city, India. Methods We conducted a cross-sectional study with 266 new sputum positive patients registered with the RNTCP in Mumbai. Patients were classified as 'outliers' if patient, provider and system delays were beyond the 95th percentile for the respective variable. Case profiles of 'outliers' for patient, provider and system delays were examined and compared with the rest of the sample to identify key factors responsible for delays. Results Forty-two patients were 'outliers' on one or more of the delay variables. All 'outliers' had a significantly lower per capita income than the remaining sample. The lack of economic resources was compounded by social, structural and environmental vulnerabilities. Longer patient delays were related to patients' perception of symptoms as non-serious. Provider delays were incurred as a result of private providers' failure to respond to tuberculosis in a timely manner. Diagnostic and treatment delays were minimal, however, analysis of the 'outliers' revealed the importance of social support in enabling access to the programme. Conclusion A proxy for those who fail to reach the programme, these case profiles highlight unique vulnerabilities that need innovative approaches by the RNTCP. The focus on 'outliers' provides a less resource- and time-intensive alternative to community-based studies for

  3. Orthodontic Space Closure Versus Prosthetic Replacement of Missing Upper Lateral Incisors in Patients With Bilateral Cleft Lip and Palate

    NARCIS (Netherlands)

    Oosterkamp, Barbara C. M.; Dijkstra, Pieter U.; Remmelink, Hendrik J.; van Oort, Robert P.; Sandham, John

    2010-01-01

    Objective To compare dental aesthetics and function of orthodontic space closure versus prosthetic replacement of upper lateral incisors in patients with bilateral cleft lip and palate The predominant mode of prosthetic replacement was resin-bonded bridges Patients and Methods The retrospective

  4. De-isolation of patients with pulmonary tuberculosis after start of treatment - clear, unequivocal guidelines are missing

    DEFF Research Database (Denmark)

    Petersen, Eskild; Khamis, Faryal; Migliori, Giovanni Battista

    2017-01-01

    The study review guidelines on isolation of patients with tuberculosis, TB, from the World Health Organization, WHO, Centers for Disease Control and Prevention, CDC, and the European Center for Disease Control, ECDC. The review found that unequivocal guidelines for removing patients out of negati...

  5. Orthodontic space closure versus prosthetic replacement of missing upper lateral incisors in patients with bilateral cleft lip and palate.

    Science.gov (United States)

    Oosterkamp, Barbara C M; Dijkstra, Pieter U; Remmelink, Hendrik J; van Oort, Robert P; Sandham, Andrew

    2010-11-01

    To compare dental aesthetics and function of orthodontic space closure versus prosthetic replacement of upper lateral incisors in patients with bilateral cleft lip and palate. The predominant mode of prosthetic replacement was resin-bonded bridges. The retrospective study group consisted of 17 patients treated with orthodontic space closure (13 men, four women; median age, 27.1 years; interquartile range, 20.6 to 33.3 years) and 10 patients treated with prosthetic replacement (five men, five women; median age, 27.7 years; interquartile range, 20.9 to 39.7 years). Dental aesthetics were evaluated by the patients and by a professional panel. Mandibular function was evaluated by means of the mandibular function impairment questionnaire. The level of mandibular impairment was calculated using the Function Impairment Rating Scale. With respect to dental aesthetics, no significant differences between patients treated with orthodontic space closure and prosthetic replacement were found. With respect to function, the level of mandibular impairment was significantly higher in patients treated with prosthetic replacement compared with patients treated with orthodontic space closure, as indicated by high scores on specific masticatory functions. Orthodontic space closure and prosthetic replacement in bilateral cleft lip and palate patients produce similar results in terms of aesthetics. In terms of function, prosthetic replacement results in significantly more impairment of specific masticatory functions.

  6. Conscious sedation for endoscopic and non-endoscopic interventional gastrointestinal procedures: meeting patients' expectations, missing the standard

    Energy Technology Data Exchange (ETDEWEB)

    Marriott, P.; Laasch, H.-U.; Wilbraham, L.; Marriott, A.; England, R.E.; Martin, D.F. E-mail: derrick.martin@smtr.nhs.uk

    2004-02-01

    AIM: To assess the level of sedation, patient satisfaction and frequency of unplanned events with conscious sedation for interventional procedures. MATERIALS AND METHODS: One hundred and seventeen patients were assessed prospectively before, during and after procedures. Blood pressure, pulse, oxygen saturation and sedation level were monitored and patients followed up after 24 h. Sedation was scored after drugs were given in accordance with an established protocol. Doses were recorded, as were patients' weight, age and ASA grade and any unplanned events and their management. RESULTS: Seventy-six of the 117 patients (65%) had no unplanned event, 20 (17.1%) became agitated, 15 (12.8%) hypotensive, three (2.6%) hypoxic and three (2.6%) had more than one response. Twelve patients required active management. Fifty-two (44.4%) had a sedation level of {<=}3 (responsive to verbal commands), but 39 (33.3%) reached level 6. Median doses were midazolam 6 mg (1-20 mg) and pethidine 50 mg (12.5-100 mg). Ninety-three percent were satisfied with their sedation. No adverse effects were observed after 24 h. CONCLUSION: Despite using a sedation protocol, unplanned events occurred in 35% (95% CI=27-44%) of patients, although not all required active management. The sedation levels reached in some exceeded guidelines. Unplanned events were commoner with increased sedation level. Patient satisfaction was high and no permanent damage was observed.

  7. Conscious sedation for endoscopic and non-endoscopic interventional gastrointestinal procedures: meeting patients' expectations, missing the standard

    International Nuclear Information System (INIS)

    Marriott, P.; Laasch, H.-U.; Wilbraham, L.; Marriott, A.; England, R.E.; Martin, D.F.

    2004-01-01

    AIM: To assess the level of sedation, patient satisfaction and frequency of unplanned events with conscious sedation for interventional procedures. MATERIALS AND METHODS: One hundred and seventeen patients were assessed prospectively before, during and after procedures. Blood pressure, pulse, oxygen saturation and sedation level were monitored and patients followed up after 24 h. Sedation was scored after drugs were given in accordance with an established protocol. Doses were recorded, as were patients' weight, age and ASA grade and any unplanned events and their management. RESULTS: Seventy-six of the 117 patients (65%) had no unplanned event, 20 (17.1%) became agitated, 15 (12.8%) hypotensive, three (2.6%) hypoxic and three (2.6%) had more than one response. Twelve patients required active management. Fifty-two (44.4%) had a sedation level of ≤3 (responsive to verbal commands), but 39 (33.3%) reached level 6. Median doses were midazolam 6 mg (1-20 mg) and pethidine 50 mg (12.5-100 mg). Ninety-three percent were satisfied with their sedation. No adverse effects were observed after 24 h. CONCLUSION: Despite using a sedation protocol, unplanned events occurred in 35% (95% CI=27-44%) of patients, although not all required active management. The sedation levels reached in some exceeded guidelines. Unplanned events were commoner with increased sedation level. Patient satisfaction was high and no permanent damage was observed

  8. Satisfaction Levels and Factors Influencing Satisfaction With Use of a Social App for Neonatal and Pediatric Patient Transfer Information Systems: A Questionnaire Study Among Doctors.

    Science.gov (United States)

    Choi, Iee; Kim, Jin Kyu; Kim, Sun Jun; Cho, Soo Chul; Kim, Il Nyeo

    2016-08-04

    The treatment of neonatal and pediatric patients is limited to certain medical institutions depending on treatment difficulty. Effective patient transfers are necessary in situations where there are limited medical resources. In South Korea, the government has made a considerable effort to establish patient transfer systems using various means, such as websites, telephone, and so forth. However, in reality, the effort has not yet been effective. In this study, we ran a patient transfer information system using a social app for effective patient transfer. We analyzed the results, satisfaction levels, and the factors influencing satisfaction. Naver Band is a social app and mobile community application which in Korea is more popular than Facebook. It facilitates group communication. Using Naver Band, two systems were created: one by the Neonatal Intensive Care Unit and the other by the Department of Pediatrics at Chonbuk National University Children's Hospital, South Korea. The information necessary for patient transfers was provided to participating obstetricians (n=51) and pediatricians (n=90). We conducted a survey to evaluate the systems and reviewed the results retrospectively. The number of patients transferred was reported to increase by 65% (26/40) obstetricians and 40% (23/57) pediatricians. The time taken for transfers was reported to decrease by 72% (29/40) obstetricians and 59% (34/57) pediatricians. Satisfaction was indicated by 83% (33/40) obstetricians and 89% (51/57) pediatricians. Regarding factors influencing satisfaction, the obstetricians reported communication with doctors in charge (P=.03) and time reduction during transfers (P=.02), whereas the pediatricians indicated review of the diagnosis and treatment of transferred patients (P=.01) and the time reduction during transfers (P=.007). The users were highly satisfied and different users indicated different factors of satisfaction. This finding implies that users' requirements should be

  9. Communication Tools for the Modern Doctor Bag. Physician Patient Communication Part 1: Beginning of a medical interview

    OpenAIRE

    Kuehl, Sapna Patel

    2011-01-01

    Effective physician patient communication is essential to best practice in medicine. Good communication with patients is critical in making the right diagnosis, improving compliance and overall outcomes for our patients (as well as improving physician satisfaction.) Communication skills can be learned and need to be taught, practiced and given the same emphasis as other core competencies in medicine. The focus of this article is on the Calgary-Cambridge Model for physician patient communicati...

  10. Sexual Harassment in the Physician-Patient Interaction: Analysis of Charges Against Doctors in the State of São Paulo

    Science.gov (United States)

    Cohen, Claudio; Kelian, Rogério L’Abbate; Oliveira, Reinaldo Ayer; Gobbetti, Gisele Joana; Massad, Eduardo

    2009-01-01

    OBJECTIVE This research intends to discuss sexual harassment within the doctor-patient relationship based on four parameters: doctor’s characteristics, accuser’s characteristics, accusation characteristics, and the evaluation by the Medicine Council of São Paulo. METHOD It is a descriptive, quantitative approach using a retrospective documental analysis. Studied subjects were doctors who were allegedly engaged in sexual harassment. This analysis considered all accusations made from January 2000 to December 2005 (n=150). RESULTS For this type of sexual abuse, there was a prevalence of male professionals (96.6%) who committed abuse against female patients (90.3%) during adulthood (77.7%). The mean age of the accused was 46.87 years, ranging from 30–76 years, concentrated between 46–75 years. The intrinsic difficulty of understanding sexual harassment by a professional constrained ethical evaluation of the cases, with 24.1% of the cases being considered proceeding charges by the professional council. When the cases were recognized as proceeding, they were either filed (88.2%) or were considered to be ethical infringement (11.8%) becoming Professional Ethical Process (PEP). In the majority of proceeding cases (87%), there was a Police Occurrence Report enclosed. DISCUSSION AND CONCLUSION The incidence of sexual abuse by professionals was independent of education, as the accused professionals came from a large variety of medical colleges, without significant differences related to institution. The predominance of accusations against older professionals may occur due to the frail personality structure that allows professional acting out. Objective evidence is very important in ethical evaluations compared to psychological and subjective evidence. PMID:19936181

  11. The Sexual Exploitation of Missing Children: A Research Review.

    Science.gov (United States)

    Hotaling, Gerald T.; Finkelhor, David

    This paper evaluates current knowledge about the prevalence, dynamics, and short- and long-term effects of sexual exploitation among missing children. It is based upon empirical research findings from books, papers presented at professional meetings, doctoral dissertations, works in progress, and more than 75 articles in professional journals.…

  12. "Doctor, please tell me it's nothing serious": an exploration of patients' worrying and reassuring cognitions using stimulated recall interviews

    NARCIS (Netherlands)

    Giroldi, E.; Veldhuijzen, W.; Mannaerts, A.; Weijden, T.T. van der; Bareman, F.; Vleuten, C.P.M. van der

    2014-01-01

    BACKGROUND: Many patients who consult their GP are worried about their health, but there is little empirical data on strategies for effective reassurance. To gain a better understanding of mechanisms for effective patient reassurance, we explored cognitions underlying patients' worries, cognitions

  13. "Doctor, please tell me it's nothing serious": An exploration of patients' worrying and reassuring cognitions using stimulated recall interviews

    NARCIS (Netherlands)

    E. Giroldi (Esther); W. Veldhuijzen (Wemke); A. Mannaerts (Alexandra); T. van der Weijden (Trudy); F. Bareman (Frits); C.P.M. van der Vleuten (Cees)

    2014-01-01

    textabstractBackground: Many patients who consult their GP are worried about their health, but there is little empirical data on strategies for effective reassurance. To gain a better understanding of mechanisms for effective patient reassurance, we explored cognitions underlying patients' worries,

  14. Patient safety in primary care has many aspects: an interview study in primary care doctors and nurses.

    NARCIS (Netherlands)

    Gaal, S.; Laarhoven, E. van; Wolters, R.J.; Wetzels, R.; Verstappen, W.H.J.M.; Wensing, M.J.P.

    2010-01-01

    RATIONALE, AIMS AND OBJECTIVES: Scientific definitions of patient safety may be difficult to apply in routine health care delivery. It is unknown what primary care workers consider patient safety. This study aimed to clarify the concept of patient safety in primary care. METHODS: We held 29

  15. Missed Radiation Therapy and Cancer Recurrence

    Science.gov (United States)

    Patients who miss radiation therapy sessions during cancer treatment have an increased risk of their disease returning, even if they eventually complete their course of radiation treatment, according to a new study.

  16. Barriers to effective, safe communication and workflow between nurses and non-consultant hospital doctors during out-of-hours.

    Science.gov (United States)

    Brady, Anne-Marie; Byrne, Gobnait; Quirke, Mary Brigid; Lynch, Aine; Ennis, Shauna; Bhangu, Jaspreet; Prendergast, Meabh

    2017-11-01

    This study aimed to evaluate the nature and type of communication and workflow arrangements between nurses and doctors out-of-hours (OOH). Effective communication and workflow arrangements between nurses and doctors are essential to minimize risk in hospital settings, particularly in the out-of-hour's period. Timely patient flow is a priority for all healthcare organizations and the quality of communication and workflow arrangements influences patient safety. Qualitative descriptive design and data collection methods included focus groups and individual interviews. A 500 bed tertiary referral acute hospital in Ireland. Junior and senior Non-Consultant Hospital Doctors, staff nurses and nurse managers. Both nurses and doctors acknowledged the importance of good interdisciplinary communication and collaborative working, in sustaining effective workflow and enabling a supportive working environment and patient safety. Indeed, issues of safety and missed care OOH were found to be primarily due to difficulties of communication and workflow. Medical workflow OOH is often dependent on cues and communication to/from nursing. However, communication systems and, in particular the bleep system, considered central to the process of communication between doctors and nurses OOH, can contribute to workflow challenges and increased staff stress. It was reported as commonplace for routine work, that should be completed during normal hours, to fall into OOH when resources were most limited, further compounding risk to patient safety. Enhancement of communication strategies between nurses and doctors has the potential to remove barriers to effective decision-making and patient flow. © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  17. Reasons for missed appointments linked to a public-sector intervention targeting patients with stable chronic conditions in South Africa: results from in-depth interviews and a retrospective review of medical records.

    Science.gov (United States)

    Magadzire, Bvudzai P; Mathole, Thubelihle; Ward, Kim

    2017-08-24

    Missed appointments serve as a key indicator for adherence to therapy and as such, identifying patient reasons for this inconsistency could assist in developing programmes to improve health outcomes. In this article, we explore the reasons for missed appointments linked to a centralised dispensing system in South Africa. This system dispenses pre-packed, patient-specific medication parcels for clinically stable patients to health facilities. However, at least 8%-12% of about 300,000 parcels are not collected each month. This article aims to establish whether missed appointments for collection of medicine parcels are indicative of loss-to-follow-up and also to characterise the patient and health system factors linked to missed appointments. We applied an exploratory mixed-methods design in two overlapping research phases. This involved in-depth interviews to yield healthcare practitioners' and patients' experiences and medical record reviews. Data collection was conducted during the period 2014-2015. Qualitative data were analysed through a hybrid process of inductive and deductive thematic analysis which integrated data-driven and theory-driven codes. Data from medical records (N = 89) were analysed in MS excel using both descriptive statistics and textual descriptions. Review of medical records suggests that the majority of patients (67%) who missed original appointments later presented voluntarily to obtain medicines. This could indicate a temporal effect of some barriers. The remaining 33% revealed a range of CDU implementation issues resulting from, among others, erroneous classification of patients as defaulters. Interviews with patients revealed the following reasons for missed appointments: temporary migration, forgetting appointments, work commitments and temporary switch to private care. Most healthcare practitioners confirmed these barriers to collection but perceived that some were beyond the scope of health services. In addition, healthcare

  18. Communication Tools for the Modern Doctor Bag. Physician Patient Communication Part 1: Beginning of a medical interview.

    Science.gov (United States)

    Kuehl, Sapna Patel

    2011-01-01

    Effective physician patient communication is essential to best practice in medicine. Good communication with patients is critical in making the right diagnosis, improving compliance and overall outcomes for our patients (as well as improving physician satisfaction.) Communication skills can be learned and need to be taught, practiced and given the same emphasis as other core competencies in medicine. The focus of this article is on the Calgary-Cambridge Model for physician patient communication in the context of a medical interview. The beginning of a patient encounter is discussed, with emphasis on appropriate introductions and attentive active listening.

  19. Communication Tools for the Modern Doctor Bag. Physician Patient Communication Part 1: Beginning of a medical interview

    Directory of Open Access Journals (Sweden)

    Sapna Patel Kuehl

    2011-10-01

    Full Text Available Effective physician patient communication is essential to best practice in medicine. Good communication with patients is critical in making the right diagnosis, improving compliance and overall outcomes for our patients (as well as improving physician satisfaction. Communication skills can be learned and need to be taught, practiced and given the same emphasis as other core competencies in medicine. The focus of this article is on the Calgary-Cambridge Model for physician patient communication in the context of a medical interview. The beginning of a patient encounter is discussed, with emphasis on appropriate introductions and attentive active listening.

  20. Radiation therapy - questions to ask your doctor

    Science.gov (United States)

    What to ask your doctor about radiation therapy ... National Cancer Institute website. Radiation therapy and you: support for people with cancer. www.cancer.gov/publications/patient-education/radiationttherapy.pdf . Updated May 2007. Accessed December ...

  1. Is it a matter of urgency? A survey of assessments by walk-in patients and doctors of the urgency level of their encounters at a general emergency outpatient clinic in Oslo, Norway.

    Science.gov (United States)

    Ruud, Sven Eirik; Hjortdahl, Per; Natvig, Bård

    2016-07-04

    Emergency room (ER) use is increasing in several countries. Variability in the proportion of non-urgent ER visits was found to range from 5 to 90 % (median 32 %). Non-urgent emergency visits are considered an inappropriate and inefficient use of the health-care system because they may lead to higher expenses, crowding, treatment delays, and loss of continuity of health care provided by a general practitioner. Urgency levels of doctor-walk-in patient encounters were assessed based on their region of origin in a diverse Norwegian population. An anonymous, multilingual questionnaire was distributed to all walk-in patients at a general emergency outpatient clinic in Oslo during two weeks in September 2009. We analysed demographic data, patient-doctor assessments of the level of urgency, and the results of the consultation. We used descriptive statistics to obtain frequencies with 95 % confidence interval (CI) for assessed levels of urgency and outcomes. Concordance between the patients' and doctors' assessments was analysed using a Kendall tau-b test. We used binary logistic regression modelling to quantify associations of explanatory variables and outcomes according to urgency level assessments. The analysis included 1821 walk-in patients. Twenty-four per cent of the patients considered their emergency consultation to be non-urgent, while the doctors considered 64 % of encounters to be non-urgent. The concordance between the assessments by the patient and by their doctor was positive but low, with a Kendall tau-b coefficient of 0.202 (p < 0.001). Adjusted logistic regression analysis showed that patients from Eastern Europe (odds ratio (OR) = 3.04; 95 % CI 1.60-5.78), Asia and Turkey (OR = 4.08; 95 % CI 2.43-6.84), and Africa (OR = 8.47; 95 % CI 3.87-18.5) reported significantly higher urgency levels compared with Norwegians. The doctors reported no significant difference in assessment of urgency based on the patient's region of origin, except

  2. Patient and System Factors Related to Missed Opportunities for Screening in an Electronic Medical Record-driven, Opt-out HIV Screening Program in the Emergency Department.

    Science.gov (United States)

    Lin, Janet; Baghikar, Sara; Mauntel-Medici, Cammeo; Heinert, Sara; Patel, Daven

    2017-11-01

    Emergency departments (EDs) have implemented HIV screening using a variety of strategies. This study investigates how specific patient and health system factors in the ED impact who is and is not screened in a combined targeted and nontargeted, electronic medical record (EMR)-driven, opt-out, HIV screening program. This was a retrospective, cross-sectional study of ED visits where patients were determined eligible for HIV screening by an EMR algorithm between November 18, 2014, and July 15, 2015. The HIV screening workflow included three sequential events, all of which were required to get screened for HIV at the ED visit. The events were having a blood draw, being informed of the HIV screening policy by an ED nurse at the point of blood draw, and the patient consenting to the HIV test. Each event represented a dichotomous outcome and its association with six patient factors (age, sex, race/ethnicity, marital status, preferred language, and Emergency Severity Index [ESI]) and two health system factors (ED crowding and program phase) was investigated using multivariable modeling. A total of 15,918 ED visits were analyzed. Blood was drawn in 8,388 of 15,918 visits (53%). Of 8,388 visits where blood was drawn, there were 5,947 (71%) visits where ED nurses documented informing patients of the HIV screening policy. Of those visits, patient consent to the HIV test was documented at 3,815 (64%) visits. Patients between 13 and 19 years of age were significantly less likely to have blood drawn, to be informed of the screening policy, and to consent to the HIV test compared to other age groups. Both ED crowding and a patient's ESI were associated with decreased odds of having a blood draw and being informed of HIV screening by an ED nurse, but showed no association with patients consenting to the HIV test. Many patients, particularly adolescents and young adults, are missed in ED HIV screening programs that require blood draw and depend on providers to obtain consent for

  3. Can patient safety be improved by reducing the volume of “inappropriate prescribing tasks” handed over to out-of-hours junior doctors?

    Directory of Open Access Journals (Sweden)

    Amis SM

    2018-03-01

    Full Text Available Samuel Martin Amis, Tobin Henry Edgar Osicki Department of Acute Internal Medicine, South Warwickshire Foundation Trust, Warwick, UK Background: First-year doctors found that during out-of-hours shifts they were being delayed and distracted from reviewing potentially sick/deteriorating patients by a high volume of prescribing tasks. This predominately consisted of oral anticoagulation prescribing and rewrites of drug charts. We hoped that if we could reduce this burden of “inappropriate prescribing tasks”, we could not only improve junior doctors’ job satisfaction and opportunities for training but also give them more time for patient reviews. Methods: Three weekends were initially audited to quantify the number of “inappropriate prescribing tasks” using data from the hospital’s computerized task assigning system. On three subsequent weekends, a checklist was handed out to the ward teams on Friday mornings. This checklist was designed to encourage the day teams to check that drug charts would not need oral anticoagulation or rewriting over the weekend. Results: An overall reduction in “inappropriate prescribing tasks” of 46% with a specific reduction in inappropriate oral anticoagulation prescribing of 65% was observed. Inappropriate drug chart rewrites were reduced by 30%. The reduction in the mean number of pre-intervention inappropriate prescribing tasks (as a percentage of total prescribing tasks and the post-intervention mean was 6.94% (95% confidence interval −0.54 to 14.42, p-value=0.062. Conclusion: Improved job satisfaction and a perceived reduced workload were noted from post-intervention qualitative surveys. While improved patient safety directly resulting from this intervention is more difficult to establish, and the observed reduction in inappropriate prescribing was only approaching statistical significance, our colleagues commented in post-intervention feedback that they felt they had more time, and felt less

  4. Patch testing with a new fragrance mix detects additional patients sensitive to perfumes and missed by the current fragrance mix

    DEFF Research Database (Denmark)

    Frosch, Peter J; Pirker, Claudia; Rastogi, Suresh C

    2005-01-01

    The currently used 8% fragrance mix (FM I) does not identify all patients with a positive history of adverse reactions to fragrances. A new FM II with 6 frequently used chemicals was evaluated in 1701 consecutive patients patch tested in 6 dermatological centres in Europe. FM II was tested in 3...... regarding a history of adverse reactions to fragrances: certain, probable, questionable, none. Positive reactions to FM I occurred in 6.5% of the patients. Positive reactions to FM II were dose-dependent and increased from 1.3% (2.8% FM II), through 2.9% (14% FM II) to 4.1% (28% FM II). Reactions classified...... as doubtful or irritant varied considerably between the 6 centres, with a mean value of 7.2% for FM I and means ranging from 1.8% to 10.6% for FM II. 8.7% of the tested patients had a certain fragrance history. Of these, 25.2% were positive to FM I; reactivity to FM II was again dose-dependent and ranged from...

  5. What is a good doctor?

    Science.gov (United States)

    Steiner-Hofbauer, Verena; Schrank, Beate; Holzinger, Anita

    2017-09-13

    Changes in medical curricula have led to a shift of focus in medical education. The goal was to implement a more practical approach to teaching and thereby create better doctors. However, the question of what makes a good doctor is not easy to answer. This article gives an overview on the literature about this topic. A systematized review and narrative synthesis were conducted including 20 articles about the features of good doctors. Qualitative and quantitative studies as well as questionnaires were included. These studies reported research involving students, doctors, patients, and nurses. The resulting characteristics of good doctors fell into six categories: (1) General interpersonal qualities, (2) Communication and patient involvement, (3) Medical competence, (4) Ethics, (5) Medical management, (6) Teaching, research, and continuous education. The different stakeholders showed different ideas of the concept of a good doctor. Interestingly, patients had a stronger focus on communication skills, whereas doctors put more emphasis on medical skills. Balancing this discrepancy will be a challenge for future medical education.

  6. [Refeeding in a teenager with an eating disorder; when the patient refuses, but the doctor is obliged to intervene].

    Science.gov (United States)

    Nusman, C M; van Bellegem, A C M

    2016-01-01

    Young patients with eating disorders frequently present with physical complications. These young patients, who may decline to eat or drink can be difficult to treat. Knowledge of possible complications, diagnostic tools and the legal situation is necessary to provide optimal care.

  7. HIPAA's Role in E-Mail Communications between Doctors and Patients: Privacy, Security, and Implications of the Bill

    Science.gov (United States)

    Stephens, James H.; Parrillo, Anthony V.

    2011-01-01

    The confidentiality of a patient's information has been sacred since the days of Hippocrates, the Father of Medicine. Today, however, merely taking an oath to respect a patient's privacy has been overshadowed by regulations governing how certain healthcare establishments handle an individual's health information on the web. Consequently, if a…

  8. Advancing Doctoral Social Work Education: An Application of the Social-Ecological Framework

    Science.gov (United States)

    Dougherty, Cynthia; Fields, Noelle L.; Schuman, Donna

    2017-01-01

    Graduates of social work doctoral programs are an integral part of social work education and, as faculty, training of BSW and MSW students. Missing from the literature are theoretical frameworks that advance the study of "what works and for whom" in social work doctoral education. Building upon the existing literature, this article…

  9. The doctoral learning penumbra

    DEFF Research Database (Denmark)

    Bengtsen, Søren Smedegaard; Robinson, Gill; Wisker, Gina

    This paper presents our cross-national research into what we term the ‘doctoral learning penumbra’, which covers the diverse, unnoticed, and often unrecognised forms of help and support that doctoral students draw from during their PhD, and which are vital for completion. Our aim is to better und...

  10. Talking to Your Doctor

    Medline Plus

    Full Text Available ... Discovery Into Health ® Impact of NIH Research Science, Health, and Public Trust You are here Home » Institutes at NIH » ... Access Talking to Your Doctor Plain Language Science, Health, and Public Trust Talking to Your Doctor Part I: Preparing ...

  11. Talking to Your Doctor

    Medline Plus

    Full Text Available ... Your Medical Provider (3:51) Part III: Understanding Diagnosis and Treatment (3:57) More Resources from NIH ... Your Doctor , National Eye Institute (NEI) Español Aging Planning Your Doctor Visit , NIHSeniorHealth.gov Videos: Talking with ...

  12. Talking to Your Doctor

    Medline Plus

    Full Text Available ... NIH Website NIH Employee Intranet Staff Directory En Español Site Menu Home Health Information Health Info Lines ... Talking With Your Doctor , NIH News in Health Español Talking to Your Doctor , National Eye Institute (NEI) ...

  13. Learning Doctor-Patient Communication – Evaluating the effectiveness of the communication training course at Leipzig University from the students' point of view

    Directory of Open Access Journals (Sweden)

    Cämmerer, Jana

    2016-05-01

    Full Text Available Objective: At the University of Leipzig, the requirements of the Licensing Regulations for Doctors (Approbationsordnung für Ärzte for the practical training of communication skills are actively implemented by a two-semester communication course. During this course, student tutors impart the basics of interpersonal as well as selected aspects of doctor-patient communication using interactive training methods. This article reports on the effect the training has on the self-assessed communication skills of the medicine students.Methods: The students’ self-perceived communication skills were assessed, both at the beginning and after the completion of the first and second course semesters using questionnaires related to the course’s learning goals. Pre-post comparisons were then carried out. 142 students (of 163 students in total participated in the survey at the start of the course, of which 117 completed the T2-questionnaire at the end of the first course semester. Only the 84 students who also completed the questionnaires in the second course semester were included in the statistical analysis. These responses were analysed using both descriptive and inferential statistics.Results: The comparison of the self-assessments between the four measurement points showed that statistically significant learning progress for all assessed communication skills had taken place from the point of view of the students. The largest changes between measurements, and therefore the greatest learning progress, could be seen in knowledge related skills.Conclusion: From the students’ point of view the communication training contributes significantly to the acquisition of communication skills. The results suggest that this “hands-on” course concept is suited to successfully enhance the students’ communication skills. The course concept should therefore be retained for both the course in its current form as well as for any extension of the course into the

  14. Solitary vertebral plasmacytoma causing compression fracture in a patient with multiple vertebral hemangiomas: a diagnosis easily missed!

    Directory of Open Access Journals (Sweden)

    Shagufta Wahab

    2011-12-01

    Full Text Available The imaging mimics, acute osteoporotic compression fractures, metastasis and malignant melanoma or plasmacytoma pathological fractures are the important clinical problems in geriatric age group that need to be differentiated due to their grossly differing prognostic and therapeutic implications. There are few suggestive features on magnetic resonance imaging (MRI that help differentiate between these entities. Hemangiomas are very common benign spinal tumors that have characteristic features on MRI. In the setting of multiple vertebral hemangiomas causing cord compression in elderly patients, the scenario is even more complex with four different entities with different prognostic profiles. We report such a diagnostic dilemma we encountered in a middle aged female patient with multiple vertebral hemangiomas and compression fracture in D10 vertebra.

  15. Applying a deliberation model to the analysis of consultations in haemophilia: Implications for doctor-patient communication.

    Science.gov (United States)

    Lamiani, Giulia; Bigi, Sarah; Mancuso, Maria Elisa; Coppola, Antonio; Vegni, Elena

    2017-04-01

    Literature highlights the importance of communication in order to achieve patient's adherence. However, the specific dialogical components likely to favor patient adherence are not clear. In this study, the deliberation dialogue model was applied as an ideal model of optimal deliberation to real physician-patient consultations in the field of hemophilia in order to identify misalignments with the model and possible improvements in physician-patient communication. By applying the deliberation model, we analyzed a corpus of 30 check-up consultations in hemophilia. Of 30 consultations, 24 (80%) contained 43 deliberation dialogues. Twenty-two (51%) deliberation dialogues were complete (e.g., included an opening stage with a clear statement of the problem, an argumentation stage in which both physician and patient participated, and a closing stage with an explicit patient commitment), whereas 21 (49%) deliberations were incomplete. These featured: Lack of/partial argumentation stage; Lack of closing stage; Lack of/partial argumentation stage and lack of closing stage. The deliberation model can be applied to empirical data and allows to identify causes for suboptimal realizations of deliberation. Once a problem is acknowledged, attention could be paid to engage hemophilic patients in the argumentation stages and elicit their explicit commitment. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  16. The effect of missing KIR ligands, activating KIR genotype and haplotype on the outcome of T-cell-replete hematopoietic stem cell transplantation from HLA-identical siblings in Thai patients.

    Science.gov (United States)

    Khanuntong, S; Kuptawintu, P; Upaisilpsathaporn, K; Poolchareon, A; Bunworasate, U; Hirankarn, N

    2016-06-01

    This study was a retrospective analysis of Thai patients undergoing T-replete hematopoietic stem cell transplant from human leukocyte antigen (HLA)-identical sibling donors. We investigated 66 patients, including 40 patients with acute myeloid leukemia (AML), 12 patients with acute lymphoblastic leukemia and 14 patients with chronic myeloid leukemia. Killer cell immunoglobulin-like receptor (KIR) genes and HLA ligands were typed by polymerase chain reaction-sequence specific oligonucleotide probes. We analyzed the effect of the number of missing KIR ligands (Bw4, C1 and C2) on clinical outcomes. A beneficial effect of missing KIR ligand was not observed in both univariate and multivariate analysis. When we analyzed the effect of specific missing KIR ligand on clinical outcomes, there was a trend that patients with missing A11 ligand had lower relapse rate (P = 0.076). Therefore, we also conducted the analysis by including the group with missing KIR ligands of Bw4, C1, C2 and A11. Patients with two or more than two missing KIR ligands had a trend for better clinical outcome including reduced relapse (P = 055) and statistically significant in terms of reduced acute graft-vs-host disease (aGVHD) rate (P = 0.013). In multivariate analysis, patients with two or more than two missing KIR ligands had a statistically significant better clinical outcome in terms of reduced aGVHD rate (HR = 0.155, 95%CI = 0.040-0.605, P = 0.007). The association between clinical outcome with KIR haplotypes, centromeric B haplotype and activating KIR was not observed here. Although the sample size in this study is rather limited, these data can later be subjected to meta-analysis to help reach the conclusion of the usefulness of this additional promising KIR genotyping in various hematopoietic stem cell transplantation types. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  17. Interactive "Video doctor" counseling reduces drug and sexual risk behaviors among HIV-positive patients in diverse outpatient settings

    OpenAIRE

    Gilbert, P; Ciccarone, D; Gansky, SA; Bangsberg, DR; Clanon, K; McPhee, SJ; Calderón, SH; Bogetz, A; Gerbert, B

    2008-01-01

    Background Reducing substance use and unprotected sex by HIV-positive persons improves individual health status while decreasing the risk of HIV transmission. Despite recommendations that health care providers screen and counsel their HIV-positive patients for ongoing behavioral risks, it is unknown how to best provide “prevention with positives” in clinical settings. Positive Choice, an interactive, patient-tailored computer program, was developed in the United States to improve clinic-based...

  18. Are graft-versus-host-disease patients missing out on the vital occupational therapy services? a systematic review.

    Science.gov (United States)

    Bakhsh, Hadeel R; Mohammed, Jaleel; Hashmi, Shahrukh K

    2018-02-14

    The aim of this review is to show the importance of occupational therapy/hand therapy for chronic graft-versus-host-disease (GVHD) patients and to outline the current state of the literature. GVHD of the hand can cause functional loss, reduced activities of daily life, poor social interaction, and loss of income because of limitations in work. Hand therapy, which is a specialty practised by both occupational therapists and physical therapists, has been proven to be an effective approach for hand-related musculoskeletal disorders; however, the literature search suggests that it is an underutilized specialty around the world. An electronic search was performed from 1997 to 2017 using OneFile (GALE), Medline/PubMed (NLM), Scopus (Elsevier), Science Citation Index Expanded (Web of Science), ProQuest Central (New), ProQuest Hospital Collection, Health Reference Center Academic (Gale), Health Research Premium Collection, Science Direct Journals (Elsevier), ProQuest Health & Medical Complete, Medical Database, Wiley Online Library, and SciTech Premium Collection for the period from 1994 to April 2017. Only randomized-controlled trials involving occupational therapy or hand therapy in patients with chronic hand GVHD were included in the final analysis. The search was limited to articles in English. Two reviewers independently assessed the methodological quality and extracted the data. The JADAD scoring method was used to score the articles. After the duplicates were excluded, 5466 articles were identified by the electronic database search for screening, out of which 5465 articles were excluded after reviewing. One article was further excluded on obtaining the full text as it was a case study. Hand therapy specialty, although a vital part of the recovery process for the patients with hand GVHD, is an underutilized specialty and well-designed trials are urgently needed for musculoskeletal hand GVHD, especially for focused hand therapy interventions.

  19. Missing the mark for patient engagement: mHealth literacy strategies and behavior change processes in smoking cessation apps.

    Science.gov (United States)

    Paige, Samantha R; Alber, Julia M; Stellefson, Michael L; Krieger, Janice L

    2018-05-01

    To examine how Transtheoretical Model (TTM)'s processes of change and mHealth literacy strategies are employed in mobile smoking cessation apps. A purposive sample of 100 iTunes apps were coded to assess descriptive (price, type, developer, user-rating) and engagement metrics, including processes of change and mHealth literacy strategies (plain language, usability, interactivity). One-way ANOVAs and independent samples t-tests examined associations between descriptive and engagement metrics. Over half of the apps included 7 (78%) processes of change. Fewer included self-liberation (36%) and reinforcement management (34%). Most apps incorporated plain language, but few integrated usability and interactivity strategies. Hypnotherapy and informational apps included more behavioral processes of change than apps incorporating a combination of features, including gaming, cigarette trackers, and motivational coaching (pApps included behavior change processes but rarely incorporated usability and interactivity features to promote patient engagement. Engagement metrics did not vary by app user-ratings, price-to-download, or developer, including for-profit organizations or government and educational institutions. Providers should acknowledge the popularity of smoking cessation apps as potential cessation aids and communicate their benefits and drawbacks to patients. Future efforts to improve smoking cessation apps should focus on enhancing the quality of tailored and interactive content. Copyright © 2017 Elsevier B.V. All rights reserved.

  20. A qualitative study of doctors' and nurses' barriers to communicating with seriously ill patients about their dependent children

    DEFF Research Database (Denmark)

    Dencker, Annemarie; Rix, Bo Andreassen; Bøge, Per

    2017-01-01

    OBJECTIVE: Research indicates that health personnel caring for seriously ill patients with dependent children aged 0 to 18 years often avoid discussing with them the challenges of being a family with a parent in treatment. Children of seriously ill patients risk serious trauma and emotional diffi...... backing for addressing children of seriously ill patients and time spent on it; and (3) the need for future HP training programmes to include how to implement procedures and how to address all barriers.......OBJECTIVE: Research indicates that health personnel caring for seriously ill patients with dependent children aged 0 to 18 years often avoid discussing with them the challenges of being a family with a parent in treatment. Children of seriously ill patients risk serious trauma and emotional......, drawing on the theoretical framework of Maturana's domains. RESULTS: The study found structural barriers (eg, lack of space in the medical recording system, professional code, time pressure, and lack of training) and emotional barriers (eg, the painful nature of the situation and the perceived need...

  1. Replacing a Missing Tooth

    Science.gov (United States)

    ... there are two options for replacement: First, a removable partial denture may be used to replace the missing tooth. ... appearance look and feel more natural than a removable partial denture. However, it does require grinding down the support ...

  2. Missing data exploration: highlighting graphical presentation of missing pattern.

    Science.gov (United States)

    Zhang, Zhongheng

    2015-12-01

    Functions shipped with R base can fulfill many tasks of missing data handling. However, because the data volume of electronic medical record (EMR) system is always very large, more sophisticated methods may be helpful in data management. The article focuses on missing data handling by using advanced techniques. There are three types of missing data, that is, missing completely at random (MCAR), missing at random (MAR) and not missing at random (NMAR). This classification system depends on how missing values are generated. Two packages, Multivariate Imputation by Chained Equations (MICE) and Visualization and Imputation of Missing Values (VIM), provide sophisticated functions to explore missing data pattern. In particular, the VIM package is especially helpful in visual inspection of missing data. Finally, correlation analysis provides information on the dependence of missing data on other variables. Such information is useful in subsequent imputations.

  3. How Doctors View and Use Social Media: A National Survey

    OpenAIRE

    Brown, James; Ryan, Christopher; Harris, Anthony

    2014-01-01

    Background Doctors are uncertain of their ethical and legal obligations when communicating with patients online. Professional guidelines for patient-doctor interaction online have been written with limited quantitative data about doctors’ current usage and attitudes toward the medium. Further research into these trends will help to inform more focused policy and guidelines for doctors communicating with patients online. Objective The intent of the study was to provide the first national profi...

  4. [The happy doctor].

    Science.gov (United States)

    van Dongen, Christel M P; van der Graaf, Yolanda

    2012-01-01

    Descriptive, questionnaire-based. To study what makes doctors and medical students happy: Descriptive, questionnaire-based. Descriptive, questionnaire-based. For the purposes of this study, doctors and medical students completed an online questionnaire in the summer of 2012. They were presented with questions enquiring into general characteristics and into happiness. We asked them to define happiness, and to describe their happiest moments. The results were interpreted with the aid of simple statistics. 401 doctors, registrars and medical students took part in the study. 41% of the respondents were male and 59% female. Average age was 40 years. Students, GPs, anaesthesiologists and internists were the best represented. On average, the participants gave their 'happiness' a score of 7.6. The younger doctors ( 48 years (7.8), which also explains the relatively low scores for students (7.1). GPs were the happiest, with an average score of 7.9, closely followed by the 'other doctors', with an average score of 7.8, and the medical specialists (7.6). Within the specialties, bearing in mind that the low numbers means that results should be interpreted with some caution, the doctors with 'minority specialties' were the happiest, followed by internists and the supporting specialties. Psychiatrists and surgical colleagues can be found at the bottom of the list. The determinants 'love and relationships' and 'family' contribute the most to feeling happy. Older doctors are happier than younger doctors and GPs are generally happier than medical specialists. The determinants 'love and relationships' and family' are the most important for doctors' happiness.

  5. Does burnout among doctors affect their involvement in patients' mental health problems? A study of videotaped consultations.

    NARCIS (Netherlands)

    Zantinge, E.M.; Verhaak, P.F.M.; Bakker, D.H. de; Meer, K. van der; Bensing, J.M.

    2009-01-01

    Background: General practitioners' (GPs') feelings of burnout or dissatisfaction may affect their patient care negatively, but it is unknown if these negative feelings also affect their mental health care. GPs' available time, together with specific communication tools, are important conditions for

  6. Does burnout among doctors affect their involvement in patients' mental health problems? : A study of videotaped consultations

    NARCIS (Netherlands)

    Zantinge, Else M.; Verhaak, Peter F. M.; de Bakker, Dinny H.; van der Meer, Klaas; Bensing, Jozien M.

    2009-01-01

    Background: General practitioners' (GPs') feelings of burnout or dissatisfaction may affect their patient care negatively, but it is unknown if these negative feelings also affect their mental health care. GPs' available time, together with specific communication tools, are important conditions for

  7. What Lesbian, Gay, Bisexual, Transgender, Queer, and Intersex Patients Say Doctors Should Know and Do: A Qualitative Study.

    Science.gov (United States)

    Alpert, Alison B; CichoskiKelly, Eileen M; Fox, Aaron D

    2017-01-01

    This qualitative study explored the experiences of lesbian, gay, bisexual, transgender, queer, and intersex (LGBTQI) people in health care and their recommendations for physicians. Six focus groups were conducted with LGBTQI people (N = 48) in four U.S. cities between October 2013 and April 2014. Five overarching themes emerged regarding patients' suggestions for providers: be comfortable with LGBTQI patients; share medical decision-making; avoid assumptions; apply LGBTQI-related knowledge; and address the social context of health disparities. These core competencies differed in meaningful ways from competencies created by national organizations such as the Association of American Medical Colleges. Community-derived competencies 1 stressed the importance of collaborative patient-physician partnerships, particularly in the setting of hormone prescription for transgender patients, and prioritized addressing social determinants of health and focusing on marginalized subpopulations 2 and stigmatized needs of the community. Limitations, particular of sampling, were considered. Community input could improve medical education interventions to reduce health disparities in marginalized communities.

  8. Doctor, can you spare some time? The role of workload in general practitioners' involvement in patients' mental health problems

    NARCIS (Netherlands)

    Zangtinge, E.M.

    2008-01-01

    GPs have an important position in the identification of patients’ mental health problems. As generalists, GPs are often the first health professionals contacted by patients with mental health problems and they are assigned to provide integrated care for both patients’ somatic and psychological

  9. Analysis of team types based on collaborative relationships among doctors, home-visiting nurses and care managers for effective support of patients in end-of-life home care.

    Science.gov (United States)

    Fujita, Junko; Fukui, Sakiko; Ikezaki, Sumie; Otoguro, Chizuru; Tsujimura, Mayuko

    2017-11-01

    To define the team types consisting of doctors, home-visiting nurses and care managers for end-of-life care by measuring the collaboration relationship, and to identify the factors related to the team types. A questionnaire survey of 43 teams including doctors, home-visiting nurses and care managers was carried out. The team types were classified based on mutual evaluations of the collaborative relationships among the professionals. To clarify the factors between team types with the patient characteristics, team characteristics and collaboration competency, univariate analysis was carried out with the Fisher's exact test or one-way analysis and multiple comparison analysis. Three team types were classified: the team where the collaborative relationships among all healthcare professionals were good; the team where the collaborative relationships between the doctors and care managers were poor; and the team where the collaborative relationships among all of the professionals were poor. There was a statistically significant association between the team types and the following variables: patient's dementia level, communication tool, professionals' experience of working with other team members, home-visiting nurses' experience of caring for dying patients, care managers' background qualifications, doctor's face-to-face cooperation with other members and home-visiting nurses' collaborative practice. It is suggested that a collaborative relationship would be fostered by more experience of working together, using communication tools and enhancing each professional's collaboration competency. Geriatr Gerontol Int 2017; 17: 1943-1950. © 2017 Japan Geriatrics Society.

  10. An educational model for improving diet counselling in primary care. A case study of the creative use of doctors' own diet, their attitudes to it and to nutritional counselling of their patients with diabetes

    DEFF Research Database (Denmark)

    Olivarius, Niels de Fine; Palmvig, Birthe; Andreasen, Anne Helms

    2005-01-01

    Nutritional counseling; Nutritional education; Nutritional assessment; Primary care; Continuing medical education; Doctors' diet; Doctors attitudes; Doctors' knowledge; Body mass index; Educational model; Food frequency questionaire......Nutritional counseling; Nutritional education; Nutritional assessment; Primary care; Continuing medical education; Doctors' diet; Doctors attitudes; Doctors' knowledge; Body mass index; Educational model; Food frequency questionaire...

  11. A quem interessa a relação médico paciente ? Who cares how doctors and patients relate ?

    Directory of Open Access Journals (Sweden)

    João Claudio Lara Fernandes

    1993-03-01

    Full Text Available A relação médico-paciente é parte integrante do cotidiano de milhares de profissionais. Para evitar uma abordagem idealista ou meramente afetiva desta questão, é necessário investigar como ela está relacionada ao conhecimento médico e à relação mais geral entre medicina e sociedade. Na verdade, longe de ser aleatória, esta relação, da forma como foi estabelecida, pode ser vista como um instrumento de difusão e manutenção do poder do Estado e da instituição médica sobre a sociedade. Para modificar esta prática, o autor propõe duas abordagens, relativas a campos distintos da prática médica: os campos hospitalar e extra-hospitalar. Na área extra-hospitalar, a humanização da prática médica dependeria, basicamente, de uma formação profissional abrangente, de modo a adaptar o médico às demandas inerentes a esta área, onde o raciocínio fisio-patológico mostra-se freqüentemente limitado. No campo hospitalar, a humanização do ato médico dependeria mais diretamente da atuação integrada de uma equipe multi-profissional.The relationship between doctors and their patients is part of everyday life for thousands of professionals. In order to avoid an idealistic or merely emotional approach to this question, it is necessary to investigate how it is related to medical science and to the overall relationship between medicine and society. Indeed, far from being aleatory, the doctor-patient relationship as it has been practiced can be understood as a tool for maintaining the power of both the medical establishment and the state over society. To change this practice, the author proposes two different approaches to specific fields of medical practice: the hospital and non-hospital fields. In the field outside hospitals, the humanization of medical practice depends basically on broadened training for professionals in order to prepare them to deal with this work's inherent demands, where a physiopathological approach is often

  12. START (screening tool to alert doctors to the right treatment)--an evidence-based screening tool to detect prescribing omissions in elderly patients.

    LENUS (Irish Health Repository)

    Barry, P J

    2012-02-03

    BACKGROUND: Inappropriate prescribing encompasses acts of commission i.e. giving drugs that are contraindicated or unsuitable, and acts of omission i.e. failure to prescribe drugs when indicated due to ignorance of evidence base or other irrational basis e.g. ageism. There are considerable published data on the prevalence of inappropriate prescribing; however, there are no recent published data on the prevalence of acts of omission. The aim of this study was to calculate the prevalence of acts of prescribing omission in a population of consecutively hospitalised elderly people. METHODS: A screening tool (screening tool to alert doctors to the right treatment acronym, START), devised from evidence-based prescribing indicators and arranged according to physiological systems was prepared and validated for identifying prescribing omissions in older adults. Data on active medical problems and prescribed medicines were collected in 600 consecutive elderly patients admitted from the community with acute illness to a teaching hospital. On identification of an omitted medication, the patient\\'s medical records were studied to look for a valid reason for the prescribing omission. RESULTS: Using the START list, we found one or more prescribing omissions in 57.9% of patients. In order of prevalence, the most common prescribing omissions were: statins in atherosclerotic disease (26%), warfarin in chronic atrial fibrillation (9.5%), anti-platelet therapy in arterial disease (7.3%) and calcium\\/vitamin D supplementation in symptomatic osteoporosis (6%). CONCLUSION: Failure to prescribe appropriate medicines is a highly prevalent problem among older people presenting to hospital with acute illness. A validated screening tool (START) is one method of systematically identifying appropriate omitted medicines in clinical practice.

  13. The Impact of Health Information Technology on the Doctor-Patient Relationship in Child and Adolescent Psychiatry.

    Science.gov (United States)

    Krishna, Rajeev

    2017-01-01

    As health information technology continues to expand and permeate medicine, there is increasing concern for the effect on the therapeutic relationship between patient and psychiatrist. This article explores this impact, seeking wisdom from adult psychiatry and more broadly from general medical disciplines to draw conclusions regarding how the child psychiatry encounter may be affected. Several proposed strategies to mitigate potential negative impacts of health information technology on the therapeutic relationship across practice settings are offered. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Talking to Your Doctor

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    Full Text Available ... can play an active role in your health care by talking to your doctor. Clear and honest ... Institute on Aging (NIA) Cancer Communication in Cancer Care , National Cancer Institute (NCI) Español Complementary and Integrative ...

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  16. Talking to Your Doctor

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    Full Text Available ... concerns before your appointment. Consider bringing a close friend or family member with you. Take notes about what the doctor says, or ask a friend or family member to take notes for you. ...

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  1. Talking to Your Doctor

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  2. Finding the Right Doctor

    Science.gov (United States)

    ... you meet someone that doesn’t match your communication style, you should switch,” Dr. Krumholz said. Another part ... for looking around: When you feel that the communication style is not matching your own If your doctor ...

  3. Talking to Your Doctor

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    Full Text Available ... Research Trials and You Talking to Your Doctor Science Education Resources Community Resources Clear Health A–Z Publications ... Record Research & Training Medical Research Initiatives Science Highlights Science Education Research in NIH Labs & Clinics Training Opportunities Library ...

  4. Talking to Your Doctor