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Liu J, Zheng H, Lu L, Liu H, Xu X, He W. The impact of patients' hostile attribution bias on aggression in doctor-patient interactions. Heliyon 2024; 10:e23971. [PMID: 38268606 PMCID: PMC10805917 DOI: 10.1016/j.heliyon.2024.e23971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 12/06/2023] [Accepted: 01/01/2024] [Indexed: 01/26/2024] Open
Abstract
Background Doctor-patient conflict is trending in social attention research. However, the existing literature rarely explores whether a patient's hostile attribution bias (HAB) in the doctor-patient interaction affects the aggression level against doctors. Objective This study aimed to explore the relationship and mechanism between different types of HAB and aggression in patients. Method In Study 1, 80 patients completed the word sentence association paradigm for hostility (WSAP-Hostility), and their explicit and implicit aggression levels were measured using the hot sauce paradigm and the single-category implicit association test (SC-IAT), respectively. In Study 2, 63 patients were randomly divided into an experimental (rejection) and a control group. Their state hostile attribution bias (SHAB) was activated through social rejection materials. They completed the SHAB questionnaire and anger expression inventory, and their explicit and implicit aggression levels were measured as in Study 1. Results In both studies, results indicated that patients' trait and state HAB were significantly related to explicit aggression but not implicit aggression. Hostile interpretation positively predicted explicit aggression, whereas benign interpretation had a negative predictive effect on explicit aggression. Patients' anger played a mediating role between SHAB and explicit aggression. Conclusions These findings suggest that patients' HAB affects explicit aggression toward doctors and anger plays a mediating role.
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Affiliation(s)
- Jie Liu
- School of Psychology, Shanghai Normal University, Shanghai, 200234, China
| | - Hong Zheng
- Changning Mental Health Center Affiliated with East China Normal University, Shanghai, China
| | - Lu Lu
- School of Psychology, Shanghai Normal University, Shanghai, 200234, China
| | - Hongying Liu
- Hangzhou Kang Sheng Health Consulting Co., Ltd. Hangzhou 310023, China
| | - Xiongwei Xu
- School of Education, Shanghai Normal University, Shanghai, 200234, China
| | - Wen He
- School of Psychology, Shanghai Normal University, Shanghai, 200234, China
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2
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Johnston EA, Ekberg S, Jennings B, Jagasia N, van der Pols JC. Discussing diet, nutrition, and body weight after treatment for gynecological cancer: a conversation analytic study of outpatient consultations. J Cancer Surviv 2023. [PMID: 36897546 DOI: 10.1007/s11764-023-01345-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 02/01/2023] [Indexed: 03/11/2023]
Abstract
PURPOSE To generate direct observational evidence for understanding how diet, nutrition, and weight-related topics are discussed during follow-up after treatment for gynecological cancer, as recommended by survivorship care guidelines. METHODS Conversation analysis of 30 audio-recorded outpatient consultations, involving 4 gyne-oncologists, 30 women who had completed treatment for ovarian or endometrial cancer, and 11 family members/friends. RESULTS From 21 instances in 18 consultations, diet, nutrition, or weight-related talk continued beyond initiation if the issue raised was ostensibly relevant to the clinical activity being undertaken at the time. These instances led to care-related outcomes (i.e., general dietary recommendations, referral to support, behavior change counseling) only when the patient identified needing further support. Diet, nutrition, or weight-related talk was not continued by the clinician if it was not apparently related to the current clinical activity. CONCLUSIONS The continuation of diet, nutrition, or weight-related talk during outpatient consultations after treatment for gynecological cancer, and the subsequent delivery of care-related outcomes, depends on its immediate clinical relevance and the patient indicating needing further support. The contingent nature of these discussions means there can be missed opportunities for the provision of dietary information and support post-treatment. IMPLICATIONS FOR CANCER SURVIVORS If seeking information or support for diet, nutrition, or weight-related issues post-treatment, cancer survivors may need to be explicit regarding their need for this during outpatient follow-up. Additional avenues for dietary needs assessment and referral should be considered to optimize the consistent delivery of diet, nutrition, and weight-related information and support after treatment for gynecological cancer.
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3
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Sheikh AM, Sajid MR, Bakshi EN, Khan AU, Wahed MM, Sohail F, Sethi A. The Perceptions of Non-native Medical Students Towards Language Barrier on Clinical Teaching and Learning: a Qualitative Study from Saudi Arabia. Med Sci Educ 2022; 32:865-872. [PMID: 36035530 PMCID: PMC9411457 DOI: 10.1007/s40670-022-01579-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/15/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Patient-doctor communication is essential for achieving the best healthcare quality for the patients. Saudi Arabia hosts a variety of healthcare providers from diverse cultures and languages, making language barriers distinctive towards effective communication for a predominantly Arab population. There is limited research on the challenges associated with language barriers among non-native medical students. The current qualitative study aims to explore the perceptions and experiences of non-native medical students during clinical encounters with Arabic speaking patient population at a private university in Riyadh, Saudi Arabia. METHODS This is a qualitative case study employing non-native medical students in clinical years to explore their perceptions and experiences towards language barriers. Participants attended four focus group discussions, following a brief regarding the concept of the challenges that language barriers pose. All interviews were recorded and transcribed verbatim. A thematic framework analysis was employed to analyze the data. RESULTS Twenty-two non-native medical students participated in the study. We identified four broad themes constituting problems in patient interaction, development of clinical skills, managing and overcoming language barriers, and student recommendations to overcome language barrier. Participants suggested improvements in available Arabic language courses and the introduction of a professional skills course in Arabic for non-native students. CONCLUSION Non-Native medical students perceived language barriers as an obstacle to a meaningful clinical experience. They identified implications for clinical learning environment, professionalism, empathy, and patient care. Recommendations for advanced occupation-related Arabic language courses to facilitate doctor-patient interactions were made to improve patient-student interactions between native patients and non-native medical students.
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Affiliation(s)
| | - Muhammad Raihan Sajid
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Department of Pathology, Alfaisal University, Takhassusi Street, Riyadh, Saudi Arabia
| | | | | | | | - Faateh Sohail
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Ahsan Sethi
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
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4
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Lian OS, Nettleton S, Wifstad Å, Dowrick C. Negotiating uncertainty in clinical encounters: A narrative exploration of naturally occurring primary care consultations. Soc Sci Med 2021; 291:114467. [PMID: 34653685 DOI: 10.1016/j.socscimed.2021.114467] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 08/14/2021] [Accepted: 10/07/2021] [Indexed: 11/22/2022]
Abstract
Based on a narrative analysis of 20 naturally occurring clinical consultations between general practitioners and patients in England, sourced from the One in a million data archive, we explore how they conceptualize and negotiate medical and existential uncertainty. To capture the interactional element, which is often overlooked, three consultations receive special attention. While exploring the ongoing dynamics of the moment-to-moment realization of negotiations, we relate their actions to the institutionalized positions of doctor and patient. Situating their negotiations in the sociocultural context in which their interaction is embedded reveals how consultations unfold as a result of communication between two different positions in a normatively structured system. When uncertainty prevails, both patients and GPs mainly conceptualize uncertainty indirectly. By conceptualizing uncertainty indirectly and in a depersonalized manner, GPs manage to safeguard against clinical errors without compromising their authority and credibility. Contrary to medical uncertainty, which is continuously discussed, existential uncertainty usually recedes in the background. However, as our consultations unfold it becomes evident that medical and existential dimensions of uncertainty are inextricably linked. By acknowledging that clinical uncertainty is not only an epistemic concern but also an existential one, existential aspects may usefully rise to the surface.
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5
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Stevenson FA, Leydon-Hudson G, Murray E, Seguin M, Barnes R. Patients' use of the internet to negotiate about treatment. Soc Sci Med 2021; 290:114262. [PMID: 34376288 DOI: 10.1016/j.socscimed.2021.114262] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 07/15/2021] [Accepted: 07/22/2021] [Indexed: 11/29/2022]
Abstract
The internet provides access to a huge variety of information, including health information. There is, however, a dearth of evidence as to how, and to what ends, patients raise prior use of the internet during medical visits. Analysis is based on the Harnessing Resources from the Internet study. Drawing on data from 281 video-recorded primary care consultations, we use conversation analysis (CA) to systematically inspect the data for instances in which patients reveal that they have accessed publicly available online resources regarding their illness, symptoms, or treatment concerns. Patients invoke the internet to support three types of action: to (i) justify concerns about a serious illness; (ii) provide a warrant for treatment where they have been unable to find a solution; and (iii) advocate in relation to treatment. Although invoking the internet risks potential encroachment into the doctor's domain of authority, patients carefully design their turns when raising the internet so as to orientate to the final decision about treatment as residing firmly within the doctor's domain of authority. The work demonstrates how detailed interactional analysis can be used to illuminate the local work that patients and doctors engage in to manage the rise in availability of information from the internet.
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Affiliation(s)
- Fiona A Stevenson
- University College London, Department of Primary Care and Population Health, Rowland Hill Street, London, NW3 2PF, UK.
| | | | - Elizabeth Murray
- University College London, Department of Primary Care and Population Health, Rowland Hill Street, London, NW3 2PF, UK
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6
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Vigier M, Thorson KR, Andritsch E, Stoeger H, Suerth L, Farkas C, Schwerdtfeger AR. Physiological linkage during interactions between doctors and cancer patients. Soc Sci Med 2021; 284:114220. [PMID: 34273870 DOI: 10.1016/j.socscimed.2021.114220] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 07/03/2021] [Accepted: 07/09/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Doctors and patients influence each other when interacting and, as a result, can become similar to each other in affect and behavior. In the current work, we examine whether they also become similar to each other on a moment-to-moment basis in their physiological responses. Specifically, we examine physiological linkage-how much a doctor's (or patient's) physiological response predicts a patient's (or doctor's) response at a subsequent time interval-and whether this changes over the course of doctor-patient relationships (measured as the number of consultations held for each unique doctor-patient dyad). METHODS We collected interbeat interval responses (IBI) continuously during consultations between oncologists and patients undergoing cancer treatment (N = 102 unique doctor-patient interactions) at a hospital in Austria. RESULTS Physiological linkage varied by an interaction between role (doctor vs. patient) and relationship length (in a non-linear, quadratic pattern). Patients showed significant positive linkage to their doctors (i.e., doctors' physiological responses positively, significantly predicted patients' responses) in relationships that spanned three to eight consultations together. Patients were not linked to their doctors in shorter or longer relationships. Doctors were never significantly linked to their patients, meaning that patients' physiological responses never predicted doctors' responses. CONCLUSION These results reveal that, by influencing patients' physiological responses on a moment-to-moment basis, doctors may have even more influence over patients' physiology than previously known.
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Affiliation(s)
- Marta Vigier
- Division of Oncology, Medical University of Graz, Graz, Austria; Department of Psychology, University of Graz, Graz, Austria.
| | - Katherine R Thorson
- Department of Psychology, Barnard College of Columbia University, New York, USA.
| | | | - Herbert Stoeger
- Division of Oncology, Medical University of Graz, Graz, Austria
| | - Leonie Suerth
- Department of Psychology, University of Graz, Graz, Austria
| | - Clemens Farkas
- Division of Oncology, Medical University of Graz, Graz, Austria
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7
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Sterponi L, Zucchermaglio C, Fantasia V, Fatigante M, Alby F. A room of one's own: Moments of mutual disengagement between doctor and patient in the oncology visit. Patient Educ Couns 2021; 104:1116-1124. [PMID: 33172737 DOI: 10.1016/j.pec.2020.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 09/22/2020] [Accepted: 10/16/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE This paper examines a previously neglected phenomenon in doctor-patient interaction studies, i.e. the achievement of mutual disengagement-a specific state of coordination, in which participants suspend reciprocal gaze and turn into separate axes of involvement. In the specialized setting of the oncology visit, which we consider in this study, mutual disengagement is linked to important tasks that the oncologist has to carry out, notably the scrutiny of the histological exam during the diagnostic assessment phase. METHODS Our data corpus includes 56 video-recorded oncology visits. We employ conversation analysis to discern how mutual disengagement is achieved, sustained and ended. RESULTS Our analysis shows that suspension of mutual engagement is a joint accomplishment that requires intersubjective cooperation. It also reveals that when talk and reciprocal engagement are suspended, intersubjective alignment is more vulnerable to breakdown. CONCLUSION Our findings eschew a characterization of the oncologist as solo arbiter of the interactional exchange. An alignment with the patient is key to the felicitous accomplishment of the visit. We also suggest that a successful medical encounter is not only characterized by harmonious verbal communication, between doctor and patient, but also by felicitous pauses in their joint engagement. PRACTICE IMPLICATIONS In building a room of one's own, the oncologist has the responsibility to co-construct with the patient an experience of interactional attunement and mutual understanding.
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Affiliation(s)
- Laura Sterponi
- University of California, Berkeley, Institute of Human Development and Graduate School of Education, 2121 Berkeley Way, Berkeley, CA, 94720, United States.
| | - Cristina Zucchermaglio
- University of Rome, La Sapienza, Department of Social and Developmental Psychology, Via dei Marsi 78, 00185, Rome, Italy
| | - Valentina Fantasia
- University of Rome, La Sapienza, Department of Social and Developmental Psychology, Via dei Marsi 78, 00185, Rome, Italy
| | - Marilena Fatigante
- University of Rome, La Sapienza, Department of Social and Developmental Psychology, Via dei Marsi 78, 00185, Rome, Italy
| | - Francesca Alby
- University of Rome, La Sapienza, Department of Social and Developmental Psychology, Via dei Marsi 78, 00185, Rome, Italy
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8
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Stevenson FA, Seguin M, Leydon-Hudson G, Barnes R, Ziebland S, Pope C, Murray E, Atherton H. Combining patient talk about internet use during primary care consultations with retrospective accounts. A qualitative analysis of interactional and interview data. Soc Sci Med 2021; 272:113703. [PMID: 33540151 DOI: 10.1016/j.socscimed.2021.113703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/06/2020] [Accepted: 01/11/2021] [Indexed: 11/22/2022]
Abstract
Despite widespread acknowledgement of internet use for information about health, patients report not disclosing use of online health information in consultations. This paper compares patients' reported use of the internet with matched video recordings of consultations. The concepts of doctorability and epistemics are employed to consider similarities and differences between patients’ reports in interviews and actions in the consultation. Data are drawn from the Harnessing Resources from the Internet study conducted in the UK. The data set consists of 281 video-recorded general practice consultations, with pre-consultation questionnaires completed by all patients, interviews with all 10 participating doctors and 28 selected patients. We focus on the 28 patient interviews and associated consultation recordings. A conversation analytic (CA) approach is used to systematically inspect both the interview and consultation data. In interviews patients presented use of the internet as associated with appropriate self-management and help-seeking. In consultations patients skilfully translated what they had found on the internet in order to provide grounds for the actions they sought. We conclude that patients translate and utilise what they have found on the internet to assert the doctorability of their presenting problems. Furthermore, patients design their talk in both interviews and consultations to accord with their understanding of the epistemic rights of both doctors and patients. Patients search the internet so they are informed about their medical problem, however they carefully manage disclosure of information to avoid disrupting the smooth running of medical interactions. Patients seek information from the internet to support decisions to consult. Patients seek information from the internet to support appropriate self-management. Patients skilfully translate what they find on the internet to support requests. Patients skilfully use the internet to invite action from their doctors. Patients do not openly challenge the epistemic authority of the doctor.
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9
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Hauge AM. One last round of chemo? Insights from conversations between oncologists and lung cancer patients about prognosis and treatment decisions. Soc Sci Med 2020; 266:113413. [PMID: 33096509 DOI: 10.1016/j.socscimed.2020.113413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/18/2020] [Accepted: 09/30/2020] [Indexed: 11/29/2022]
Abstract
One more chemo or one too many? The increasing use of expensive cancer treatments close to the patient's death is often explained by oncologists' failure to communicate to patients how close to dying they are, implying that patients are often both ill-prepared and over-treated when they die. This article aims at interrogating the politically charged task of prognosticating. Drawing on an ethnographic study of conversations between oncologists and patients with metastatic lung cancer in a Danish oncology clinic, I show that oncologists utilize, rather than avoid, prognostication in their negotiations with patients about treatment withdrawal. The study informs the emerging sociology of prognosis in three ways: First, prognostication is not only about foreseeing and foretelling, but also about shaping the patient's process of dying. Second, oncologists prognosticate differently depending on the level of certainty about the patient's trajectory. To unfold these differences, the article provides a terminology that distinguishes between four 'modes of prognostication', namely hinting, informing, calibrating and organizing. Third, prognosticating can unfold over time through multiple consultations, emphasizing the relevance of adopting methodologies enabling the study of prognosticating over time.
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Affiliation(s)
- Amalie M Hauge
- VIVE - the Danish Center for Social Science Research, Herluf Trollesgade 11, 1052, København K, Denmark.
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10
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Kushida S, Kawashima M, Abe T. Why this clinic now? A context-sensitive aspect of accounting for visits. Soc Sci Med 2020; 265:113278. [PMID: 32947182 DOI: 10.1016/j.socscimed.2020.113278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 07/06/2020] [Accepted: 07/30/2020] [Indexed: 11/24/2022]
Abstract
In presenting problems in medical consultations, patients face the task of justifying their visit to the doctor. Previous studies have shown that patients establish the legitimacy of their visit by characterizing their problem as "doctorable" and presenting themselves as reasonable patients (Halkowski, 2006; Heritage and Robinson, 2006). This study explores a context-sensitive aspect of this justification issue by analyzing patients' first visits to a department of general medicine under the Japanese "free access" system. Patients are shown to present their problem in a way that conveys its relevance to the particular medical setting: they characterize their problem as suitable for relatively high-level medical care or as not easily falling under other specialties. The patient's problem's relevance to the setting is treated as normative in that participants take measures to remedy the possible mismatch between the problem and the setting. The institutional arrangement of the Japanese free access system is "talked into being" as a relevant context for the consultations through the practices participants use to establish the legitimacy of their visits.
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11
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Abstract
In recent years, the opioid crisis in the United States has sparked significant discussion on doctor-patient interactions concerning chronic pain treatments, but little to no attention has been given to investigating the vocal aspects of patient talk. This exploratory sociolinguistic study intends to fill this knowledge gap by employing prosodic discourse analysis to examine context-specific linguistic features used by the interlocutors of two distinct medical interactions. We found that patients employed both low pitch and creak as linguistic resources when describing chronic pain, narrating symptoms, and requesting opioids. The situational use of both features informs us about the linguistic ways in which patients frame fraught issues like chronic pain in light of the current opioid crisis. This study expands the breadth of phonetic analysis within the domain of discourse analysis, serving to illuminate discussions surrounding the illocutionary role of the lower vocal tract in expressing emotions.
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Affiliation(s)
| | - Stephen Gresham Henry
- Division of General Medicine, Geriatrics, and Bioethics, University of California Davis, Sacramento, CA, USA
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12
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Abstract
Existing sociological research documents patient and physician reticence to discuss death in the context of a patient's end of life. This study offers a new approach to analyzing how death gets discussed in medical interaction. Using a corpus of 90 video-recorded oncology visits and conversation analytic (CA) methods, this analysis reveals that when existing parameters are expanded to look at mentions of death outside of the end-of-life context, physicians do discuss death with their patients. Specifically, the most frequent way physicians invoke death is in a persuasive context during treatment recommendation discussions. When patients demonstrate active or passive resistance to a recommendation, physicians invoke the possibility of the patient's death to push back against this resistance and lobby for treatment. Occasionally, physicians invoke death in instances where resistance is anticipated but never actualized. Similarly, death invocations function for treatment advocacy. Ultimately, this study concludes that physicians in these data invoke death to leverage their professional authority for particular treatment outcomes.
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Affiliation(s)
- Alexandra Tate
- Department of Medicine, The University of Chicago, 5841 S. Maryland Ave, MC1005, M200, Chicago, IL 60637, United States.
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13
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Mackenzie M, Gannon M, Stanley N, Cosgrove K, Feder G. 'You certainly don't go back to the doctor once you've been told, "I'll never understand women like you."' Seeking candidacy and structural competency in the dynamics of domestic abuse disclosure. Sociol Health Illn 2019; 41:1159-1174. [PMID: 31001866 DOI: 10.1111/1467-9566.12893] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
A reticence on the part of women to disclose domestic abuse (DA) to family doctors, allied to front-line responses that do not always reflect an understanding of the structure and dynamics of DA, hampers the provision of professional support. Using data from 20 qualitative interviews with women who have experienced DA, this paper explores their discourse about interacting with family doctors. It is the first study to explore firsthand accounts of these interactions through Dixon Woods' lens of candidacy. It finds disclosure to be inherently dynamic as a process and expands the candidacy lens by considering the: (i) conflicting candidacies of victims and perpetrators; (ii) diversionary disclosure tactics deployed by perpetrators and, (iii) the potential role of General Practitioner (GPs) in imagining candidacies from a structural perspective. By exploring the dynamics of disclosure through the concept of 'structural competency' it finds that in encounters with women who have experienced abuse GPs ineluctably communicate their views on the legitimacy of women's claims for support; these in turn shape future candidacy and help-seeking. Greater GP awareness of the factors creating and sustaining abuse offers the potential for better care and reduced stigmatisation of abused women.
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Affiliation(s)
- Mhairi Mackenzie
- Urban Studies, School of Social & Political Sciences, University of Glasgow, Glasgow, UK
| | - Maria Gannon
- Urban Studies, School of Social & Political Sciences, University of Glasgow, Glasgow, UK
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14
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Borghi L, Leone D, Poli S, Becattini C, Chelo E, Costa M, De Lauretis L, Ferraretti AP, Filippini C, Giuffrida G, Livi C, Luehwink A, Palermo R, Revelli A, Tomasi G, Tomei F, Vegni E. Patient-centered communication, patient satisfaction, and retention in care in assisted reproductive technology visits. J Assist Reprod Genet 2019; 36:1135-1142. [PMID: 31077010 DOI: 10.1007/s10815-019-01466-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 04/28/2019] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To explore the association between patient-centered communication, patients' satisfaction, and retention in care in assisted reproductive technology (ART) visits. METHODS ART visits at eight Italian clinics were videotaped and coded using the Roter Interaction Analysis System, which includes a Patient-Centered Index (PCI), a summary "patient-centered communication" ratio. After the visit, patients completed a satisfaction questionnaire (SATQ). After 3 months, patients were asked about their retention in care. Spearman correlations and Mann-Whitney tests were used to test associations between the study variables; the open-ended item of SATQ was analyzed through content analysis. RESULTS Eighty-five visits were videotaped (involving 28 gynecologists and 160 patients). PCI score (μ = 0.51 ± 0.28) revealed a more disease-oriented communication during the visit. Patients reported high levels of satisfaction with the visit and identified in the information provision or in the doctor's humanity or kindness the main reasons of satisfaction. At the follow-up, the majority of the couples declared to have followed the clinicians' recommendations and to have remained related to the ART center. No associations were found among the study variables, except for a lower male satisfaction among couples who declared to have changed ART clinic. CONCLUSIONS Contrary to what was expected, the style of physician-patient communication was not found to be associated with patient satisfaction and retention in care. However, patients were highly satisfied and engaged. The actual meaning of a communication that is "patient-centered" in the ART context might be wider, including the couples' need for information, as suggested by qualitative findings.
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Affiliation(s)
- L Borghi
- Department of Health Sciences, University of Milan, 20142, Milan, Italy.
| | - D Leone
- Department of Health Sciences, University of Milan, 20142, Milan, Italy
- San Paolo University Hospital, Asst-Santi Paolo e Carlo, 20142, Milan, Italy
| | - S Poli
- Department of Health Sciences, University of Milan, 20142, Milan, Italy
| | - C Becattini
- Futura Assisted Reproductive Center, 50129, Florence, Italy
| | - E Chelo
- Demetra Assisted Reproductive Center, 50141, Florence, Italy
| | - M Costa
- Ospedale Evangelico Internazionale, Assisted Reproductive Unit, 16122, Genoa, Italy
| | - L De Lauretis
- Istituto Clinico Città Studi, Assisted Reproductive Center, 20131, Milan, Italy
| | - A P Ferraretti
- S.I.S.Me.R. Reproductive Medicine Unit, 40138, Bologna, Italy
| | - C Filippini
- Department of Surgical Sciences, University of Turin, 10126, Turin, Italy
| | - G Giuffrida
- CRA, Assisted Reproductive center, 95128, Catania, Italy
| | - C Livi
- Demetra Assisted Reproductive Center, 50141, Florence, Italy
| | - A Luehwink
- Azienda Provinciale per i Servizi Sanitari-Provincia Autonoma di Trento, Assisted Reproductive Unit, 38123, Arco, Italy
| | - R Palermo
- Ambra Assisted Reproductive Center, 90138, Palermo, Italy
| | - A Revelli
- Gynecology and Obstetrics I, Physiopathology of Reproduction and IVF Unit, Department of Surgical Sciences, S. Anna Hospital, University of Torino, 10126, Torino, Italy
| | - G Tomasi
- CRA, Assisted Reproductive center, 95128, Catania, Italy
| | - F Tomei
- Azienda Ospedaliera Santa Maria degli Angeli, 33170, Pordenone, Italy
| | - E Vegni
- Department of Health Sciences, University of Milan, 20142, Milan, Italy
- San Paolo University Hospital, Asst-Santi Paolo e Carlo, 20142, Milan, Italy
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15
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Kalateh Sadati A, Bagheri Lankarani K. The pattern of educator voice in clinical counseling in an educational hospital in Shiraz, Iran: a conversation analysis. J Med Ethics Hist Med 2017; 10:9. [PMID: 29296258 PMCID: PMC5747836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 10/03/2017] [Indexed: 11/04/2022] Open
Abstract
Doctor-patient interaction (DPI) includes different voices, of which the educator voice is of considerable importance. Physicians employ this voice to educate patients and their caregivers by providing them with information in order to change the patients' behavior and improve their health status. The subject has not yet been fully understood, and therefore the present study was conducted to explore the pattern of educator voice. For this purpose, conversation analysis (CA) of 33 recorded clinical consultations was performed in outpatient educational clinics in Shiraz, Iran between April 2014 and September 2014. In this qualitative study, all utterances, repetitions, lexical forms, chuckles and speech particles were considered and interpreted as social actions. Interpretations were based on inductive data-driven analysis with the aim to find recurring patterns of educator voice. The results showed educator voice to have two general features: descriptive and prescriptive. However, the pattern of educator voice comprised characteristics such as superficiality, marginalization of patients, one-dimensional approach, ignoring a healthy lifestyle, and robotic nature. The findings of this study clearly demonstrated a deficiency in the educator voice and inadequacy in patient-centered dialogue. In this setting, the educator voice was related to a distortion of DPI through the physicians' dominance, leading them to ignore their professional obligation to educate patients. Therefore, policies in this regard should take more account of enriching the educator voice through training medical students and faculty members in communication skills.
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Affiliation(s)
- Ahmad Kalateh Sadati
- Assistant Professor, Department of Social Sciences, Yazd University, Yazd, Iran.
| | - Kamran Bagheri Lankarani
- Professor, Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran.,Corresponding Author: Kamran Bagheri Lankarani. Address: Building No.2, Eighth Floor, School of Medicine, Zand Avenue, Shiraz, Iran., Postal Code: 71348-45794. Tel/Fax: + 98 71 32309615
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Jalil A, Zakar R, Zakar MZ, Fischer F. Patient satisfaction with doctor-patient interactions: a mixed methods study among diabetes mellitus patients in Pakistan. BMC Health Serv Res 2017; 17:155. [PMID: 28222721 PMCID: PMC5320691 DOI: 10.1186/s12913-017-2094-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 02/11/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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-.99) and access/availability (OR = .78; 95% CI = .72-.84). Several factors involving doctors' incompetence, such as inappropriate handling of critical cases, inaccurate diagnose, excessive reliance on medical tests, absence of physical examination, non-availability of specialist doctors, and experimentation by trainee doctors were related to patient dissatisfaction. CONCLUSION The findings of this study highlight a need to develop the interpersonal and clinical skills of doctors in order to improve the quality of doctor-patient interactions in public clinics for diabetes in Pakistan. Prospective researches should explore context-specific factors that form patient satisfaction.
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Affiliation(s)
- Aisha Jalil
- Department of Sociology, Institute of Social and Cultural Studies, University of the Punjab, Lahore, Pakistan
| | - Rubeena Zakar
- Department of Public Health, Institute of Social and Cultural Studies, University of the Punjab, Lahore, Pakistan
| | - Muhammad Zakria Zakar
- Institute of Social and Cultural Studies, University of the Punjab, Lahore, Pakistan
| | - Florian Fischer
- Department of Public Health Medicine, School of Public Health, Bielefeld University, Bielefeld, Germany.
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Norhayati MN, Masseni AA, Azlina I. Patient satisfaction with doctor-patient interaction and its association with modifiable cardiovascular risk factors among moderately-high risk patients in primary healthcare. PeerJ 2017; 5:e2983. [PMID: 28243527 PMCID: PMC5322751 DOI: 10.7717/peerj.2983] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 01/12/2017] [Indexed: 12/04/2022] Open
Abstract
Background The outcomes of the physician-patient discussion intervene in the satisfaction of cardiovascular disease risk patients. Adherence to treatment, provision of continuous care, clinical management of the illness and patients’ adjustment are influenced by satisfaction with physician-patient interaction. This study aims to determine the patient satisfaction with doctor-patient interaction and over six months after following prevention counselling, its associations with modifiable cardiovascular risk factors amongst moderately-high risk patients in a primary healthcare clinic in Kelantan, Malaysia. Methods A prospective survey was conducted amongst patients with moderately-high cardiovascular risk. A total of 104 moderately-high risk patients were recruited and underwent structured prevention counselling based on the World Health Organization guideline, and their satisfaction with the doctor-patient interaction was assessed using ‘Skala Kepuasan Interaksi Perubatan-11,’ the Malay version of the Medical Interview Satisfaction Scale-21. Systolic blood pressure, total cholesterol and high-density lipoprotein cholesterol were measured at baseline and at a follow-up visit at six months. Descriptive analysis, paired t test and linear regression analyses were performed. Results A total of 102 patients responded, giving a response rate of 98.1%. At baseline, 76.5% of the respondents were satisfied with the relation with their doctor, with the favourable domain of distress relief (85.3%) and rapport/confidence (91.2%). The unfavourable domain was interaction outcome, with satisfaction in only 67.6% of the respondents. Between the two visits, changes had occurred in total cholesterol (P = 0.022) and in systolic blood pressure (P < 0.001). Six months after the initial visits, no relationship existed between patient satisfaction scores and changes in modifiable cardiovascular risks. Discussion The ‘Skala Kepuasan Interaksi Perubatan-11’ which represents a component of the interpersonal doctor-patient relationship can be used to assess improvements of the medical skills and in medical training to enhance the quality of therapeutic communication.
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Affiliation(s)
- Mohd Noor Norhayati
- Department of Family Medicine, Universiti Sains Malaysia , Kubang Kerian , Kelantan , Malaysia
| | | | - Ishak Azlina
- Department of Family Medicine, Universiti Sains Malaysia , Kubang Kerian , Kelantan , Malaysia
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Kelly G. Patient agency and contested notions of disability in social assistance applications in South Africa. Soc Sci Med 2017; 175:109-116. [PMID: 28088616 DOI: 10.1016/j.socscimed.2017.01.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 01/06/2017] [Accepted: 01/08/2017] [Indexed: 11/28/2022]
Abstract
Problems in fairly allocating welfare and health resources are very often located in the spaces where citizens interact directly with state workers. This study draws on observations of doctor-patient encounters in disability assessments for the South African disability grant (DG) to examine how doctor-patient interactions and patient agency shape social welfare allocation in a context of high poverty and inequality. Data were gathered via interviews with healthcare workers and observations of doctor-patient interactions in twelve clinics and three hospitals in the Western Cape province between October 2013 and August 2014. Twenty-four doctors were interviewed, of whom seventeen were observed conducting a total of 216 consultations with patients. Two training sessions of DG assessors were also observed. Findings show that interactions between doctors and patients are sites of negotiation and contestation over rights to social assistance. Claimants' understanding of disability differed from biomedical and bureaucratic definitions. Patients attempted to influence doctors' decisions through narratives of suffering and performances of disability. Others used verbal or physical abuse as a form of protest against perceived unfair treatment. To defend themselves from these pressures and maintain authority in these interactions, doctors employed coping strategies that distanced and objectified claimants. This resulted in strained doctor-patient relationships and made the DG system confusing to the public. This demonstrates the importance of considering trust, power dynamics and the exercise of agency by both patients and providers in understanding policy implementation.
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Affiliation(s)
- Gabrielle Kelly
- Centre for Social Science Research, Rm 4.89, Leslie Social Science Building, 12 University Avenue, University of Cape Town, Rondebosch 7701, South Africa.
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Kalateh Sadati A, Iman MT, Bagheri Lankarani K, Ebrahimzadeh N. From good to great physician: a critical ethnography based on patients' views. J Med Ethics Hist Med 2016; 9:18. [PMID: 28523119 PMCID: PMC5432951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 12/14/2016] [Indexed: 12/02/2022] Open
Abstract
The doctor-patient interaction (DPI) plays an important role in the way patients view physicians. Thus, response to the question of ''Who is a great physician?'' is related to DPI experiences of patients. The aim of this qualitative study was to explore patients' views regarding this subject. Based on critical ethnography in one educational hospital in Shiraz, Iran, the study was performed based on 156 clinical consultations, 920 hours of participant observations, and 6 focus groups with patients and their relatives. The results revealed that asymmetrical power relationships exist in this context. Based on the general views of participants and their recent DPI experiences, a great physician should be kind, empathetic, friendly, and a good listener. Considering the presence of an asymmetrical power relationships in this context, results showed that doctors do not participate in an active interaction. Based on sociological theories, it can be concluded that the concept of a great physician is not only limited to obligations as in the Parsonian view, but is also related to active communication between both sides which is presented in the critical view. Through active communication, asymmetrical power relationships can be reduced. Thus, if a physician wants to become a great physician, he/she must strengthen his/her humanistic dimensions and communicative skills alongside his/her medical skills.
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Affiliation(s)
- Ahmad Kalateh Sadati
- Assistant Professor, Department of Social Sciences, Yazd University, Yazd, Iran;
| | - Mohammad Taghi Iman
- Professor, Department of Sociology and Social Planning, Shiraz University, Shiraz, Iran;
| | - Kamran Bagheri Lankarani
- Professor, Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran;,Corresponding Author: Kamran Bagheri Lankarani. Address: Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. Tel/Fax: 98 711 2309615
| | - Najmeh Ebrahimzadeh
- MA, Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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