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To purchase or authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1532-5415.2007.01504.x Byline: Ronald D. Adelman (*), Michele G. Greene ([dagger]), Erika Friedmann ([double dagger]), Mary Ann Cook (s.) Keywords: depression; older patient-physician communication Abstract: OBJECTIVES: To determine the frequency of discussion about depression in follow-up medical visits of older patients, who initiates these discussions, the quality of responsiveness of physicians and patients in these discussions, and patient and physician characteristics that influence these discussions. DESIGN: Convenience sample of 482 audiotaped follow-up visits. SETTING: Three community-based practice sites. PARTICIPANTS: Three hundred seventy-six community-dwelling older patients without dementia and 43 primary care physicians. MEASUREMENTS: Audiotapes were analyzed using the Multi-Dimensional Interaction Analysis system to determine the content and process of medical conversations; patients completed Medical Outcomes Study 36-item Short Form Survey questionnaires immediately after the visit. RESULTS: Depression was discussed in 7.3% of medical visits; physicians raised this topic in 41% of visits, patients raised it in 48% of visits, and accompanying persons raised it in 10% of visits. Visits were longer when the topic of depression was discussed. Depression was raised almost exclusively in the first 2.5 years of the patient-physician relationship. Physicians with some geriatric training were more likely to discuss depression, and these visits were shorter than visits to physicians without geriatric training. CONCLUSION: Depression was raised infrequently in follow-up visits. The high prevalence of depression in older people and the associated mortality merit discussion of depression early and later in the patient-physician relationship. Although visits were longer when depression was discussed, physicians with some geriatric training were more likely to raise depression, and more time-efficient when they did so, than physicians without geriatric training. Author Affiliation: (*)Division of Geriatrics and Gerontology, Weill Medical College of Cornell University, New York, New York ([dagger])Department of Health and Nutrition Sciences, Brooklyn College, Brooklyn, New York ([double dagger])School of Nursing, University of Maryland, Baltimore, Maryland (s.)JVC Radiology and Medical Analysis, St. Louis, Missouri. Article note: Address correspondence to Dr. Ronald Adelman, The Division of Geriatrics and Gerontology, Weill Medical College of Cornell University, 525 East 68th Street, Box 39, New York, NY 10021. E-mail: rdadelma@med.cornell.edu

To purchase or authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1532-5415.2007.01467.x Byline: Ming Tai-Seale (*), Thomas McGuire ([dagger]), Christopher Colenda (*), David Rosen (*), Mary Ann Cook ([double dagger]) Keywords: mental health; primary care; geriatric patients; time use; quality of care Abstract: OBJECTIVES: To assess how care is delivered for mental disorders using videotapes of office visits involving elderly patients. DESIGN: Mixed-method observational analysis of the nature of the topics discussed, content of discussion, and the time spent on mental health. SETTINGS: Three types of settings: an academic medical center, a managed care group, and fee-for-service solo practitioners. PARTICIPANTS: Thirty-five primary care physicians and 366 of their elderly patients. MEASUREMENTS: Videotapes of 385 visits covering 2,472 diverse topics were analyzed. Coding of the videotapes identified topics, determined talk time, and coded the dynamics of talk. RESULTS: Mental health topics occurred in 22% of visits, although patient survey indicated that 50% of the patients were depressed. A typical mental health discussion lasted approximately 2 minutes. Qualitative analysis suggested wide variations in physician effort in providing mental health care. Referrals to mental health specialists were rare even for severely depressed and suicidal patients. CONCLUSION: Little time is spent on mental health care for elderly patients despite heavy disease burdens. Standards of care based on a count of visits 'during which a mental health problem is discussed' may need to be supplemented with guidelines about what should happen during the visit. System-level interventions are needed. Author Affiliation: (*)Texas A&M Health Science Center, College Station, Texas ([dagger])Harvard Medical School, Boston, Massachusetts ([double dagger])JVC Radiology and Medical Analysis LLC, St. Louis, Missouri. Article note: Address correspondence to Ming Tai-Seale, PhD, MPH, Texas A&M Health Science Center, College Station, TX. E-mail: mtaiseale@srph.tamhsc.edu

Mary Ann Cook is a consultant in health care research with JVC Radiology and Medical Analysis (6319 Alexander Dr., St. Louis, MO 63105). She conducted the ethnographic study of homeless [...], Substance-Abusing Homeless Mothers in Treatment Programs: A Question of Knowing Drawing on analyses of Women's Ways of Knowing, a study of 12 African-American female clients of a demonstration program in St. Louis found no clear relation of treatment to changes in ways of knowing, rather than the hypothesized development from 'silence' to 'received knowledge' to 'subjective knowledge.'

The article discusses the procedure through which the managerial executive named Chatpata Terkar can improve employee experience. It outlines the need for them to understand the psychological factors which tend to drive loyalty of employees. Topics discussed include the need to for the Terkar to foster employee engagement, the necessity to connect with and support employees and the psychological aspects of employee engagement.

To the Editor: We conducted a pilot study to examine the effect of religious-awareness training on medical students' 'bedside manners.' Research has documented physician avoidance of religious inquiry due to [...]

The article highlights the lessons that leaders can follow to minimize their communications' margin of error. It focuses on to rethink the organizational approach; maintain foster Trust and integrity; and align strategy and culture through important business elements that bridge between culture and strategy.

The objective of this study was to examine primary care physicians’ propensity to assess their elderly patients for depression using data from videotapes and patient and physician surveys.