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Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This essay analyses and historicises a contemporary dominant narrative among India's biomedical doctors, that the early post‐independence period (1940s–1970s) was characterised by immense public trust and confidence in the biomedical profession, with the patient‐doctor relationship experiencing a 'golden era'. By exploring people's experiences with and perceptions of doctors during these decades, I show that contrary to contemporary understanding, public dissatisfaction with doctors was substantial even in the early post‐independence period. I argue that the dominance of privileged‐caste and ‐class Indians in the medical profession nurtured a caste privilege‐based elitist outlook within the mainstream profession and its leadership and created an insurmountable socioeconomic distance between doctors and the large majority of the public. What doctors deemed as people's 'trust' in them and their profession was often simply a manifestation of people's general deference towards the elites of the society. This incorrect interpretation of patient‐doctor dynamics in the past has been a constant feature of mainstream narratives around the doctor‐society relationship in post‐independence India and has remained largely under‐explored and under‐historicised in the medical, scholarly and public discourses. [ABSTRACT FROM AUTHOR]

Starting at the end of the 1940s, the so-called "democratic transformation of healthcare" was not limited to the expansion of beneficiaries and making care provided in the system free of charge. It also sought to define the new roles of those who run (physicians) and use (patients) the system. To enforce the implementation of new norms, medical ethics committees were set up, and in many respects, these new structures were integrated into the system of social courts and were tasked mainly with the protection patients' rights during investigations into complaints against doctors. This article aims to address the following question: What role did the functioning of these medical ethics committees play in healthcare operations organized along socialist principles, considering their involvement in both politics and healthcare? Additionally, what forms of governmentality can be inferred from the ways these committees functioned within the framework of socialist healthcare? To answer these questions, I examine patients' complaints received by the medical ethics committees, as the core objective of socialist healthcare was to provide quality healthcare and educate individuals about utilizing the socialist healthcare system. My hypothesis is that while the committees exhibited organizational and operational characteristics aligned with the basic institutions of socialist democracy, their ultimate goal was to educate individuals in accordance with the principles of the socialist system. However, the committees' decisions were influenced by the degrees of autonomy granted to them and existing practices for supervising medical activity prior to the establishment of the state-socialist system. Consequently, they functioned not as guardians of the socialist state's biopolitics but rather as autonomous bodies of medical advocacy. Although patients used various strategies of argumentation to justify the incompatibility of their grievances with socialist healthcare, doctors did not primarily assess the seriousness of the problems based on patient complaints. Institutional constraints and specific professional practices, which also played a role in medical activities, had a more significant impact on the decision-making process. [ABSTRACT FROM AUTHOR]

A 9-month-old baby girl was admitted to our family health center with the complaint of areas of rash concentrated on her skin. A preliminary diagnosis of seborrheic dermatitis was made for the baby, who underwent periodic health examinations, and blood tests were requested. The patient's blood results and general condition were evaluated, and she was referred for further examination. Bone marrow biopsy results showed positive results consistent with Langerhans cell histiocytosis (LCH) on CD1a and langerin staining using immunohistochemistry. When a patient presents with a persistent seborrheic dermatitis-like rash or chronic diaper rash, the healthcare professional should consider the possibility of LCH. Early recognition and accurate diagnosis of LCH are critical for oncological evaluation and treatment. Therefore, it has been concluded that regular health examinations are essential in diagnosing the disease. [ABSTRACT FROM AUTHOR]

Copyright of Saberes Plurais is the property of Saberes Plurais and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

BackgroundPhysicians' fear of difficult patient interactions is an important barrier to discontinuing long-term opioid therapy.ObjectiveTo identify patient statements about opioids that indicate potential openness to tapering opioids or trying non-opioid pain treatments DESIGN: This is an observational study of regularly scheduled primary care visits involving discussion of chronic pain management. A coding system to characterize patient assessments about opioids, physician responses to assessments, and patient-endorsed opioid side effects was developed and applied to transcripts of video-recorded visits. All visits were independently coded by 2 authors.ParticipantsEighty-six established adult patients taking opioids for chronic pain; 49 physicians in 2 academic primary care clinics MAIN MEASURES: Frequency and topic of patients' opioid assessments; proportion of opioid assessments classified as clues (assessments indicating potential willingness to consider non-opioid pain treatments or lower opioid doses); physician responses to patient clues; frequency and type of patient-endorsed side effects KEY RESULTS: Patients made a mean of 3.2 opioid assessments (median 2) per visit. The most common assessment topics were pain relief (51%), effect on function (21%), and opioid safety (14%). Forty-seven percent of opioid assessments (mean 1.5 per visit) were classified as clues. Fifty-three percent of visits included ≥ 1 clue; 21% of visits contained ≥ 3 clues. Physicians responded to patient clues with no/minimal response 43% of the time, sympathetic/empathetic statements 14% of the time, and further explored clues 43% of the time. Fifty-eight percent of patients endorsed ≥ 1 opioid-related side effect; 10% endorsed ≥ 3 side effects. The most commonly endorsed side effects were constipation (15% of patients), sedation (15%), withdrawal symptoms (13%), and nausea (12%).ConclusionsPatient statements suggesting openness to non-opioid pain treatments or lower opioid doses are common during routine primary care visits. Listening for and exploring these clues may be a patient-centered strategy for broaching difficult topics with patients on long-term opioid therapy.

Background Since the full implementation of contracted family doctor services in 2016, we have achieved phased results. Further work needs to be paid equal attention to "quality" and "quantity", focusing on improving the residents' sense of service access and satisfaction, however, at present, the residents' evaluation of contracted family doctor services is not clear. Objective To investigate the contracted residents' evaluation for the continuity of family doctor contract, explore its influencing factors, and propose improvement strategies. Methods This study used a multi-stage stratified random sampling method to select 1 193 contracted residents from 9 community health service institutions and 9 township health centers in Heze City, Shandong Province in January 2021. A household survey was conducted on the included residents by using the continuity dimension of the Chinese version of the Primary Care Assessment Tools (PCAT) , which contains 15 items. We compared the PCAT-continuity dimension scores of contracted residents with different characteristics, and used multiple linear regression to analyze the factors influencing the PCAT-continuity dimension scores of contracted residents. Results A total of 1 098 valid questionnaires were collected, with a valid response rate of 92.04%. 541 (49.27%) of them were contracted to community health service institutions and 557 (50.73%) of them were contracted to township health centers. The average score of the PCAT-continuity dimension of the contracted residents was (3.38±0.51) . The item with the highest score was "Does your family doctor listen to you patiently", with a score of (3.64±0.59) . The item with the lowest score was "Would you be willing to change your family doctor if it was easy to do so", with a score of (2.98±0.92) . Multiple linear regression analysis showed that the type of contract organization, age, education, marital status, occupation, and chronic diseases were the factors that influence the PCAT-continuity dimension score of contracted residents (P

Rationale: Preventive health is a core part of primary care clinical practice and it is critical for both disease prevention and reducing the consequences of chronic disease. In primary care, the 5As framework is often used to guide behaviour change consultations for smoking, nutrition, alcohol use and physical activity. Aims and Objectives: Our objective was to analyze the emphasis placed on each 5As term in commonly used guidelines in Australian general practice and compare this to behaviour change terms/concepts essential to effective consultations. Method: A content analysis was undertaken to explore frequency of 5A terms and key behaviour change concepts/terms chapter‐by‐chapter across the three most commonly used guidelines in Australian general practice. Results: The prevalence of each 5As term differed in all three guidelines, with 'Arrange' being mentioned the least often. Behaviour change concepts and terms, such as patient‐centredness, listening, trust and tailoring, were infrequently used and were often confined to a separate chapter of the guidelines. Conclusion: The language and content of the guidelines contrast with known effective components of behaviour change consultations. Future revisions could reconsider emphasis of 5As terms to avoid paternalistic approaches, improve shared language across guidelines and incorporate behavioural science principles to enhance preventative care delivery. [ABSTRACT FROM AUTHOR]

BackgroundPain management racial disparities exist, yet it is unclear whether disparities exist in pain management in advanced cancer.ObjectiveTo examine the effect of race on physicians' pain assessment and treatment in advanced lung cancer and the moderating effect of patient activation.DesignRandomized field experiment. Physicians consented to see two unannounced standardized patients (SPs) over 18 months. SPs portrayed 4 identical roles-a 62-year-old man with advanced lung cancer and uncontrolled pain-differing by race (black or white) and role (activated or typical). Activated SPs asked questions, interrupted when necessary, made requests, and expressed opinions.ParticipantsNinety-six primary care physicians (PCPs) and oncologists from small cities, and suburban and rural areas of New York, Indiana, and Michigan. Physicians' mean age was 52 years (SD = 27.17), 59% male, and 64% white.Main measuresOpioids prescribed (or not), total daily opioid doses (in oral morphine equivalents), guideline-concordant pain management, and pain assessment.Key resultsSPs completed 181 covertly audio-recorded visits that had complete data for the model covariates. Physicians detected SPs in 15% of visits. Physicians prescribed opioids in 71% of visits; 38% received guideline-concordant doses. Neither race nor activation was associated with total opioid dose or guideline-concordant pain management, and there were no interaction effects (p > 0.05). Activation, but not race, was associated with improved pain assessment (ẞ, 0.46, 95% CI 0.18, 0.74). In post hoc analyses, oncologists (but not PCPs) were less likely to prescribe opioids to black SPs (OR 0.24, 95% CI 0.07, 0.81).ConclusionsNeither race nor activation was associated with opioid prescribing; activation was associated with better pain assessment. In post hoc analyses, oncologists were less likely to prescribe opioids to black male SPs than white male SPs; PCPs had no racial disparities. In general, physicians may be under-prescribing opioids for cancer pain.Trial registrationNCT01501006.

During the COVID-19 pandemic, an increasing number of infections and a need for medical consultations forced the society to implement remote forms of contact with patients. The aim of this study was to analyze the experiences and preferences of patients regarding the doctor-patient relationship. A quantitative study was conducted using the CAWI technique. The study involved 1011 adult patients who were consulted by their family physicians. The patients generally declared unfavorable changes regarding their access to medical services. While comparing the experiences before and during the pandemic, most patients (70.3%) revealed that they had difficulties accessing their family physicians. Many patients (83.1%) preferred a personal visit as a form of consultation. Identification of the constraints relating to the COVID-19 pandemic can contribute to optimizing the health care system, particularly the organization of remote medical consultations. [ABSTRACT FROM AUTHOR]

Copyright of Sexualidad, Salud y Sociedad: Revista Latinoamericana is the property of Editora da Universidade do Estado do Rio de Janeiro (EdUERJ) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Higher trust in healthcare providers has been linked to better health outcomes and satisfaction. Lower trust has been associated with healthcare-based discrimination., Objective: Examine associations between experiences of healthcare discrimination and patients' and caregivers of pediatric patients' trust in providers, and identify factors associated with high trust, including prior experience of healthcare-based social screening., Methods: Secondary analysis of cross-sectional study using logistic regression modeling. Sample consisted of adult patients and caregivers of pediatric patients from 11 US primary care/emergency department sites., Results: Of 1,012 participants, low/medium trust was reported by 26% identifying as non-Hispanic Black, 23% Hispanic, 18% non-Hispanic multiple/other race, and 13% non-Hispanic White ( P  = .001). Experience of any healthcare-based discrimination was reported by 32% identifying as non-Hispanic Black, 23% Hispanic, 39% non-Hispanic multiple/other race, and 26% non-Hispanic White ( P  = .012). Participants reporting low/medium trust had a mean discrimination score of 1.65/7 versus 0.57/7 for participants reporting high trust ( P  < .001). In our adjusted model, higher discrimination scores were associated with lower trust in providers (aOR 0.74, 95%CI = 0.64, 0.85). A significant interaction indicated that prior healthcare-based social screening was associated with reduced impact of discrimination on trust: as discrimination score increased, odds of high trust were greater among participants who had been screened (aOR = 1.28, 95%CI = 1.03, 1.58)., Conclusions: Patients and caregivers reporting more healthcare-based discrimination were less likely to report high provider trust. Interventions to strengthen trust need structural antiracist components. Increased rapport with patients may be a potential by-product of social screening. Further research is needed on screening and trust., Competing Interests: Conflict of interest: The authors have no conflicts of interest to report., (© Copyright by the American Board of Family Medicine.)

This article features data drawn from interviews with doctors working in the Finnish occupational health‐care system. These are used to explore the value of an Eliasian approach towards interpreting and assessing the moral meanings and social dynamics of relationships between health practitioners and their patients. We attend to spiralling 'formalizing' and 'informalizing' processes and how these are operating to reconfigure doctor–patient relationships. We document some of the ways in which Finnish doctors are adapting to these processes. While data drawn from a British context suggest both doctor and patients are inclined to adopt positions of mutual distrust and hostility, by contrast we note that in this Finnish setting more concerted attempts are being made to renegotiate social roles, cultural meanings and individual responsibilities. We propose that this can be taken as an instance where informalization is accompanied by revitalized currents of formalization and new syntheses of moral codes and conduct. [ABSTRACT FROM AUTHOR]

Abstract Objective The paper characterizes outpatient communication in a major cancer hospital in southern China with regard to the structure, style and focus of doctor–patient communication. Method Fifty‐one encounters between doctors and patients were recorded in the outpatient department of the cancer hospital and analysed inductively to identify patterns of doctor–patient outpatient communication. Results Outpatient communication in the cancer hospital is characterized by structuralized conversation, doctor domination of the conversation and a focus on technology during communication. These characteristics suggest an extreme inequality of power between Chinese doctors and patients at the individual level. They are also shaped by the institutional environment of Chinese hospitals. Discussion Measures should be taken at both the interpersonal and institutional level to improve doctor–patient communication. At the micro‐interpersonal level, public education and professional skills training are needed to improve communication and promote mutual understanding between patients and doctors. At the macro‐institutional level, changes are needed in terms of transforming the structural factors that shape doctor–patient communication. Conclusions Structuralized conversation, doctor domination of the conversation and a focus on technology during outpatient encounters present challenges to effective doctor–patient communication. These patterns are shaped by the institutional environment of Chinese hospitals and suggest the extreme power imbalance between Chinese doctors and patients.

Background: Consultation room design varies from country to country. The layout of a general practitioner’s (GP’s) consulting room may influence the physician’s or patient’s experience. The aim of this study is to explore and investigate the layout of GP’s consulting rooms around the world and to describe any significant differences. Methods: Between 3rd July and 2nd August 2018, an internet-based questionnaire on Google Docs was distributed by email, social media and WhatsApp platforms to several worldwide rural medicine groups. Analysis of an internet-based questionnaire to explore possible layouts of consultation rooms within practices was performed. The questionnaire was designed with three distinct sections: first, a GP demographic profile including gender, year of graduation from medical school, country of graduation, and type of practice (private or public); second, questions relating to the office layout; third, a section for questionnaire feedback. Results: 502 responses to the questionnaire were received; 65.3% women and 34.7% men. The most common layout in Europe and America was where the physician and the patient were separated by a desk. The layout where the physician and the patient had a 90º angle facing each other was the most commonly used layout in Asia-Pacific and Africa. For GPs who graduated before 1990 and between 1990-2010, the layout where the table was between the patient and physician was preferred. However, physicians graduating after 2010 preferred a layout with the physician and the patient with a 90º angle facing each other. Conclusion: The position of the GP’s desk differs between and within countries as well as the gender of the physician and year of graduation. Next steps should focus on gathering an even greater breadth of GP input, as well as comparing and contrasting those to the preferences of our patients and communities.

Copyright of Interface - Comunicação, Saúde, Educação is the property of Fundacao UNI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: Filipinos have unique social determinants of health, cultural values, and beliefs that contribute to a higher prevalence of cardiovascular comorbidities such as hypertension, diabetes, and dyslipidemia. We aimed to identify Filipino values, practices, and belief systems that influenced health care access and utilization., Methods: We conducted 1-on-1 semistructured interviews with self-identified Filipino patients. Our qualitative study utilized a constant-comparative approach for data collection, thematic coding, and interpretive analysis., Results: We interviewed 20 Filipinos in a remote rural community to assess structural and social challenges experienced when interacting with the health care system. Our results suggest that Filipinos regard culture and language as pillars of health access. Filipinos trust clinicians who exhibited positive tone and body language as well as relatable and understandable communication. These traits are features of Pakikisama, a Filipino trait/value of "comfortableness and getting along with others." Relatability and intercultural values familiarity increased Filipino trust in a health care clinician. Filipinos may lack understanding about how to navigate the US Health care system, which can dissuade access to care., Conclusions: For the Filipino community, culture and language are fundamental components of health access. Health care systems have the opportunity to both improve intercultural clinical training and increase representation among clinicians and support staff to improve care delivery and navigation of health services. Participants reported not routinely relying on health care navigators., Competing Interests: Conflict of interest: The authors have no conflicts of interest to declare., (© Copyright 2024 by the American Board of Family Medicine.)

Over the last three decades, the Soviet model of universal, free health care has shifted to a mix of public, private, and semi-private services influenced by neoliberal ideology. These changes have been particularly palpable in the emergence of new consumer relationships between health care users and providers. Examining St. Petersburg childbirth services from the early 1990s to the present, this paper examines the gradual development of consumer subjectivities and their impacts on authority, trust, and domination in Russian health care relations. We trace three processes: (1) women's emerging uses of monetary payments for care in both unofficial transactions ("in the doctor's pocket") and through official channels ("at the cashier"), as symbolic expressions of new consumerist subjectivities; (2) hospitals' transformation of unofficial, personalized health care relations into officially paid consumer relations; and (3) the partial transformation of providers' power, authority, and domination through consumer relationships with patients. We argue that Russian childbirth services illuminate the ways consumer relations address particular problems of Soviet health care while remaining a severely limited means of empowerment for patients and providers. [ABSTRACT FROM AUTHOR]

Background: Physicians' fear of difficult patient interactions is an important barrier to discontinuing long-term opioid therapy.Objective: To identify patient statements about opioids that indicate potential openness to tapering opioids or trying non-opioid pain treatments DESIGN: This is an observational study of regularly scheduled primary care visits involving discussion of chronic pain management. A coding system to characterize patient assessments about opioids, physician responses to assessments, and patient-endorsed opioid side effects was developed and applied to transcripts of video-recorded visits. All visits were independently coded by 2 authors.Participants: Eighty-six established adult patients taking opioids for chronic pain; 49 physicians in 2 academic primary care clinics MAIN MEASURES: Frequency and topic of patients' opioid assessments; proportion of opioid assessments classified as clues (assessments indicating potential willingness to consider non-opioid pain treatments or lower opioid doses); physician responses to patient clues; frequency and type of patient-endorsed side effects KEY RESULTS: Patients made a mean of 3.2 opioid assessments (median 2) per visit. The most common assessment topics were pain relief (51%), effect on function (21%), and opioid safety (14%). Forty-seven percent of opioid assessments (mean 1.5 per visit) were classified as clues. Fifty-three percent of visits included ≥ 1 clue; 21% of visits contained ≥ 3 clues. Physicians responded to patient clues with no/minimal response 43% of the time, sympathetic/empathetic statements 14% of the time, and further explored clues 43% of the time. Fifty-eight percent of patients endorsed ≥ 1 opioid-related side effect; 10% endorsed ≥ 3 side effects. The most commonly endorsed side effects were constipation (15% of patients), sedation (15%), withdrawal symptoms (13%), and nausea (12%).Conclusions: Patient statements suggesting openness to non-opioid pain treatments or lower opioid doses are common during routine primary care visits. Listening for and exploring these clues may be a patient-centered strategy for broaching difficult topics with patients on long-term opioid therapy. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to construct indicators of physicians’ professional competence on health literacy in order to motivate healthcare providers to pay attention to master, and respond to patients’ health literacy; conduct good doctor-patient communication; and assist patients in effectively using medical resources. Methods: The Delphi method was applied, and three rounds of investigation were conducted to gather the consensus of 13 experts. According to the literature and results of focus group interviews, the connotations and dimensions of physicians’ professional competence on health literacy were defined, and the first draft of indicators was drawn up. In the course of each round of investigation, the suitability and consistency of various indicators were analyzed, and indicators were revised, added, or deleted according to the experts’ opinions. Results: Four dimensions, namely “concept and evaluation”, “acceptance and respect”, “communication and interaction”, and “medical information and decision-making”; and 13 sub-dimensions and 44 indicators were constructed to help physicians play the roles of health literacy evaluators, receivers, planners, and guides. Conclusions: The indicators of physicians’ professional competence on health literacy constructed in this study can be used as a reference for future planning of pre-service and on-the-job education courses related to physicians’ professional competence on health literacy, as well as development of related measurement tools. [ABSTRACT FROM AUTHOR]

Background: Health clinic design varies from country to country. The layout of a general practitioner’s (GP’s) consulting room may influence the physician’s or patient’s experience. The aim of this study is to explore and investigate the layout of GP’s consulting rooms around the world and to describe any significant differences. Methods: Between 3rd July and 2nd August 2018, an internet-based questionnaire on Google Docs was distributed by email, social media and WhatsApp platforms to several worldwide rural medicine groups. Analysis of an internet-based questionnaire to explore possible layouts of consultation rooms within practices was performed. The questionnaire was designed with three distinct sections: first, a GP demographic profile including gender, year of graduation from medical school, country of graduation, and type of practice (private or public); second, questions relating to the office layout; third, a section for questionnaire feedback. Results: 502 responses to the questionnaire were received; 65.3% women and 34.7% men. The most common layout in Europe and America was where the physician and the patient were separated by a desk. The layout where the physician and the patient had a 90º angle facing each other was the most commonly used layout in Asia-Australia and Africa. For GPs who graduated before 1990 and between 1990-2010, the layout where the table was between the patient and physician was preferred. However, physicians graduating after 2010 preferred a layout with the physician and the patient with a 90º angle facing each other. Conclusion: The position of the GP’s desk differs between and within countries as well as the gender of the physician and year of graduation. Next steps should focus on gathering an even greater breadth of GP input, as well as comparing and contrasting those to the preferences of our patients and communities.

This article contains the results of the empirical analysis carried out in 2012-2016 which sought to examine whether patients’ narratives of their illness were present in doctor-patient communication and whether this subjective story was significant to both sides of the medical communication in Russian somatic disease medicine. The research was carried out in four stages and combined qualitative and quantitative methods, analyzing the perspectives of patients, doctors and medical students through surveys and interviews as well as looking at online doctor-patient communication in health forums. In all four stages, the results of the research showed that little value was placed on the subjective experience of disease in doctor-patient interactions. The topic of narrative medicine is new to Russian social studies, making the results of this research an important contribution to the establishment of narrative medicine as a global idea advocating the universal therapeutic and ethical value of patients’ stories of illness in the “remission society,” in which chronic pathologies dominate.

Background: Information asymmetry is a widely studied economic phenomenon. It refers to the situation in which one group in a transaction has more information than the other. Nowadays, information asymmetry has been studied not only as a financial topic but also as a potential reason for essential social problems.Objective: To take Chinese doctor–patient relationship as an example and investigate the relationship among information asymmetry, trust level, and aggression behavior using an experimental design.Methods: A total of 44 undergraduates (information asymmetry group, N = 22, 5 males, 17 females, mean age = 18.95, SD = 0.18; information symmetry group, N = 22, 7 males, 15 females, mean age = 19.27, SD = 0.18) took part in our experiment. Different slides and guidance were used to create a virtual information asymmetry situation, and we use the Wake Forest Physician Trust Scale (WFPTS) and the hot sauce allocation paradigm to measure their trust level and aggression, respectively.Results: Participants in the information asymmetry group allocated significantly more hot sauce to the doctor (p

Social isolation is a risk factor for many diseases and overall increased mortality. Alternatively human connection has been noted to lead to healthier lives and longevity. Medical clinicians need to be more aware of this condition and consider how to prescribe friendship. This is not just an issue for the elderly; many Americans are being ravaged by being alone. There are many organizations that we can refer our patients to in order to make connections. This lesson is one we as physicians need to embrace ourselves as loneliness during our busy days is affecting us too., Competing Interests: Conflict of interest: None., (© Copyright by the American Board of Family Medicine.)

Objective: The paper characterizes outpatient communication in a major cancer hospital in southern China with regard to the structure, style and focus of doctor–patient communication. Method: Fifty‐one encounters between doctors and patients were recorded in the outpatient department of the cancer hospital and analysed inductively to identify patterns of doctor–patient outpatient communication. Results: Outpatient communication in the cancer hospital is characterized by structuralized conversation, doctor domination of the conversation and a focus on technology during communication. These characteristics suggest an extreme inequality of power between Chinese doctors and patients at the individual level. They are also shaped by the institutional environment of Chinese hospitals. Discussion: Measures should be taken at both the interpersonal and institutional level to improve doctor–patient communication. At the micro‐interpersonal level, public education and professional skills training are needed to improve communication and promote mutual understanding between patients and doctors. At the macro‐institutional level, changes are needed in terms of transforming the structural factors that shape doctor–patient communication. Conclusions: Structuralized conversation, doctor domination of the conversation and a focus on technology during outpatient encounters present challenges to effective doctor–patient communication. These patterns are shaped by the institutional environment of Chinese hospitals and suggest the extreme power imbalance between Chinese doctors and patients. [ABSTRACT FROM AUTHOR]

Diagnosis is one of medicine's most important tools. It structures the relationship between patient and diagnostician, organises illness and provides access to resources. In this article, I reveal how the manner in which a serious diagnosis is revealed creates a kind of 'epistemic posture' reinforcing the power of medical knowledge, and contributing to medical authority. To achieve this, I explore historical material written by and for doctors about the disclosure of difficult diagnoses. Using historical data for sociological purposes follows Zerubavel, who asserts that phenomena should be studied across eras, media and cultures. I have chosen to focus on how diagnostic disclosure, as described by mid-19th to mid-20th century doctors, serves to promote the profession of medicine. The means of revealing a diagnosis served as a demonstration of, and a means for deflecting threats to, medicine's esoteric nature. The historical data provide a novel approach for understanding how diagnosis operates, even today, to confirm the professional status of the doctor. [ABSTRACT FROM AUTHOR]

Background: Pain management racial disparities exist, yet it is unclear whether disparities exist in pain management in advanced cancer.Objective: To examine the effect of race on physicians' pain assessment and treatment in advanced lung cancer and the moderating effect of patient activation.Design: Randomized field experiment. Physicians consented to see two unannounced standardized patients (SPs) over 18 months. SPs portrayed 4 identical roles-a 62-year-old man with advanced lung cancer and uncontrolled pain-differing by race (black or white) and role (activated or typical). Activated SPs asked questions, interrupted when necessary, made requests, and expressed opinions.Participants: Ninety-six primary care physicians (PCPs) and oncologists from small cities, and suburban and rural areas of New York, Indiana, and Michigan. Physicians' mean age was 52 years (SD = 27.17), 59% male, and 64% white.Main Measures: Opioids prescribed (or not), total daily opioid doses (in oral morphine equivalents), guideline-concordant pain management, and pain assessment.Key Results: SPs completed 181 covertly audio-recorded visits that had complete data for the model covariates. Physicians detected SPs in 15% of visits. Physicians prescribed opioids in 71% of visits; 38% received guideline-concordant doses. Neither race nor activation was associated with total opioid dose or guideline-concordant pain management, and there were no interaction effects (p > 0.05). Activation, but not race, was associated with improved pain assessment (ẞ, 0.46, 95% CI 0.18, 0.74). In post hoc analyses, oncologists (but not PCPs) were less likely to prescribe opioids to black SPs (OR 0.24, 95% CI 0.07, 0.81).Conclusions: Neither race nor activation was associated with opioid prescribing; activation was associated with better pain assessment. In post hoc analyses, oncologists were less likely to prescribe opioids to black male SPs than white male SPs; PCPs had no racial disparities. In general, physicians may be under-prescribing opioids for cancer pain.Trial Registration: NCT01501006. [ABSTRACT FROM AUTHOR]

Copyright of Ethnologia Polona is the property of Instytut Archeologii I Etnologii Polskiej Akademii Nauk and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In narratives of birth of two age groups of middle class women in Rio de Janeiro, Brazil, they focused to a great extent on how their experiences had the participation of obstetricians and how trusting them was an important issue. In this article, I want to discuss the recurrent mention of trust in doctor-patient relations, seeking to understand its particular significance in the experiences of birth of the women studied and to contribute to a broader theoretical discussion of trust. Its meaning has to be placed in relation to women´s notions and experiences of pregnancy and birth, which are in turn tied to ideas of personhood, body, gender and are affected by their age group, social standing and race. I argue more generally that trust is not only about establishing cooperative relations, as it often appears in many social sciences studies. Treating trust as a moral relational idiom, I specify that it is more fundamentally about how people are thought to be and how they are expected to behave.

Background: Previous studies have identified issues with the doctor-patient relationship in irritable bowel syndrome (IBS) that negatively impact symptom management. Despite this, little research has explored interactions between GPs and patients with refractory IBS. National guidelines suggest cognitive behavioural therapy (CBT) as a treatment option for refractory symptoms.Aim: To explore perceptions of interactions with GPs in individuals with refractory IBS after receiving CBT for IBS or treatment as usual (TAU).Design and Setting: This qualitative study was embedded within a trial assessing CBT in refractory IBS. Fifty-two participants took part in semi-structured interviews post-treatment in UK primary and secondary care.Method: Inductive and/or data-driven thematic analysis was conducted to identify themes in the interview data.Results: Two key themes were identified: perceived paucity of GPs' IBS knowledge and lack of empathy from GPs, but with acknowledgement that this has improved in recent years. These perceptions were described through three main stages of care: reaching a 'last-resort diagnosis'; searching for the right treatment through a trial-and-error process, which lacked patient involvement; and unsatisfactory long-term management. Only CBT participants reported a shared responsibility with their doctors concerning symptom management and an intention to reduce health-seeking behaviour.Conclusion: In this refractory IBS group, specific doctor-patient communication issues were identified. Increased explanation of the process of reaching a positive diagnosis, more involvement of patients in treatment options (including a realistic appraisal of potential benefit), and further validation of symptoms could help. This study supports a role for CBT-based IBS self-management programmes to help address these areas and a suggestion that earlier access to these programmes may be beneficial. [ABSTRACT FROM AUTHOR]

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Under a health service framework marked by the territory segmentation and the coexistence of public administration and public-private ventures, it makes sense to analyze and classify the health service departments by considering the following objectives: to know the way patients actually behave when the choice of the service place is up to themselves; to adapt the service offer to the patient's preferences; and to organize health service based on the territory location, thus considering its influence on the management model. Secondary data from the Valencian Community (over two million data) are used in the cluster analysis of the patient loyal behavior (entering, retention and drop out). This methodology enables the department clustering based on their similarities, thus explaining the homogeneity and heterogeneity with each other. This analysis shows to be useful for the said health service sector. In addition, the resulting classification provides a guide for the strategic management of the health services (at the macro and micro levels) and goes deeper in the debate about public-private ventures. [ABSTRACT FROM AUTHOR]

Background: There is a growing interest in how doctors learn from narratives about individual cases, reflected, for example, in the use of e-portfolios. Aim: This study aimed to evaluate how GP trainers conceptualised ‘learning from patients’, and what use they currently made of narrative recounts in training. Design & setting: Thematic analysis (TA) and corpus-linguistic (CL) analysis, with data collected from a convenience sample of trainers in the UK, Ireland, and Spain. Method: GP trainers in the three settings were contacted, and volunteers recruited (22 in UK, 24 in Ireland, and 16 in Spain). Volunteers were interviewed and asked to offer a narrative about ‘a patient you learned from’ and whether they used narratives as a training device. Results: There were no differences between settings. Trainers described an engaged and personal relationship with patients. They described learning about themselves, the human condition, and about how to live and die well. Their narratives were structured in various ways. At times, they led to precise conclusions: at times, they were perceived as meaningful, but resisting analysis. As regards teaching through narrative, it was reported as commonly used, but present practice appears ad hoc rather than planned. Discussion: The lack of difference between settings suggests a degree of commonality about how trainers perceive learning and teaching in the areas explored, but cannot be generalised further. The level of personal engagement was more than anticipated, and suggests the label ‘doctor–patient relationship’, as the term is used, may not be adequate to describe the nature of some interactions.

The aim of this study was to investigate dental students' long-term retention of clinical communication skills learned in a second-year standardized patient simulation at one U.S. dental school. Retention was measured by students' performance with an actual patient during their fourth year. The high-fidelity simulation exercise focused on clinical communication skills took place during the spring term of the students' second year. The effect of the simulation was measured by comparing the fourth-year clinical performance of two groups: those who had participated in the simulation (intervention group; Class of 2016) and those who had not (no intervention/control group; Class of 2015). In the no intervention group, all 47 students participated; in the intervention group, 58 of 59 students participated. Both instructor assessments and students' self-assessments were used to evaluate the effectiveness of key patient interaction principles as well as comprehensive presentation of multiple treatment options. The results showed that students in the intervention group more frequently included cost during their treatment option presentation than did students in the no intervention group. The instructor ratings showed that the intervention group included all key treatment option components except duration more frequently than did the no intervention group. However, the simulation experience did not result in significantly more effective student-patient clinical communication on any of the items measured. This study presents limited evidence of the effectiveness of a standardized patient simulation to improve dental students' long-term clinical communication skills with respect to thorough presentation of treatment options to a patient. [ABSTRACT FROM AUTHOR]

The importance of how disease and illness are conceptualised lies in the fact that such definition is paramount to understand the boundaries and scope of responsibility associated with medical work. In this paper, we aim to provide an overview of the interplay of these understandings in shaping the nature of medical work, philosophically, and in practice. We first discuss the emergence of the biopsychosocial model as an attempt to both challenge and broaden the traditional biomedical model. Then, we outline the main criticisms associated with the biopsychosocial model and note a range of contributions addressing the shortcomings of the model as initially formulated. Despite recurrent criticisms and uneven uptake, the biopsychosocial model has gone on to influence core aspects of medical practice, education, and research acrossmany areas ofmedicine. One of these areas is adolescent medicine, which provides a particularly good exemplar to examine the contemporary challenges associated with the practical application of the biopsychosocial model. We conclude that a more optimal use of existing bodies of evidence, bringing together evidence-based methodological advances of the biopsychosocial model and existing evidence on the psychosocial needs associated with specific conditions/populations, can help to bridge the gap between philosophy and practice. [ABSTRACT FROM AUTHOR]

This article outlines the journey of behavioral sciences education from a multidisciplinary array of topics to a discipline with a name, core identity, and mission in dental schools' curricula. While not exhaustive, it covers pivotal events from the time of the Gies report in 1926 to the present. Strengths and weaknesses of current behavioral sciences instruction in dental schools are discussed, along with identification of future opportunities and potential threats. Suggestions for future directions for behavioral sciences and new roles for behavioral sciences faculty in dental schools are proposed. This article was written as part of the project "Advancing Dental Education in the 21st Century." [ABSTRACT FROM AUTHOR]

This article contains the results of the empirical analysis carried out in 2012- 2016 which sought to examine whether patients' narratives of their illness were present in doctor-patient communication and whether this subjective story was significant to both sides of the medical communication in Russian somatic disease medicine. The research was carried out in four stages and combined qualitative and quantitative methods, analyzing the perspectives of patients, doctors and medical students through surveys and interviews as well as looking at online doctor-patient communication in health forums. In all four stages, the results of the research showed that little value was placed on the subjective experience of disease in doctor-patient interactions. The topic of narrative medicine is new to Russian social studies, making the results of this research an important contribution to the establishment of narrative medicine as a global idea advocating the universal therapeutic and ethical value of patients' stories of illness in the "remission society," in which chronic pathologies dominate. [ABSTRACT FROM AUTHOR]

Objectives: Patient Web portals (PWPs) have been gaining traction as a means to collect patient-reported outcomes and maintain quality patient care between office visits. PWPs have the potential to impact patient-provider relationships by rendering additional channels for communication outside of clinic visits and could help in the management of common chronic medical conditions. Studies documenting their effect in primary care settings are limited. This perspective aims to summarize the benefits and drawbacks of using PWPs in the management of chronic conditions, such as diabetes mellitus, hypertension, and asthma, focusing on communication, disease management, compliance, potential barriers, and the impact on patient-provider dynamic. After a review of these topics, we present potential future directions.Methods: We conducted an exploratory PubMed search of the literature published from inception through December 2015, and focused our subsequent searches specifically to assess benefits and drawbacks of using PWPs in the management of diabetes mellitus, hypertension, and asthma.Results: Our search revealed several potential benefits of PWP implementation in the management of chronic conditions with regards to patient-provider relationships, such as improved communication, disease management, and compliance. We also noted drawbacks such as potentially unreliable reporting, barriers to use, and increased workload.Conclusions: PWPs offer opportunities for patients to report symptoms and outcomes in a timely manner and allow for secure online communication with providers. Despite the drawbacks noted, the overall benefits from successful PWP implementation could improve patient-provider relationships and help in the management of chronic conditions, such as diabetes mellitus, hypertension, and asthma. [ABSTRACT FROM AUTHOR]

• The first real-world-based video-recorded corpus of doctor-patient interactions in clinical practices. • Our database combines objective and subjective evaluation based on doctor-patient interactions. • Artificial empathy based on facial expression recognition could be applied objectively to evaluate doctor-patient interaction in clinical practice. • Emotions revealed by artificial empathy show that doctors express significantly more emotions than patients. • Patients felt happier in the latter half of clinical session as a reflection of good doctor-patient interaction. The promising use of artificial intelligence (AI) to emulate human empathy may help a physician engage with a more empathic doctor-patient relationship. This study demonstrates the application of artificial empathy based on facial emotion recognition to evaluate doctor-patient relationships in clinical practice. A prospective study used recorded video data of doctor-patient clinical encounters in dermatology outpatient clinics, Taipei Municipal Wanfang Hospital, and Taipei Medical University Hospital collected from March to December 2019. Two cameras recorded the facial expressions of four doctors and 348 adult patients during regular clinical practice. Facial emotion recognition was used to analyze the basic emotions of doctors and patients with a temporal resolution of 1 second. In addition, a physician-patient satisfaction questionnaire was administered after each clinical session, and two standard patients gave impartial feedback to avoid bias. Data from 326 clinical session videos showed that (1) Doctors expressed more emotions than patients (t [326] > = 2.998, p < = 0.003), including anger, happiness, disgust, and sadness; the only emotion that patients showed more than doctors was surprise (t [326] = -4.428, p <.001) (p <.001). (2) Patients felt happier during the latter half of the session (t [326] = -2.860, p =.005), indicating a good doctor-patient relationship. Artificial empathy can offer objective observations on how doctors' and patients' emotions change. With the ability to detect emotions in 3/4 view and profile images, artificial empathy could be an accessible evaluation tool to study doctor-patient relationships in practical clinical settings. [ABSTRACT FROM AUTHOR]

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

One in four community-dwelling older adults is prescribed an inappropriate medication. Educational interventions aimed at patients to reduce inappropriate medications may cause patients to question their prescriber’s judgment. The objective of this study was to determine whether a patient-focused deprescribing intervention compromised trust between older adults and their healthcare providers. An educational brochure was distributed to community-dwelling older adults by community pharmacists in order to trigger deprescribing conversations. At baseline and 6-months post-intervention, participants completed the Primary Care Assessment Survey, which measures patient trust in doctors and pharmacists. Changes in trust were ascertained post-intervention. Proportions with 95% confidence intervals (CI), and logistic regression were used to determine a shift in trust and associated predictors. 352 participants responded to the questionnaire at both time points. The majority of participants had no change or gained trust in their doctors for items related to the choice of medical care (78.5%, 95% CI = 74.2–82.8), communication transparency (75.4%, 95% CI = 70.7–79.8), and overall trust (81.9%, 95% CI = 77.9–86.0). Similar results were obtained for participants’ perceptions of their pharmacists, with trust remaining intact for items related to the choice of medical care (79.4%, 95% CI = 75.3–83.9), transparency in communicating (82.0%, 95% CI = 78.0–86.1), and overall trust (81.6%, 95% CI = 77.5–85.7). Neither age, sex nor the medication class targeted for deprescribing was associated with a loss of trust. Overall, the results indicate that patient-focused deprescribing interventions do not shift patients’ trust in their healthcare providers in a negative direction.