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Aggarwal A, Zhang R, Qiao S, Wang B, Lwatula C, Menon A, Ostermann J, Li X, Harper G. Stigmatizing clinical setting erodes physician-patient interaction quality for sexual minority men through perceived HIV stigma and HIV infection concerns in Zambia. AIDS Care 2024; 36:797-806. [PMID: 38437705 DOI: 10.1080/09540121.2024.2324288] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 02/22/2024] [Indexed: 03/06/2024]
Abstract
This study investigated whether perceived HIV stigma and HIV infection concerns among healthcare providers (HCPs) mediate the association between stigmatizing clinical setting and their interaction quality with sexual minority men (SMM) patients in Zambia. In 2021, a cross-sectional survey was conducted with 91 HCPs offering HIV-related services to SMM in Zambia. Path analysis was conducted to examine the potential mediation effect of "perceived HIV stigma" and "HIV infection concern" among HCPs in the association between "stigmatizing clinical setting" and their "interaction quality with SMM". Mediators i.e., "perceived HIV stigma" and "HIV infection concern" among HCPs, were associated positively with the stigmatizing clinical setting (β = 0.329, p < .01, β = 0.917, p < 0.01), and negatively with physician-patient interaction quality (β = -0.167, p = 0.051; β = -0.126, p < 0.05). Stigmatizing clinical setting had a significant and negative indirect effect on HCPs interaction quality with SMM through increased perceived HIV stigma (z = -1.966, p < 0.05) and increased HIV infection concern (z = -1.958, p = 0.050). To improve physician-patient interaction quality, stigma reduction interventions among HCPs, who serve SMM in Zambia, should target development of development of inclusive policies and the cultivation of cultural norms that are supportive and respectful to SMM, and protection of HCPs from enacted stigma due to offering care to SMM.
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Affiliation(s)
- Abhishek Aggarwal
- Department of Health Promotion, Education and Behavior, University of South Carolina, Columbia, USA
| | - Ran Zhang
- Department of Health Promotion, Education and Behavior, University of South Carolina, Columbia, USA
| | - Shan Qiao
- Department of Health Promotion, Education and Behavior, University of South Carolina, Columbia, USA
| | - Bo Wang
- Population and Quantitative Health Sciences, University of Massachusetts, Boston, USA
| | | | - Anitha Menon
- Department of Psychology, University of Zambia, Lusaka, Zambia
| | - Jan Ostermann
- Department of Health Service Policy and Management, University of South Carolina, Columbia, USA
| | - Xiaoming Li
- Department of Health Promotion, Education and Behavior, University of South Carolina, Columbia, USA
| | - Gary Harper
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, USA
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Rego C, Montague E. The Impact of Feedback Modalities and the Influence of Cognitive Load on Interpersonal Communication in Nonclinical Settings: Experimental Study Design. JMIR Hum Factors 2023; 10:e49675. [PMID: 37796596 PMCID: PMC10587814 DOI: 10.2196/49675] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/14/2023] [Accepted: 08/17/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND The escalating demands of modern health care systems, combined with the emotional toll of patient care, have led to an alarming increase in physician burnout rates. This burnout, characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment, can hinder doctors' ability to connect with patients effectively. Moreover, the cognitive load arising from information overload and the need for multitasking can further hinder doctors' ability to connect with patients effectively. Understanding the complex relationship between physician burnout and cognitive load is crucial for devising targeted interventions that enhance physician well-being and promote effective physician-patient interactions. Implementing strategies to alleviate burnout and cognitive load can lead to improved health care experiences and patient outcomes. OBJECTIVE Our study explores the interplay between physician burnout and its potential impact on interpersonal communication, particularly focusing on the role of cognitive load using a pilot study in a nonclinical setting involving nonclinical participants. METHODS This study uses an experimental design to evaluate 3 feedback tools (haptic, visual, and postvisit summary) and measure the cognitive load they impose on nonclinical participants in a nonclinical environment. The NASA Task Load Index, a widely accepted measure of cognitive load, was used to quantify the cognitive load associated with the feedback tools. The study used a within-subject design, meaning participants experienced all 3 feedback methods. A sample of 18 nonclinical participants was selected using counterbalancing techniques. RESULTS Postsession feedback not only enhancing performance but also mitigating the influence of cognitive load as compared with real-time feedback (haptic+visual). Participants with interview experience showed lower cognitive load levels when exposed to real-time feedback as compared with novice users. In contrast, postsession feedback was more effective for novice users. In addition, cognitive workload emerged as a moderating factor in the relationship between feedback tools and their impact on performance, particularly in terms of speaking balance and pace. This moderating effect suggests that the correlation between feedback tool efficacy and performance varies based on an individual's cognitive load while using the feedback tool. The comparison of postfeedback with haptic feedback yielded a Z score of -3.245 and a P value of .001, while the comparison with visual feedback resulted in a Z score of -2.940 and a P value of .003. These outcomes underscore a significant disparity in the means between postsession feedback and real-time feedback (haptic+visual), with postsession feedback indicating the lowest mean score. CONCLUSIONS Through the examination of various feedback tools, this study yields significant and insightful comparisons regarding their usability and appropriateness in nonclinical settings. To enhance the applicability of these findings to clinical environments, further research encompassing diverse participant cohorts and clinical scenarios is warranted.
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Affiliation(s)
- Chryselle Rego
- Jarvis College of Computing and Digital Media, DePaul University, Chicago, IL, United States
| | - Enid Montague
- Department of Mechanical & Industrial Engineering, University of Toronto, Toronto, ON, Canada
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Quasinowski B, Assa S, Bachmann C, Chen W, Elcin M, Kamisli C, Liu T, Maass AH, Merse S, Morbach C, Neumann A, Neumann T, Sommer I, Stoerk S, Weingartz S, Weiss A, Wietasch G. Hearts in their hands-Physicians' gestures embodying shared professional knowledge around the world. Sociol Health Illn 2023. [PMID: 36998218 DOI: 10.1111/1467-9566.13639] [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] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 03/14/2023] [Indexed: 06/19/2023]
Abstract
The biomedical approach to medical knowledge is widely accepted around the world. This article considers whether the incorporated aspects of physician-patient interaction have become similarly common across the globe by comparing the gestures that physicians use in their interactions with patients. Up to this point, there has been little research on physicians' use of gestures in health-care settings. We explore how-in four university hospitals in Turkey, the People's Republic of China, The Netherlands and Germany-physicians use gesture in their discussions with simulated patients about the condition of heart failure. Our analysis confirms the importance of gestures for organising both the personal interaction and the knowledge transfer between physician and patient. From the perspective of global comparison, it is notable that physicians in all four hospitals used similar gestures. This demonstrates the globality of biomedical knowledge in an embodied mode. Physicians used gestures for a range of purposes, including to convey the idea of an 'anatomical map' and for constructing visual models of (patho-)physiological processes. Since biomedical language is rife with metaphor, it was not surprising that we also identified an accompanying metaphorical gesture which has a similar form in the various locations that were part of the study.
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Affiliation(s)
| | - Solmaz Assa
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Cadja Bachmann
- Faculty of Medicine, Office of the Dean of Education, University of Rostock, Rostock, Mecklenburg-Vorpommern, Germany
| | - Wei Chen
- Department of Cardiology, Peking Union Medical College Hospital, Beijing, China
| | - Melih Elcin
- Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Caner Kamisli
- Faculty of Humanities, Institute of German Studies, University of Hamburg, Hamburg, Germany
| | - Tao Liu
- School of Public Affairs and Academy of Social Governance, Zhejiang University, Zhejiang, China
| | - Alexander H Maass
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stefanie Merse
- Faculty of Medicine, University of Duisburg-Essen, Duisburg, Nordrhein-Westfalen, Germany
| | - Caroline Morbach
- Department of Clinical Research & Epidemiology, Comprehensive Heart Failure Center and Department Internal Medicine I, University Hospital Würzburg, Würzburg, Bayern, Germany
| | - Anja Neumann
- Faculty of Economics and Business Administration, Institute of Healthcare Management, University of Duisburg-Essen, Duisburg, Germany
| | - Till Neumann
- Outpatient Department of Cardiology Cardio-Praxis, Bochum, Nordrhein-Westfalen, Germany
| | - Ilka Sommer
- Faculty of Social Sciences, Institute of Sociology, University of Duisburg-Essen, Duisburg, Nordrhein-Westfalen, Germany
| | - Stefan Stoerk
- Department of Clinical Research & Epidemiology, Comprehensive Heart Failure Center and Department Internal Medicine I, University Hospital Würzburg, Würzburg, Bayern, Germany
| | - Sarah Weingartz
- Faculty of Social Sciences, Institute of Sociology, University of Duisburg-Essen, Duisburg, Nordrhein-Westfalen, Germany
| | - Anja Weiss
- Faculty of Social Sciences, Institute of Sociology, University of Duisburg-Essen, Duisburg, Nordrhein-Westfalen, Germany
| | - Goetz Wietasch
- Department of Anesthesiology, University Medical Center Groningen, Groningen, The Netherlands
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Mavragani A, Dang Y, Vogel D, She B. The Effect of Offline Medical Resource Distribution on Online Physician-Patient Interaction: Empirical Study With Online and Offline Data. JMIR Form Res 2023; 7:e43533. [PMID: 36626204 PMCID: PMC9874990 DOI: 10.2196/43533] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/20/2022] [Accepted: 11/23/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The relationship between online health communities (OHCs) and offline medical care is unclear because both provide physician-patient interaction services and channels. Taking advantage of information and communication technology, patients have been using OHCs widely. However, some physical medical resources (such as hospital beds and medical devices) cannot be replicated by information and communication technologies. Therefore, it is worth studying how offline medical resources affect physician-patient interactions in OHCs and how OHCs help to solve resource scarcity and the uneven distribution of traditional medical treatment. OBJECTIVE This study aimed to support the notion that physician-patient consultations in OHCs are influenced by the objective distribution of offline health care capital (accessibility and availability) and to provide suggestions for the allocation of medical resources in practice through the judicious use of offline and online channels. METHODS The empirical data in this study were collected from both online and offline channels. The offline data include 9 years (2006-2014) of medical resource statistics of 31 provincial administrative regions in mainland China. Moreover, data regarding the geolocation-based physician-patient interaction network in the OHC were also collected. The online data come from one of China's largest OHCs. We obtained 92,492 telephone consultation records of 6006 physicians using an automatic web crawler program. Social network analysis was used to visualize the descriptive statistics of the offline geolocation-based physician-patient interaction network in the OHC. A regression model with a squared variable was applied to analyze online and offline empirical data to further test our hypothesis. Two types of robustness tests were used to increase the reliability of the test results of the initial model. RESULTS The results of our social network analysis show that there is a uniform geographic distribution of patients who use OHCs, whereas the physician relies more on geographic advantage (eg, a higher medical resource capability). Moreover, the empirical results of the regression model support the notion that physician-patient telephone consultations are positively influenced by physicians' online contributions (βcontribution=.210; P<.001) and capital availability (βbed=.935; P=.07), and, interestingly, spatial accessibility has an inverted U-shaped effect (βdistance=.199; P<.001 and βdistance2=-.00449; P=.008). The results indicate that the use of OHCs, although constrained by offline medical resources, provides a channel for offline resources to flow from areas with high availability to those with low availability. CONCLUSIONS This study explores the relationship between online and offline channels by investigating online physician-patient interactions and offline medical resources. In particular, this study analyzes the impact of offline channels on online channels and verifies the possibility of OHC capital use shifting from a high-availability area to a low-availability area. In addition, it provides a theoretical and practical basis for understanding the interaction of online and offline channels of medical care.
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Affiliation(s)
| | - Yuanyuan Dang
- School of Business Administration, South China University of Technology, Guangzhou, China
| | - Doug Vogel
- School of Management, Harbin Institute of Technology, Harbin, China
| | - Bofei She
- School of Business Administration, South China University of Technology, Guangzhou, China
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Thompson GA, Segura J, Cruz D, Arnita C, Whiffen LH. Cultural Differences in Patients' Preferences for Paternalism: Comparing Mexican and American Patients' Preferences for and Experiences with Physician Paternalism and Patient Autonomy. Int J Environ Res Public Health 2022; 19:10663. [PMID: 36078378 PMCID: PMC9518551 DOI: 10.3390/ijerph191710663] [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] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/17/2022] [Accepted: 08/24/2022] [Indexed: 06/15/2023]
Abstract
Following up on previous research demonstrating the high level of care realized by a paternalistic Mexican physician, the present research further explored the hypothesis that there are cultural differences in preferences for and experiences with physician paternalism vs. patient autonomy in White American culture as compared with Mexican culture. In this research, we interviewed sixty (60) people including twenty (20) Mexican, twenty (20) Mexican American, and twenty (20) White American respondents. We asked these patients about their experiences with and attitudes towards paternalism and patient autonomy in healthcare interactions. With some caveats, our data showed strong support for both hypotheses while also suggesting a high level of care can be realized by paternalistic physicians when "paternalism" is understood in a cultural context. We close with a brief consideration of the implications of these findings.
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Filut A, Alexander L, Ray A, Pecanac K, Carnes M. "This happens all the time": a Qualitative Study of General Internists' Experiences with Discriminatory Patients. J Gen Intern Med 2021; 36:1553-1560. [PMID: 33782894 PMCID: PMC8007052 DOI: 10.1007/s11606-021-06696-7] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 03/02/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Workplace discrimination negatively affects physicians of color personally and professionally. Although the occurrence of discrimination from patients has been visible in social media, popular press, and personal essays, scant research exists on patients as a source of discrimination directed at physicians of color. OBJECTIVE To explore practicing general internists' experiences observing or interacting with patients exhibiting discriminatory behavior directed at physicians of color. DESIGN A qualitative study with in-depth, semi-structured, one-on-one telephone interviews conducted and recorded between May and September 2019. PARTICIPANTS A purposive sample of 24 general internists practicing at 12 academic health centers in the USA: 14 self-identified as White and 10 as a physician of color, which included Asian, Black, Native American, and self-identified other race. APPROACH Four coders analyzed the transcribed and verified interview text; thematic analysis was used to inductively identify cohesive themes and subthemes. KEY RESULTS Analyses revealed four major themes: (1) assumption that a legitimate doctor is White, male, and able-bodied; (2) legacy of the Black experience; (3) working through the struggle of discrimination; and (4) ethical dilemma of providing care to discriminatory patients. In addition to discrimination from patients based on a physician's race or ethnicity, participants described experiencing or observing discrimination based on a physician's gender and disability status. Participants generally expressed a need for greater support from colleagues and more guidance from institutional policies. CONCLUSIONS General internists practicing in academic settings reported observing or experiencing discrimination from patients based on the physician's race, ethnicity, gender (or their intersection), and disability status and the ethical dilemma of providing care to such patients. These results contribute to growing evidence of the need for institutions to better support an increasingly diverse physician workforce with policies and specific guidance to help physicians respond to discrimination from patients while still providing quality care.
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Affiliation(s)
- Amarette Filut
- Center for Women's Health Research, University of Wisconsin-Madison, Madison, WI, USA
| | - Lacey Alexander
- Center for Women's Health Research, University of Wisconsin-Madison, Madison, WI, USA
| | - Alexis Ray
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Kristen Pecanac
- Departments of Medicine, Psychiatry, and Industrial Engineering, University of Wisconsin-Madison, Madison, WI, USA.
| | - Molly Carnes
- Center for Women's Health Research, University of Wisconsin-Madison, Madison, WI, USA.
- Departments of Medicine, Psychiatry, and Industrial Engineering, University of Wisconsin-Madison, Madison, WI, USA.
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7
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Röttele N, Schöpf-Lazzarino AC, Becker S, Körner M, Boeker M, Wirtz MA. Agreement of physician and patient ratings of communication in medical encounters: A systematic review and meta-analysis of interrater agreement. Patient Educ Couns 2020; 103:1873-1882. [PMID: 32376141 DOI: 10.1016/j.pec.2020.04.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 10/30/2019] [Revised: 03/29/2020] [Accepted: 04/03/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To determine the agreement of physician and patient ratings of communication in medical face-to-face consultations. METHODS A systematic search of twelve databases was conducted. Studies investigating agreement between physician and patient ratings of communication in medical face-to-face encounters and reporting interrater agreement were included. Methodological quality was assessed, and study characteristics and physician-patient agreement were narratively summarized. Meta-analysis was conducted for a subsample of the included studies investigating shared decision making. RESULTS Of the 17 included studies, ten studies did not demonstrate any correspondence between physician and patient ratings. The remaining seven studies revealed poor to fair absolute agreement (κ between .13 and .42; κw between .31 and .49; 95% CI 0.13 - 0.76) and poor to moderate consistency (r = .17 and .06; rpolyc between .39 and .63; p < .05). Meta-analysis of six studies yielded small association (rpolyc = .15). CONCLUSION Physicians and patients evaluate communication differently and at best, only slightly agree in their ratings, indicating that the construct of communication is not measurable in a stable manner. PRACTICE IMPLICATIONS Decision makers and researchers should be aware that they assess different aspects of communication, depending on the perspective examined. PROSPERO registration number: CRD42019120065.
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Affiliation(s)
- Nicole Röttele
- Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Andrea C Schöpf-Lazzarino
- Division of General Practice/Family Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Sonja Becker
- Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Mirjam Körner
- Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Martin Boeker
- Medical Data Science, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Markus A Wirtz
- Department of Research Methods, Freiburg University of Education, Freiburg, Germany
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Lu X, Zhang R, Zhu X. An Empirical Study on Patients' Acceptance of Physician-Patient Interaction in Online Health Communities. Int J Environ Res Public Health 2019; 16:ijerph16245084. [PMID: 31842465 PMCID: PMC6949919 DOI: 10.3390/ijerph16245084] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 12/09/2019] [Accepted: 12/11/2019] [Indexed: 12/15/2022]
Abstract
In China, the utilization of medical resources is contentious, and a large of hospitals are seriously congested because of the huge population and uneven distribution of medical resources. Online health communities (OHCs) provide patients with platforms to interact with physicians and to get professional suggestions and emotional support. This study adopted the unified theory of acceptance and use of technology to identify factors influencing patients’ behavioral intention and usage behavior when interacting with physicians in OHCs. An investigation involving 378 valid responses was conducted through several Chinese OHCs to collect data. Confirmatory factor analysis and structural equation modelling were utilized to test hypotheses. Both the reliability and validity of the scales were acceptable. All five hypotheses were supported, and behavioral intention played a significant mediating role between independent variables and dependent variables. This study clarified the mechanism by which performance expectancy, effort expectancy, social influence and attitude toward using technology affect usage behavior through the mediation of behavioral intention in OHCs. These findings suggest that OHCs can change the actions of websites such as adopting some incentives to promote patients’ intention of interaction. Physicians should understand patients’ actual attitudes toward OHCs and try to guide patients in their interactions, improving the quality of physician–patient interaction.
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Affiliation(s)
- Xinyi Lu
- School of Economics and Management, Beijing Jiaotong University, No. 3 Shangyuancun, Haidian District, Beijing 100044, China; (X.L.); (R.Z.)
| | - Runtong Zhang
- School of Economics and Management, Beijing Jiaotong University, No. 3 Shangyuancun, Haidian District, Beijing 100044, China; (X.L.); (R.Z.)
| | - Xiaomin Zhu
- School of Mechanical, Electronic and Control Engineering, Beijing Jiaotong University, No. 3 Shangyuancun, Haidian District, Beijing 100044, China
- Correspondence: ; Tel.: +86-10-5168-3854
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Abstract
RATIONALE, AIMS AND OBJECTIVES Understanding the impact of health information technology on doctor-patient interaction is vital to designing better electronic health records (EHRs). This article quantitatively examines and compares clinically experienced physicians' interactions with patients using paper or EHRs in ambulatory primary care settings. METHODS Clinical encounters using paper or EHRs were recorded with high-resolution video cameras to capture physicians' interactions with the health records and patients. All videos were coded using quantified video coding methodology to understand how physicians interacted with EHRs and patients through measuring eye gaze durations. Statistical analysis was conducted to compare the results of the paper and EHR visits. RESULTS Eight experienced family medicine physicians and 80 patients participated in the study. A total of 80 visits, 40 with paper and 40 with EHRs were recorded. The proportion of time physicians spent gazing at medical records during EHR visits was significantly more than in paper chart visits (35.2 versus 22.1%, P = 0.001). A significantly smaller proportion of physician time was spent gazing at the patient when using an EHR compared with when using a paper chart (52.6 versus 45.6%, P = 0.041). CONCLUSIONS For this group of family medicine physicians, more time was spent looking at the EHR screen than paper records and a little less time looking at the patient. These findings may negatively affect the patient perception of the visit with the physician and have implications for the design of future EHRs.
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Affiliation(s)
- Onur Asan
- Center for Patient Care and Outcomes Research, Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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Tarn DM, Paterniti DA, Good JS, Coulter ID, Galliher JM, Kravitz RL, Karlamangla AS, Wenger NS. Physician-patient communication about dietary supplements. Patient Educ Couns 2013; 91:287-294. [PMID: 23466249 PMCID: PMC3648214 DOI: 10.1016/j.pec.2013.01.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [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] [Received: 08/07/2012] [Revised: 01/28/2013] [Accepted: 01/29/2013] [Indexed: 06/01/2023]
Abstract
OBJECTIVE Describe the content and frequency of provider-patient dietary supplement discussions during primary care office visits. METHODS Inductive content analysis of 1477 transcribed audio-recorded office visits to 102 primary care providers was combined with patient and provider surveys. Encounters were collected in Los Angeles, CA (2009-2010), geographically diverse practice settings across the United States (2004-2005), and Sacramento, CA (1998-1999). RESULTS Providers discussed 738 dietary supplements during encounters with 357 patients (24.2% of all encounters in the data). They mentioned: (1) reason for taking the supplement for 46.5% of dietary supplements; (2) how to take the supplement for 28.2%; (3) potential risks for 17.3%; (4) supplement effectiveness for 16.7%; and (5) supplement cost or affordability for 4.2%. Of these five topics, a mean of 1.13 (SD=1.2) topics were discussed for each supplement. More topics were reviewed for non-vitamin non-mineral supplements (mean 1.47 (SD=1.2)) than for vitamin/mineral supplements (mean 0.99 (SD=1.1); p<0.001). CONCLUSION While discussions about supplements are occurring, it is clear that more discussion might be needed to inform patient decisions about supplement use. PRACTICE IMPLICATIONS Physicians could more frequently address topics that may influence patient dietary supplement use, such as the risks, effectiveness, and costs of supplements.
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Affiliation(s)
- Derjung M Tarn
- Department of Family Medicine, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA 90024, USA.
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Abstract
Modern patients walk a tightrope between respecting medical authority and acting as knowledgeable advocates regarding health issues, with the agency and responsibilities that come with this. This article uses conversation analysis to explore this balance in relation to patient disclosures of medical misdeeds in video-recorded primary care medical visits (e.g., taking another's prescription medication or failing to adhere to a healthy lifestyle or prescription regimen). We focus on patient-initiated disclosures. We show that disclosures are used (1) where patients are seeking physician assessment of their behavior, (2) where patients are proposing the etiology of a health problem, and (3) where patients are lobbying for a particular treatment outcome. We argue that disclosures of medical misdeeds are an important but understudied domain of conduct in which patients show awareness of their own agency over, and responsibility for, their healthcare and respect for the physician's medical authority.
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Thüm S, Janssen C, Pfaff H, Lefering R, Neugebauer EA, Ommen O. The association between psychosocial care by physicians and patients' trust: a retrospective analysis of severely injured patients in surgical intensive care units. Psychosoc Med 2012; 9:Doc04. [PMID: 23049644 PMCID: PMC3461762 DOI: 10.3205/psm000082] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM Trust is an essential element in physician-patient interaction fostering in general adherence and improving patient- and physician-reported outcomes. Regarding severely injured patients, trust-building behaviour is important because of the severity of injuries and therefore potential associated physical and psychological consequences. The objective of this study was to identify significant and relevant determinants on trust of severely injured patients in their physicians in surgical intensive care units. METHODS Ninety-one severely injured patients completed a self-administered questionnaire after being transferred from surgical intensive care unit to surgical unit. All patients were treated in four hospitals of maximal care in North Rhine-Westphalia between 2001 and 2005. To assess different aspects of trust the "trust in physician" scale of the Cologne Patient Questionnaire (CPQ) was used. "Psychosocial care by physicians" is measured through: support, devotion, information and shared-decision making provided by physicians. Patient- and trauma related control variables are also included in a logistic regression model. RESULTS Stepwise logistic regression identified "psychosocial care provided by physicians" as a significant contributor to severely injured patients' trust (Nagelkerke's R(2): 41%). "Trust in physicians" is correlated with all four dimensions of "psychosocial care by physicians": support (0.546), devotion (0.443), information (0.396), and shared-decision making behaviour (0.342) provided by physicians in surgical intensive care units. CONCLUSIONS This finding confirms the importance of supportive communication style in physician-patient interaction concerning reported trust of severely injured patients on surgical intensive care units. Medical education should integrate sound knowledge about psychosocial aspects of interaction to provide effective emotional and informational support to build up and maintain patient trust.
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Affiliation(s)
- Sonja Thüm
- Institute for Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), University of Cologne, Germany
| | - Christian Janssen
- Faculty of Applied Social Sciences, University of Applied Sciences Munich, Germany
| | - Holger Pfaff
- Institute for Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), University of Cologne, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine, Faculty of Medicine, University of Witten/Herdecke, Campus Cologne-Merheim, Cologne, Germany
| | - Edmund A. Neugebauer
- Institute for Research in Operative Medicine, Faculty of Medicine, University of Witten/Herdecke, Campus Cologne-Merheim, Cologne, Germany
| | - Oliver Ommen
- Institute for Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), University of Cologne, Germany
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Kravitz RL, Paterniti DA, Epstein RM, Rochlen AB, Bell RA, Cipri C, Fernandez y Garcia E, Feldman MD, Duberstein P. Relational barriers to depression help-seeking in primary care. Patient Educ Couns 2011; 82:207-13. [PMID: 20570462 PMCID: PMC2953600 DOI: 10.1016/j.pec.2010.05.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [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] [Received: 01/13/2010] [Revised: 05/03/2010] [Accepted: 05/06/2010] [Indexed: 05/14/2023]
Abstract
OBJECTIVE To identify attitudinal and interpersonal barriers to depression care-seeking and disclosure in primary care and in so doing, evaluate the primary care paradigm for depression care in the United States. METHODS Fifteen qualitative focus group interviews in three cities. Study participants were English-speaking men and women aged 25-64 with first-hand knowledge of depression. Transcripts were analyzed iteratively for recurring themes. RESULTS Participants expressed reservations about the ability of primary care physicians (PCPs) to meet their mental health needs. Specific barriers included problems with PCP competence and openness as well as patient-physician trust. While many reflected positively on their primary care experiences, some doubted PCPs' knowledge of mental health disorders and believed mental health concerns fell outside the bounds of primary care. Low-income participants in particular shared stories about the essentiality, and ultimate fragility, of patient-PCP trust. CONCLUSION Patients with depression may be deterred from care-seeking or disclosure by relational barriers including perceptions of PCPs' mental health-related capabilities and interests. PRACTICE IMPLICATIONS PCPs should continue to develop their depression management skills while supporting vigorous efforts to inform the public that primary care is a safe and appropriate venue for treatment of common mental health conditions.
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Affiliation(s)
- Richard L Kravitz
- Department of Internal Medicine, Division of General Medicine, University of California Davis School of Medicine, Sacramento, CA 95817, USA.
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Christensen AJ, Howren MB, Hillis SL, Kaboli P, Carter BL, Cvengros JA, Wallston KA, Rosenthal GE. Patient and physician beliefs about control over health: association of symmetrical beliefs with medication regimen adherence. J Gen Intern Med 2010; 25:397-402. [PMID: 20174972 DOI: 10.1007/s11606-010-1249-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2009] [Revised: 12/02/2009] [Accepted: 01/04/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Past work suggests that the degree of similarity between patient and physician attitudes may be an important predictor of patient-centered outcomes. OBJECTIVE To examine the extent to which patient and provider symmetry in health locus of control (HLOC) beliefs was associated with objectively derived medication refill adherence in patients with co-morbid diabetes mellitus (DM) and hypertension (HTN). PARTICIPANTS Eighteen primary care physicians at the VA Iowa City Medical Center and affiliated clinics; 246 patients of consented providers with co-morbid DM and HTN. DESIGN Established patient-physician dyads were classified into three groups according to the similarity of their HLOC scores (assessed in parallel). Data analysis utilized hierarchical linear modeling (HLM) to account for clustering of patients within physicians. MAIN MEASURES Objectively derived medication refill adherence was computed using data from the VA electronic pharmacy record; blood pressure and HgA1c values were considered as secondary outcomes. KEY RESULTS Physician-patient dyads holding highly similar beliefs regarding the degree of personal control that individual patients have over health outcomes showed significantly higher overall and cardiovascular medication regimen adherence (p = 0.03) and lower diastolic blood pressure (p = 0.02) than in dyads in which the patient held a stronger belief in their own personal control than did their treating physician. Dyads in which patients held a weaker belief in their own personal control than did their treating physician did not differ significantly from symmetrical dyads. The same pattern was observed after adjustment for age, physician sex, and physician years of practice. CONCLUSIONS These data are the first to demonstrate the importance of attitudinal symmetry on an objective measure of medication adherence and suggest that a brief assessment of patient HLOC may be useful for tailoring the provider's approach in the clinical encounter or for matching patients to physicians with similar attitudes towards care.
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Abstract
OBJECTIVE To assess the comprehensibility of hepatitis B translations for Cambodian refugees, to identify Cambodian illnesses that include the symptoms of hepatitis, and to combine these observations with critical theoretical perspectives of language to reflect on the challenges of medical translations generally. DESIGN Open-ended, semistructured interviews, and participant-observation of a refugee community in Seattle, Washington. SETTING Homes of Cambodian residents of inner-city neighborhoods. PARTICIPANTS Thirty-four adult Cambodian refugees who had each been educated about hepatitis B through public health outreach. RESULTS Medical interpreters translated hepatitis B as rauk tlaam, literally "liver disease." Unfortunately, while everyone knew of the liver (tlaam), rauk tlaam was a meaningless term to 28 (82%) of 34 respondents and conveyed none of the chronicity and communicability intended by refugee health workers for 34 (100%) of the respondents. In contrast, all respondents knew illnesses named after symptom complexes that include the symptoms of acute and chronic hepatitis, but do not refer to diseased organs. The Cambodian words chosen to translate hepatitis B reflect the medical thinking and medical authority that can unintentionally overwhelm attempts at meaningful communication with non-English-speaking patients. CONCLUSIONS To improve comprehension of hepatitis B translations for the Khmer, translators must choose between medical terminology focused on the liver and Khmer terminology which identifies recognizable experiences, but represents important Khmer health concepts. A critical linguistic view of this situation suggests that for these translations to be meaningful clinicians and health educators must first analyze and then monitor the contextual significance of medical language. In cross-cultural settings, this means a partnership with medical interpreters to pay close attention to the experience of illness and social context of the translation.
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Affiliation(s)
- J C Jackson
- Division of General Internal Medicine, University of Washington, Seattle, USA
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