Search

Objective To explore how patients enact presentations of self in consultations dealing with lifestyle in general practice. Methods We conducted a qualitative observational study with thematic, cross-case analysis of video-recorded consultations inspired by discourse analysis. Results Patients presented themselves with an orientation toward responsibility in dialog about lifestyle. They described how they were taking care of themselves and doing their best. In this respect, they demonstrated their achievements as matters of honor. If one lifestyle issue was considered problematic, in some cases patients shifted attention to another, of which they were more proud. In areas where they were not doing well, some patients revealed shame for not acting responsibly. In such cases, patients spoke of themselves in terms of self-deprecation or admitted not living up to expected standards. Conclusion Negotiations of shame and honor, revolving around personal responsibility, are embedded in clinical discourse about lifestyle. Patients take a proactive role in presenting and defending the self against shame. Practice implications GPs should pay more attention to the tacit role of shame in consultations. Failure to do so could lead to distance and hostility while a strategy to acknowledge the impact of shame could help develop and strengthen the doctor–patient relationship. [ABSTRACT FROM AUTHOR]

Despite patient-centered communication has been recognized in medical education for decades, it has been reported that medical students detach from the patient during medical school and that their empathy declines. In addition, poor communication with doctors has been shown as one of the most common problems in patient complaints, which indicate that patient-centered communication training needs to be developed further. Therefore, many educational initiatives engage patients' experiences but there is no explicit understanding about how patients contribute to the process of educating medical students. The context for this study is a learning situation in which medical students have communication training with patients with chronic conditions in a simulation lab. This provides opportunity to investigate what medical students learn from patients and how they learn it. This qualitative study involves four focus groups with each 3–7 participants, 2 paired interviews and 8 individual semi-structured interviews (30–90 min) with 32 medical students, who had attended the communication course. The interviews were recorded, transcribed and thematic analysis was applied inductively and organized into four main themes. Learning from patients provided medical students opportunities to 1) see the world through the patients' eyes, 2) understand the diversity of patients' needs, and 3) recognize the importance of matching patients' and doctors' perspectives. Consequently, 4) students expressed challenges in interacting with the patients when performing the role as 'medical expert'. Difficulty empathizing became visible in the students' interaction with patients. The patients' authentic contributions provided the students with unique opportunities to engage with their own emotions and capacity for empathy. However, for students to benefit from this affective practical training, they need guidance to balance professional and personal aspects in encounters. Perhaps there is a need to introduce the 'doctor as person' in medical education. [ABSTRACT FROM AUTHOR]

Objective: To explore what and how medical students learn from patients with chronic conditions in the context of communication skills training.Methods: Semi-structured interviews and focus groups with 32 medical students. Interviews were recorded, transcribed, analyzed inductively and organized into four main narrative themes.Results: Learning from patients provided medical students opportunities to see the world through the patients' eyes, understand the diversity of patients' needs, and recognize the importance of matching patients' and doctors' perspectives. Consequently, students expressed emotional responses on challenges in interactions with the patients related to performing the role as 'medical expert'. Difficulty empathizing became visible in the students' interaction with patients.Conclusion: The patients' authentic contributions provided the students with unique opportunities to engage with their own emotions and capacity for empathy. However, for students to benefit from this affective practical training, they need guidance to balance professional and personal aspects in encounters. There is a need to introduce the 'doctor as person' in medical education.Practice Implications: Patients with chronic conditions strengthen students' learning of empathy as part of transformative learning. Doing so with patients is a challenging way of learning. Thus, faculty and educators must provide explicit guidance for students to benefit. [ABSTRACT FROM AUTHOR]