Search

This article examines the concept of health tourism in orthopaedic surgery, with a focus on the UK. Health tourism refers to individuals and families traveling to other countries for medical treatment, often to access better care or avoid long wait times. The article discusses the pros and cons of health tourism, including its impact on the economy, waiting lists, quality of care, postoperative complications, doctor training, and sustainability. The author suggests involving all stakeholders in developing a viable strategy and calls for further research on the long-term effects of medical tourism. Additionally, two sources related to junior doctor pay disputes and the UK surgical workforce are provided, including a BBC News article on the 11th strike of the dispute and a report from the Royal College of Surgeons of England on the UK surgical workforce census. These sources can be helpful for library patrons researching these specific topics. [Extracted from the article]

A stay in hospital and an operation are always an exceptional situation for children and their parents, which is accompanied by great uncertainty and fear. The aim of this article is to show what possibilities exist as a caring anesthetist to accompany a child and the parents through the operation and that anesthesia remains a good memory. The effect of communication on a verbal and nonverbal level is discussed. The focus is on dealing with children and their parents, taking the influence of the psychological developmental stages of children into account and on presenting helpful coping strategies in exceptional situations. [ABSTRACT FROM AUTHOR]

Background: China has made remarkable achievements in tuberculosis (TB) prevention and control, but it still takes long way to achieve the End TB goal especially in underdeveloped Southwest China. TB healthcare workers (HCWs) are core forces in TB prevention and control but often face job burnout. This study aimed to explore the burden and associated factors of job burnout among TB HCWs in Southwest China. Methods: This cross-sectional study used both survey questionnaires and semi-structured interviews, to assess job burnout among TB HCWs based on Malasch Model and explore the associated factors based on Herzberg's two-factor theory (different hygiene and motivation factors). Quantitative data analysis adopts multiple linear regression to in SPSS 22.0, and qualitative data were analyzed through a framework approach. Results: A total of 1140 TB HCWs were included in questionnaire surveys. The overall job burnout rates of TB HCWs in Centers for Disease Control and Prevention (CDC), designated hospitals and Primary Health Care (PHC) sectors were 55%, 70.1% and 67.5%, respectively. TB HCWs in CDC who scored lower in interpersonal factors had a higher risk of depersonalization (DP) [B(95%CI): -0.89 (-1.71 to -0.80)]. TB HCWs in designated hospitals who scored lower in doctor-patient relationship factors [B (95%CI): 6.63 (-12.06 to -1.20)] were more likely to have emotional exhaustion (EE). TB HCWs who were less satisfied with training, supervision and assessment in PHC sectors [B(95%CI): 0.65 (0.03 to 1.26)] had less personal accomplishment (PA). Interviews with nine TB HCWs showed that poor environment could lead to high infection and heavy workload could lead to work pressure among TB HCWs in Chongqing. It is also found that performance assessment and management of TB HCWs, communication and cooperation and so on are related to job burnout. Conclusions: TB HCWs had different levels of job burnout in CDC, designated hospitals, and PHC sectors of Chongqing, which were affected by different hygiene and motivation factors. Governments, organizations and individuals should take cooperative measures such as strengthening communication to deal with job burnout among TB HCWs. [ABSTRACT FROM AUTHOR]

Background: Managing diagnostic uncertainty is a major challenge in primary care due to factors such as the absence of definitive tests, variable symptom presentations and disease evolution. Maintaining patient trust during a period of investigative uncertainty, whilst minimising scope for diagnostic error is a challenge. Mismanagement can lead to diagnostic errors, treatment delays, and suboptimal patient outcomes. Objective: Our aim was to explore how UK primary care physicians (GPs) address and communicate diagnostic uncertainty in practice. Design: This qualitative study used video and audio-recordings. Verbatim transcripts were coded with a modified, validated tool to capture GPs' actions and communication in primary care consultations that included diagnostic uncertainty. The tool includes items relating to advice regarding new symptoms or symptom deterioration (sometimes called 'safety netting'). Video data was analysed to identify GP and patient body postures during and after the delivery of the management plan. Participants: All patient participants had a consultation with a GP, were over the age of 50 and had (1) at least one new presenting problem or (2) one persistent problem that was undiagnosed. Approach: Data collection occurred in GP-patient consultations during 2017–2018 across 7 practices in UK during 2017–2018. Key results: GPs used various management strategies to address diagnostic uncertainty, including (1) symptom monitoring without treatment, (2) prescribed treatment with symptom monitoring, and (3) addressing risks that could arise from administrative tasks. GPs did not make management plans for potential treatment side effects. Specificity of uncertainty management plans varied among GPs, with only some offering detailed actions and timescales. The transfer of responsibility for the management plan to patients was usually delivered rather than negotiated, with most patients confirming acceptance before concluding the discussion. Conclusions: We offer guidance to healthcare professionals, improving awareness of using and communicating management plans for diagnostic uncertainty. [ABSTRACT FROM AUTHOR]

Background: Withholding or withdrawing life-sustaining treatment in end-of-life patients is a challenging ethical issue faced by physicians. Understanding physicians' experiences and factors influencing their decisions can lead to improvement in end-of-life care. Objectives: To investigate the experiences of Thai physicians when making decisions regarding the withholding or withdrawal of life-sustaining treatments in end-of-life situations. Additionally, the study aims to assess the consensus among physicians regarding the factors that influence these decisions and to explore the influence of families or surrogates on the decision-making process of physicians, utilizing case-based surveys. Methods: A web-based survey was conducted among physicians practicing in Chiang Mai University Hospital (June - October 2022). Results: Among 251 physicians (response rate 38.3%), most of the respondents (60.6%) reported that they experienced withholding or withdrawal treatment in end-of-life patients. Factors that influence their decision-making include patient's preferences (100%), prognosis (93.4%), patients' quality of life (92.8%), treatment burden (89.5%), and families' request (87.5%). For a chronic disease with comatose condition, the majority of the physicians (47%) chose to continue treatments, including cardiopulmonary resuscitation (CPR). In contrast, only 2 physicians (0.8%) would do everything, in cases when families or surrogates insisted on stopping the treatment. This increased to 78.1% if the families insisted on continuing treatment. Conclusion: Withholding and withdrawal of life-sustaining treatments are common in Thailand. The key factors influencing their decision-making process included patient's preferences and medical conditions and families' requests. Effective communication and early engagement in advanced care planning between physicians, patients, and families empower them to align treatment choices with personal values. [ABSTRACT FROM AUTHOR]

Background: As a person nears the end of their life, culture and ethnicity increasingly drive preferences and priorities for care. Understanding these preferences and priorities is fundamental to health care professionals' goals to respect decision making and support the individual throughout this phase of life. Across Africa, several countries are in the initial stages of implementing palliative care services in their burgeoning health care systems. Moving forward, it is imperative to consider cultural similarities and differences when compared with the Western world, where the field of palliative care evolved, to create a tailored palliative care approach that is consistent with African culture. In palliative care, understanding cultural preferences and priorities requires communication between the patient and the provider and is a crucial step toward a successful implementation in Africa. A paternalistic patient–provider relationship is the current leading model in sub-Saharan Africa.1 Aim: This narrative review explores the prevalence of paternalism and explores its appropriateness and necessity in the current application of palliative care in sub-Saharan African countries. Methods: This narrative review was conducted using four databases as well as hand searching of relevant articles sourced from references of already selected articles. A total of 730 articles were identified. Fourteen articles met the inclusion/exclusion criteria set for this narrative review. Results: In sub-Saharan Africa, the leading patient–provider relationship was determined to be paternalistic. Reasons for this were language, education, cultural norms and expectations, lack of time, and benevolence. Conclusions: The implementation of palliative care often relies on communication of patient desires and goals. Consideration is needed to determine how a provider can appropriately know these factors in a paternalistic relationship. [ABSTRACT FROM AUTHOR]

Little is known about the experience of healthcare professionals (HCPs) in the community providing healthcare to people with aphasia. In this study we aimed to explore the experiences of community HCPs in healthcare conversations with people with aphasia, and whether a high-tech, purpose-built aphasia app could assist. A generic qualitative study was conducted. HCPs from seven different clinical backgrounds were interviewed and data was thematically analysed. The experiences of healthcare providers providing healthcare to people with aphasia were identified in six major themes. These were: (1) Healthcare communication topics; (2) HCP knowledge; (3) Communication exchanges during the interactions (4) Communication impacts on care; (5) Interactions and relationships grew easier over time; and (6) How technology could help interactions. HCPs with more aphasia knowledge reported having more positive experiences. Unsuccessful interactions were believed to lead to negative emotional responses in people with aphasia and HCPs, and that miscommunications could lead to compromised care. HCPs reported that interactions and relationships with people with aphasia grew easier over time. HCPs need system level support to acquire the knowledge and skills needed to engage people with aphasia in effective healthcare conversations. Technology has potential to improve interactions. The overall experience of Health care professionals (HCPs) providing healthcare to people with aphasia was reported to be challenging, taking extra emotional and intellectual effort and time. When communication was unsuccessful this often led to emotional distress for both the HCP and person with aphasia and compromised care for the person with aphasia. HCPs with more knowledge and skill, who had conversation partner training, were more likely to have successful communication interactions. More system-level supports such as conversation partner training, and technology support were perceived to be beneficial. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To develop guidance for pediatric clinicians on how to discuss race and racism in pediatric clinical settings. METHODS: We conducted a modified Delphi study from 2021 to 2022 with a panel of pediatric clinicians, psychologists, parents, and adolescents with expertise in racism and child health through scholarship or lived experience. Panelists responded to an initial survey with openended questions about how to talk to youth about race and racism. We coded the responses using qualitative methods and presented them back to the panelists. In iterative surveys, panelists reached a consensus on which themes were most important for the conversation. RESULTS: A total of 29 of 33 panelists completed the surveys and a consensus was reached about the concepts pediatric clinicians should consider before, during, and after conversations about race and racism and impediments clinicians may face while having these discussions. Panelists agreed that it was within the pediatric clinician's role to have these conversations. An overarching theme was the importance of having background knowledge about the systemic nature of racism. Panelists agreed that being active listeners, learning from patients, and addressing intersectionality were important for pediatric clinicians during conversations. Panelists also agreed that shortand long-term benefits may result from these conversations; however, harm could be done if pediatric clinicians do not have adequate training to conduct the conversations. CONCLUSIONS: These principles can help guide conversations about race and racism in the pediatric clinical setting, equipping clinicians with tools to offer care that acknowledges and addresses the racism many of their patients face. [ABSTRACT FROM AUTHOR]

Simple Summary: Communication by health professionals impacts the mental health of cancer patients. This research sought to further explore this matter by studying the possible relationships between communication and a patient's depression, anxiety, quality of life, coping strategies, and perception of their state of health. A total of 177 patients diagnosed with cancer answered a battery of questionnaires on these aspects. Our findings show that oncologists are better at delivering a cancer diagnosis than other healthcare professionals and that communication by them can impact patients' mental and health variables. We believe that there is a need to implement better communication strategies among all healthcare professionals to facilitate the task of breaking bad news to patients. This will have a positive impact on patients' emotional states and health while reducing stress and burnout among the healthcare professionals themselves. The field of healthcare is increasingly adopting a humanistic perspective in the physician–patient relationship. One of the more salient aspects being studied is the communication between the two. This study serves a dual purpose. Our initial aim was to study how a cancer diagnosis is disclosed to patients by different physicians (GPs/other specialists/oncologists). Secondly, we set out to study how the way in which oncologists normally communicate with their patients impacts variables such as a patient's anxiety, depression, coping mechanisms, and perception of both their health and their quality of life. A total of 177 patients answered a battery of questionnaires on sociodemographic and disease data: the SPIKES protocol, the EORTCQLQ-COMU26, and the ADAF screening questionnaire. The analyses recorded medium or high scores for some of the steps in the SPIKES protocol when delivering the diagnosis, and significant differences were observed for some of them among different physicians. The level of a cancer patient's satisfaction with the communication by oncologists was related to their levels of anxiety, depression, vulnerability, and perception of their health and quality of life. Better communication strategies are called for among all healthcare professionals to facilitate the task of breaking bad news to their patients. [ABSTRACT FROM AUTHOR]

Social prescribing link workers are recently introduced roles in English primary care. One of their intended functions is to support patients with conditions influenced by the wider, social determinants of health. Their main purpose is to connect people to community resources to meet their nonmedical needs. However, our research reveals that link workers provide not only connections but also what we have described as "holding" for individuals with complex needs, who lack informal networks of support or who are waiting to access services. We explore the concept of holding, its meaning and significance in this context, and consider its consequences. As part of a realist evaluation, we observed seven link workers in GP practices in England during focussed ethnographies over a 3‐week period. We took field notes and interviewed 61 patients and 93 healthcare and voluntary sector professionals. Nine to twelve months later, we carried out follow‐up interviews with forty‐one patients, seven link workers, and a link worker manager. We identified four functions of holding: supporting patients waiting for services, sustaining patients as they prepare for change, reducing the emotional burden of primary healthcare professionals, and bearing witness to patients' distress. Holding appears to be a vital but often overlooked aspect of social prescribing. Patients benefit from having a reliable and consistent person to support their emotional needs. However, similar to the impact of holding on other primary care professionals, there are unintended consequences: some link workers exceed their capacity, become overburdened, experience burnout, and leave their job. Recognizing the importance of holding and understanding its role in link workers' primary care responsibilities are critical. If holding work is accepted as a role for link workers, providing training and support to them should be prioritised to ensure successful implementation and positive outcomes for patients, link workers, and primary healthcare staff. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To identify the most important attributes related to the process of achieving, and outcomes associated with, successful care for differences of sex development (DSD). METHODS: We developed a best--worst scaling survey administered to 520 DSD stakeholders, including individuals or family members of those with DSD, health care specialists, and patient support and advocacy representatives. Fourteen process-related attributes and 16 outcomerelated attributes were identified through qualitative research. We estimated relative importance scores and coefficients from regression analysis to understand the relative importance of attributes and conducted latent class analysis to explore heterogeneity in preferences. RESULTS: The 3 most important process attributes were (1) good communication between care team and patient/family, (2) care team educated patient/family about condition, and (3) care team incorporates the values of patient/family. The 3 most important outcome attributes were (1) patient satisfaction, (2) patient mental health, and (3) treatment maintains physical health. Latent class analyses showed that respondents had heterogeneous preferences. For processrelated attributes, we identified 3 respondent groups: "Patient autonomy and support" (46% of respondents), "Education and care transitions" (18%), and "Shared decision-making" (36%). For outcome-related attributes, we identified 2 respondent groups: "Preserving function and appearance" (59% of respondents) and "Patient health and satisfaction" (41%). CONCLUSIONS: Outcomes such as patient satisfaction and health were the most important outcome attributes, and good communication and education from the care team were the most important process attributes. Respondents expressed heterogeneous preferences for selected DSD care attributes that providers should consider to improve satisfaction with and quality of DSD care. [ABSTRACT FROM AUTHOR]

Diet plays a pivotal role in health outcomes, influencing various metabolic pathways and accounting for over 20% of risk-attributable disability adjusted life years (DALYs). However, the limited time during primary care visits often hinders comprehensive guidance on dietary and lifestyle modifications. This paper explores the integration of electronic consultations (eConsults) in Culinary Medicine (CM) as a solution to bridge this gap. CM specialists, with expertise in the intricate connections between food, metabolism, and health outcomes, offer tailored dietary recommendations through asynchronous communication within the electronic health record (EHR) system. The use of CM eConsults enhances physician-patient communication and fosters continuous medical education for requesting clinicians. The benefits extend directly to patients, providing access to evidence-based nutritional information to address comorbidities and improve overall health through patient empowerment. We present a comprehensive guide for CM specialist physicians to incorporate CM eConsults into their practices, covering the historical context of eConsults, their adaptation for CM, billing methods, and insights from the implementation at UT Southwestern Medical Center. This initiative delivers expanded access to patient education on dietary risks and promotes interprofessional collaboration to empower improved health. Plain Language Summary: What you eat significantly impacts your health, affecting various aspects including weight, blood sugar, and inflammation. This paper highlights how health-related issues are linked to diet and presents one solution to help doctors guide patients more effectively. Often, the limited time during medical visits makes it challenging for doctors to provide detailed advice on lifestyle changes. Additional common barriers are that many doctors lack nutrition expertise, and access to nutrition experts such as registered dietitian nutritionists can be limited geographically and financially. This paper introduces the concept of electronic consultations (eConsults) in Culinary Medicine (CM) to help overcome this challenge. CM specialists are licensed healthcare professionals who understand how food influences the body and can use eConsults to offer personalized dietary recommendations. EConsults occur via a secure electronic medical record system that connects doctors and specialists, ensuring efficient communication. Patients benefit by gaining access to reliable nutritional information tailored to their specific health needs. This innovative approach also enhances communication between doctors and patients and helps doctors stay updated on the new research about how nutrition and food impact health. The paper provides a practical guide for doctors to integrate CM eConsults into their practices, making it easier to give valuable advice on dietary risks and promote healthier lifestyles. Overall, this initiative represents a significant step in improving patient nutrition education and fostering positive changes in health through the power of informed dietary choices. [ABSTRACT FROM AUTHOR]

Prognostic conversations present many challenges for patients, caregivers, and providers alike. Most research examining the context of prognostic conversations have used a more siloed approach to gather the range of perspectives of those involved, typically through the lens of patient-centered care. However, the mutual influence evident in prognostic conversations suggests a relationship-centered care model may be useful in cancer communication research. Similarities and differences in preferences for and experiences with prognostic conversations among oncology patients, caregivers, and providers (N = 32) were explored. Identified themes were then mapped to the principles of the relationship-centered care framework to extend our understanding of prognostic conversations and contribute to a new direction in the application of relationship-centered care. Findings suggest fewer similarities than differences, point to important discrepancies among participant perspectives, and reinforce the utility of relationshipcentered care in identifying communication practices that enhance the prognostic conversation experience. [ABSTRACT FROM AUTHOR]

The article discusses the challenges clinicians face in conducting goals of care discussions for patients with chronic critical illness, and it highlights the difficulties in patient participation, decision-making complexity, and the importance of building strong relationships. It emphasizes the ethical obligation to ensure treatment decisions reflect patient values and provide support during serious illness.

This wide range of health-related theories often makes use of algorithms as tools to support diagnoses and the identification of optimal care and wellbeing pathways. Medical platforms, the algorithms that characterize them, and the digital devices needed to overlap/integrate the digital environment with everyday spaces allow for collecting, sharing, and storing health and well-being data (Lupton, 2015). In the case of TonicApp1, a medical device that, in its presentation, recognizes and guarantees the technical and scientific safety of its diagnostic algorithms; data are generated and stored directly by healthcare professionals, who are accompanied by other types of professionals, such as engineers responsible for algorithmic transposition. How is the algorithmic intervention configured to create and administer medical diagnoses? What is the level of trust of medical personnel in these platforms, and how does the use of these platforms change the practice of medicine and the doctor-patient relationship? These research questions guide the work in adopting a mixed-digital research design with a sequential-exploratory approach. These questions invite an initial exploration of the context, structure, and environments of TonicApp in Italy. The Walkthrough approach (Light, Burgess, and Duguay, 2018; Decuypere, 2019) allows for direct interaction with the TonicApp interface to identify, select, and dissect the technological mechanisms it comprises and define any cultural references that icons and interfaces may incorporate. Following this initial exploratory phase, an in-depth immersion phase will be prepared through a series of semi-structured interviews with the doctorusers of TonicApp to shed light on the platform's usage patterns and how this tool has contributed to changes in the practice of medicine and the relationship with patients. [ABSTRACT FROM AUTHOR]

This perspective paper provides a comprehensive examination of artificial intelligence (AI) in healthcare, focusing on its transformative impact on clinical practices, decision-making, and physician-patient relationships. By integrating insights from evidence, research, and real-world examples, it offers a balanced analysis of AI's capabilities and limitations, emphasizing its role in streamlining administrative processes, enhancing patient care, and reducing physician burnout while maintaining a human-centric approach in medicine. The research underscores AI's capacity to augment clinical decision-making and improve patient interactions, but it also highlights the variable impact of AI in different healthcare settings. The need for context-specific adaptations and careful integration of AI technologies into existing healthcare workflows is emphasized to maximize benefits and minimize unintended consequences. Significant attention is given to the implications of AI on the roles and competencies of healthcare professionals. The emergence of AI necessitates new skills in data literacy and technology use, prompting a shift in educational curricula towards digital health and AI training. Ethical considerations are a pivotal aspect of the discussion. The paper explores the challenges posed by data privacy concerns, algorithmic biases, and ensuring equitable access to AI-driven healthcare. It advocates for the development of comprehensive ethical frameworks and ongoing research to guide the responsible use of AI in healthcare. Conclusively, the paper advocates for a balanced approach to AI adoption in healthcare, highlighting the importance of ongoing research, strategic implementation, and the synergistic combination of human expertise with AI technologies for optimal patient care. [ABSTRACT FROM AUTHOR]

The aim of this study was to develop and evaluate a proof-of-concept opensource individualized Patient Decision Aid (iPDA) with a group of patients, physicians, and computer scientists. The iPDA was developed based on the International Patient Decision Aid Standards (IPDAS). A previously published questionnaire was adapted and used to test the user-friendliness and content of the iPDA. The questionnaire contained 40 multiple-choice questions, and answers were given on a 5-point Likert Scale (1-5) ranging from "strongly disagree" to "strongly agree." In addition to the questionnaire, semi-structured interviews were conducted with patients. We performed a descriptive analysis of the responses. The iPDA was evaluated by 28 computer scientists, 21 physicians, and 13 patients. The results demonstrate that the iPDA was found valuable by 92% (patients), 96% (computer scientists), and 86% (physicians), while the treatment information was judged useful by 92%, 96%, and 95%, respectively. Additionally, the tool was thought to be motivating for patients to actively engage in their treatment by 92%, 93%, and 91% of the above respondents groups. More multimedia components and less text were suggested by the respondents as ways to improve the tool and user interface. In conclusion, we successfully developed and tested an iPDA for patients with stage I-II Non-Small Cell Lung Cancer (NSCLC). [ABSTRACT FROM AUTHOR]

Epistemic trust – i.e. the belief in knowledge claims we do not understand or cannot validate – is pivotal in healthcare interactions where trust in the source of knowledge is the foundation for adherence to therapy as well as general compliance with the physician's suggestions. However, in the contemporary knowledge society professionals can no longer count on unconditional epistemic trust: boundaries of the legitimacy and extension criteria of expertise have become increasingly fuzzier and professionals must take into account laypersons' expertise. Drawing on a conversation analysis-informed study of 23 videorecorded pediatrician-led well-child visits, the article deals with the communicative constitution of healthcare-relevant phenomena such as: epistemic and deontic struggles between parents and pediatricians, the local accomplishment of (responsible) epistemic trust, and the possible outcomes of blurred boundaries between the layperson's and the professional's "expertise." In particular, we illustrate how epistemic trust is communicatively built in sequences where parents request the pediatrician's advice and resist it. The analysis shows how parents perform epistemic vigilance by suspending the immediate acceptance of the pediatrician's advice in favor of inserting expansions that make it relevant for the pediatrician to account for her advice. Once the pediatrician has addressed parents' concerns, parents perform (delayed) acceptance, which we assume indexes what we call responsible epistemic trust. While acknowledging the advantages of what seems to be a cultural change in parent-healthcare provider encounters, in the conclusion we advance that possible risks are implied in contemporary fuzziness of the legitimacy and extension criteria of expertise in doctor-patient interaction. [ABSTRACT FROM AUTHOR]

This paper addresses doctor-patient communication about C-sections (CSs) in Shanghai, China. Specifically, we examine the information discrepancies between obstetricians' and patients' perceptions of CS and the important factors affecting shared decision-making. We conducted semi-structured individual interviews with 12 postnatal women who experienced CS and with 12 obstetricians. We identified barriers to patient-doctor communication and shared decision-making: obstetricians' lack of time in outpatient prenatal visits to explain the implications of CSs, family members' knowledge and opinions on CSs, and information from media and social networks. The lack of communication between the expectant women and the obstetricians was driving the women's distrust in the latter. The lack of obstetricians' time to communicate with the pregnant woman led to low trust in the medical staff and overutilization of CS, whereas a lack of financial resources led to underutilization of CS. The obstetricians suggested providing expectant women with more education programs and midwifery support. [ABSTRACT FROM AUTHOR]

Objective of this study was to survey the rationalities given for treatment nonadherence and their association with DM practice. Methods: The Ottawa decision Support Framework was used as a theoretical background for the study. Multiple choice and open-text responses indicating nonadherence were drawn from vignette survey data. The results have been analyzed and reported as descriptive statistics and findings of data-driven content analysis. The number of observatory units was 1032 in the within-subject study design. Results: DM practice was predominantly associated with nonadherence to vaccination, whereas nonadherence to treatment was consistently associated with attitudinal reasons independent of DM practice. Nonadherence to vaccination was most often rationalized by prior negative experiences in simple DM scenarios. After other DM practices, nonadherence was rationalized by uncertainty and criticism about the benefits of the recommended vaccine. Mistrust toward healthcare providers stood out, first in treatment nonadherence generally and, second, in vaccination nonadherence after simple DM where the final decision was left to the patient. Conclusion: In medical DM, adherence to treatment and vaccination may be achieved through a recognition of patients' previous healthcare encounters and potential trust-related concerns, which could pose a risk for nonadherence. To be able to observe these risks, patient engagement and mutual trust should be priorities in decision support in healthcare. Plain Language Summary: Research on treatment and vaccination adherence aim at increasing knowledge about improving adherence and treatment outcomes. This study examined explanations given for not adhering to treatment and an association between the explanations and medical decision-making practices. Decision-making practices are known to impact patient–physician interaction and the patients' motivation to have an active role at the appointment. In a shared decision-making (SDM) practice, patients' participation is encouraged. SDM is built on both medical expertise of the practitioner and individual views, values and preferences of the patient. As opposed to SDM, authoritarian decision-making refers to a practice in which decisions are made solely by the physician. In guided decision-making, the physician shares information with the patient but makes the final decision. In simple decision-making, the final decision is left to the patient after consultation. This empirical study used illustrated vignette survey data from Finland. Out of the 1935 respondents, 64% were female with an average age of 68. In the study design, nonadherence was presumed to depend on a decision-making practice presented. Primary findings showed that nonadherence to treatment is most correlated with attitudinal predetermination of the patient and mistrust toward healthcare providers. Nonadherence to vaccination had a stronger association with decision-making practices. After simple decision-making, declining vaccination was most often explained by prior negative experiences and mistrust toward healthcare providers. After other decision-making practices, explanations for declining included uncertainty and criticism about the benefits of the recommended vaccine. This study underscores the pivotal role of trust in the patient-physician interaction. [ABSTRACT FROM AUTHOR]

People with disabilities, especially children and youth, are often not considered in emergency and disaster preparedness planning, which leaves them vulnerable and at a higher risk of the negative effects of natural and human caused disasters. The purpose of this study was to understand the extent of emergency and disaster preparedness and factors influencing preparedness among children and youth with disabilities and chronic conditions, their caregivers and service providers. Our scoping review involved searching six international databases that identified 1146 studies of which 27 met our inclusion criteria. The studies in this review involved 2613 participants (i.e., children, parents, educators and clinicians) across nine countries over a 20-year period. Our results highlighted the following trends: (1) the extent of emergency preparedness; (2) factors affecting emergency preparedness; and (3) interventions to enhance preparedness. Our findings underscore the critical need for more attention to emergency preparedness for children and youth with disabilities, their families and service providers and their inclusion in planning. Support is needed for emergency preparedness for children with disabilities at an individual, family and community level. Clinicians should assist children with disabilities and their families to develop a disaster and emergency preparedness plan that includes their medical needs, basic supplies and connections to relevant resources and supports. Clinicians and educators should advocate for the inclusion of children and youth with disabilities in emergency and disaster preparedness. [ABSTRACT FROM AUTHOR]

Background Speculum examination is an intrusive practice in the clinical care of women. It requires privacy and patients may experience discomfort or anxiety related to the procedure, which can result in delays or avoidance of necessary healthcare. Speculum self-insertion originated in the United States in the 1970s as part of the self-help movement. However, this clinical practice is largely unknown among healthcare providers and has rarely been assessed. Aim This study investigates the women's views and healthcare providers' experiences of the self-insertion method. Method A qualitative study was conducted between December 2021 and October 2022, including fieldwork combining semi-structured interviews (10 women) and focus groups associated with individual interviews of 13 healthcare providers. The data collected were independently coded by 2 authors and analysed using an inductive approach and grounded theory method. Results Speculum self-insertion was described as a way to decrease discomfort and facilitate speculum insertion. Self-insertion was proposed as a means of allowing women to participate in the examination, reducing their vulnerability against power imbalances in the doctor–patient relationship. Both patients and healthcare providers have reported that speculum self-insertion is a method that can contribute to improving trust and communication during the examination. Conclusion The practice of speculum self-insertion during the consultation is an alternative to traditional practitioner insertion and may be offered to all women by any practitioner who wishes to use this technique. [ABSTRACT FROM AUTHOR]

Purpose: Good relationships between physicians, patients, families and the healthcare team are essential for high‐quality care. Medical encounters are sometimes challenging. They may include conflicts, requiring physicians to be assertive: that is to share and protect their needs, rights and values while preserving those of others. Whereas assertiveness has been studied in patients and nursing staff (those with less power in healthcare), physicians' assertiveness, which must be mindful of these power differences, lacks a comprehensive review. Thus, this scoping review focuses on assertive communication in physicians' encounters. Methods: A literature search of four online databases: MEDLINE, Embase, PsycINFO and WoS, seeking articles on physicians' assertiveness as a communication style published until February 2022. The Joanna Briggs Institute approach and the Preferred Reporting Items for Systematic Reviews checklist underpinned the review protocol. Results: We identified 1513 articles relating to assertiveness, reviewed 153 full‐text articles and selected 22 for full review, 68% from the last decade. The articles focused mainly on assertive communication and relationships with medical staff, with 54% focusing on bottom‐up power relations. In 40% of the articles, no clear definition of assertiveness was included. Definitions included had varied focus: on self, on the other or both. Overall, assertiveness measures varied widely, precluding a methodical comparison. Conclusions: Despite the growing interest in physicians' assertiveness, a clearer definition and in‐depth exploration of assertiveness are needed alongside development of valid measures of assertiveness appropriate to physicians. Based on the review, we offer a relational definition of assertiveness as the capacity to communicate one's views, concerns, rights and needs while respecting others and preserving therapeutic, collegial and educational professional alliances. This definition may serve to expand research in the field while offering a professional alternative to problematic communication styles—passive and self‐denying or paternalistic and aggressive —that obfuscate and thus undermine physician–patient relationships. Gutgeld‐Dror et al. provide evidence that assertiveness is important to physicians' interactions as long as it takes into account the needs of both parties and is engaged while valuing maintainance of professional relationships. [ABSTRACT FROM AUTHOR]

Background: In the highly competitive landscape of healthcare, nurturing strong relationships between referring healthcare providers and healthcare facilities is essential for maintaining patient loyalty. This study explores the factors influencing referring health care provider engagement and its subsequent impact on the willingness to rerefer to healthcare facilities. Methods: A cross-sectional quantitative survey was conducted with 181 healthcare providers who regularly refer patients to a private hospital in Jakarta. Data were collected through an online structured questionnaire consisting of 29 questions. The following dimensions were covered: specialist characteristics, practice characteristics, healthcare provider–specialist interaction, patient– specialist interaction, returning referral, training opportunity, healthcare provider engagement, and willingness to rerefer to hospital. Results: The study yielded significant findings, with five out of the six antecedents associated with healthcare provider engagement demonstrating statistical significance (p < 0.05). The most significant coefficient value pertaining to healthcare provider engagement was observed in patient–specialist interaction (β = 0.287, p < 0.05). Furthermore, the analysis indicated a substantial and positive correlation between health care provider engagement and willingness to rerefer to the healthcare provider (p < 0.05). Conclusions: Healthcare providers who demonstrate engagement with the hospital are likely willing to rerefer their patients to the hospital. Therefore, to increase the willingness to rerefer patients to the hospital, hospital management should prioritize fostering engagement with healthcare providers, particularly by improving patient and specialist interaction experiences. [ABSTRACT FROM AUTHOR]

Background: Effective communication and information delivery enhance doctor–patient relationships, improves adherence to treatment, reduces work burden, and supports decision-making. The study developed a head and neck cancer (HNC) communication platform to support effective delivery of information about HNC treatment and improve the doctor-patient relationship. Methods: This study was structured in three main phases: 1) The requirement elicitation phase sought an understanding of the HNC treatment journey and service failure points (FPs) obtained through patient/medical staff interviews and observations, along with a review of the electronic health record system; 2) The development phase involved core needs analysis, solutions development through a co-creation workshop, and validation of the solutions through focus groups; and 3) the proposed HNC communication platform was integrated with the current treatment system, and the flow and mechanism of the interacting services were structured using a service blueprint (SB). Results: Twenty-two service FPs identified through interviews and observations were consolidated into four core needs, and solutions were proposed to address each need: an HNC treatment journey map, cancer survivor stories, operation consent redesign with surgical illustrations, and a non-verbal communication toolkit. The communication platform was designed through the SB in terms of the stage at which the solution was applied and the actions and interactions of the service providers. Conclusions: The developed platform has practical significance, reflecting a tangible service improvement for both patients and medical staff, making it applicable in hospital settings. [ABSTRACT FROM AUTHOR]

This article follows Blaxter's foundational call for a sociology of diagnosis that addresses the dual aspects of diagnosis‐as‐category and diagnosis‐as‐process. Drawing on video recordings from an autism clinic, we show how the process of attaching the diagnosis to a child involves interactions between clinicians, parents and children, and that in the course of such interactions, a diagnostic category officially defined in terms of deficits can instead be formulated in terms of valuable social and cognitive differences. More specifically, we show that the child's age is crucial for how clinicians formulate the diagnosis: with younger children, clinicians treat autism exclusively as a deficit to be remedied, whereas with older children, clinicians may treat autism either as a deficit or as a social‐cognitive difference. Further, because older children are often co‐recipients of diagnostic news, we find that clinicians carefully manage the implications such news may have for their self/identity. Finally, we suggest that (1) the equation of a diagnostic category with dysfunction is achieved in interaction; (2) the meaning of a diagnosis may vary with characteristics of its recipients; and (3) that meaning can be worked up by clinicians and recipients in ways that centre difference rather than deficit. [ABSTRACT FROM AUTHOR]

Background: Children with medical complexity (CMC) have unique, and often unmet, housing needs that place them at risk for housing insecurity and poor health outcomes. Yet, little is known about how families with CMC discuss their housing needs with healthcare providers. We sought to understand: (1) how housing is currently discussed between CMC caregivers and healthcare providers, and (2) how CMC caregivers want such conversations to occur. Methods: From August to November 2020, we conducted semi‐structured interviews with parents/guardians of CMC (<26 years old) in Maryland as part of a larger study to understand their housing experience. Four questions on communication with providers about housing were developed a priori and included in this analysis. Qualitative content analysis was applied to interview transcripts. Results: Among 31 completed interviews, most participants were female (90%), lived in single‐family homes (68%) and were from a mix of neighbourhood types (urban 19%, suburban 58%, rural 22%). Their children ranged in age from 6 months to 22 years, had a mix of insurance types (public 65%, private 29%, both 6%) and nearly all required medical equipment or technology. Four themes emerged: (1) Current housing conversations are rare and superficial, (2) Ideal housing conversations would result in thoughtful care plans and concrete supports, (3) Frequency and initiation of housing conversations are best tailored to family preferences and (4) Value of housing conversations are limited by lack of provider knowledge and time. Conclusions: Conversations about housing needs for CMC happen in limited ways with healthcare providers, despite a desire on the part of their caregivers. Such conversations can give meaningful insights into the family's specific housing challenges, allowing providers to appropriately tailor care plans and referrals. Future work is needed to capture provider perspectives, design CMC‐specific housing screeners and develop interdisciplinary referral strategies. [ABSTRACT FROM AUTHOR]

The article focuses on the role of "ethics liaisons" in healthcare settings, who act as intermediaries between clinicians, patients, and ethicists to address ethical dilemmas. Topics discussed include the responsibilities of ethics liaisons, challenges in implementing liaison programs, and the positive impact of such programs on staff morale and patient care.

Introduction. The value of family health history as a means to understanding health risk has been long known. Its value in a precision medicine context is also now becoming apparent. General practitioners (GPs) are considered to play a key role in the collection, and investigation, of family health history, but it remains widely reported as being both poorly and infrequently undertaken. Little is known about this practice in Aotearoa New Zealand (NZ). Aim. This study aimed to explore current practices in relation to the ascertainment of family health history, with a view towards precision medicine. Methods. Semi-structured interviews were conducted with 10 GPs recruited from one urban area of NZ. The interviews were subjected to a thematic analysis. Results. Family health history information was used to varying degrees in four areas - risk ascertainment, patient engagement with a diagnosis, social context and building relationships. Patient cultural considerations were rarely mentioned. Reliability of information provided by patients, resource constraints, context driven consults and electronic health record limitations are potential indicators of current limits of family health history. Discussion. Our findings present a baseline of current practice and echo larger studies from overseas. As precision medicine is not yet routine, a unique opportunity exists for consideration to be given to establishing specific roles within the NZ health system to enable equitable practice of, and subsequent health gains from, the use of family/whānau health history information as part of precision medicine. [ABSTRACT FROM AUTHOR]

A key challenge of implementing advance care planning lies in the fact that decisions made in advance require patients and their family members to imagine what their clinical picture will look like rather than knowing or experiencing the clinical circumstances as they unfold. Even more important is the acknowledgment of the unpredictability of a given clinical course. This type of situation requires adaptiveness and flexibility in decision‐making that frequently occurs in the moment(s) triggered by changes in health state(s). We describe an alternative frameshifting approach called "Adaptive Care Planning (AdaptCP)," which features an evolving communication between physicians and patients/families with ongoing incorporation of the patient's/family's perspective. This process continues iteratively until each decision can be reached in a way that is both harmonious with the patient's/family's perspective and is consistent with medical treatment options that are actionable for the healthcare team. We include a table of tools drawn from the literature that can help clinicians when implementing AdaptCP. [ABSTRACT FROM AUTHOR]

The article focuses on introducing the concept of "interpersonal energy" as a metaphor to enhance human connection in end-of-life care, suggesting its potential to support the spiritual needs of patients and families. Topics include the definition and exploration of interpersonal energy, its application in palliative care health professions education, and its implications for fostering compassionate patient care and understanding of the subjective experiences in end-of-life interactions.

Introduction: Adolescents with Type 1 diabetes are a cohort whose self‐management of their diabetes care often declines during adolescence which can lead to adverse health outcomes. Research indicates that providers find it challenging to engage adolescents in communication exchanges during triadic encounters in diabetes clinics. Our study aimed to explore adolescents, parents, and providers' experiences of clinic encounters. Methods: A qualitative study was conducted with a convenience sample of 13 adolescents with Type 1 diabetes (aged 11–17), 14 parents, and seven providers. Participants were recruited from two outpatient diabetes clinics in two urban children's hospitals, Ireland. Data were obtained using a combination of interviews and focus groups. Data were analysed thematically. Results: Adolescents and their parents appeared to hold both positive and negative experiences of diabetes clinic encounters. Providers reported challenges associated with engaging adolescents in communication exchanges. The structure, focus and style of clinic encounters created barriers that potentially led to suboptimal adolescent participation and impaired provider–adolescent communication during clinic visits. Conclusions: The findings provide insights into the challenges associated with adolescents' engagement in communication encounters in diabetes clinics. Healthcare providers could encourage adolescents to be more actively involved in their diabetes management, by taking an adolescent‐centred approach and creating a nonjudgemental milieu. Focusing on adolescent's agenda could lead to more meaningful and relevant discussions between providers and adolescents and ensure more tailored education in the time available. Adolescence is a risky period for nonadherence and adverse health complications; therefore, it is critical that providers make every contact count in diabetes clinic encounters. Patient or Public Involvement: The study's design and delivery were guided by two advisory groups, comprising (1) five adolescents living with Type 1 diabetes (T1D) and (2) five parents of an adolescent with T1D. [ABSTRACT FROM AUTHOR]

Background: Precision oncology, using comprehensive biomarker testing (cBT) to inform individual cancer diagnosis, prognosis and treatment, includes increasingly complex technology and clinical data sets. People impacted by cancer (patients and caregivers) and healthcare professionals (HCPs) face distinct challenges in navigating the cBT and personalized treatment landscape. This review summarizes evidence regarding cBT‐related communication between people impacted by cancer and HCPs and identifies important avenues for future research in precision oncology. Methods: A scoping review was conducted using records published in PubMed during January 2017–August 2022, focusing on the breadth of topics on patient‐HCP communication and knowledge resources used by HCPs as guidance in cBT‐related communication. Data were extracted from records meeting inclusion criteria, and findings were summarized according to main topics. Results: The search identified 287 unique records and data were extracted from 42 records, including nine from expert input. Most records originated from the United States included patients with different types of cancer, and oncologists were the main HCPs. Patients' motivation for undergoing cBT and receiving results was generally high in different settings. However, patients' understanding of cBT‐related concepts was limited, and their knowledge and information preferences changed based on cBT implications and significance to family members. HCPs were valued by patients as a trusted source of information. Limited evidence was available on HCPs' information‐seeking behavior and factors influencing cBT‐related knowledge and confidence, often self‐reported as insufficient. Conclusions: Patient education by knowledgeable and confident HCPs, information management and a caring patient‐HCP relationship communicating continuity of care regardless of cBT results are crucial to empower patients and shared decision‐making in precision oncology. More data on the process and structure of cBT‐related communication, distinction between and characterization of different timepoints of patient‐HCP interactions are needed. [ABSTRACT FROM AUTHOR]

The digital transformation is taking place in the healthcare sector and requires that professional qualifications be expanded to include digital competencies. Some medical faculties have already implemented curricula for this. An adapted curriculum is being developed for the primary care-oriented Brandenburg Reformed Medical Study Program, taking into account the needs of the teaching practice network. For this purpose, teaching practices were queried via a questionnaire about which digital technologies are used in patient treatment or will be used in the future and which competencies should be added to medical training. The analysis revealed that the majority were aware of digital topics and technologies, but that implementation due to legal requirements was in competition with time and monetary resources. In addition, there were uncertainties regarding the use of digital media, especially regarding background knowledge of legal and technological aspects of data protection. Furthermore, the importance of direct contact between physicians and patients was also emphasized. The incorporation of teaching practices provides the basis for developing needs-oriented curricula for training and continuing education. It became apparent that the central guiding principles of data protection and physician-patient relationships should be taken into account in order to make the best possible use of the potential of digitalization in healthcare for patient care. The goal should be to integrate digital technologies as a meaningful addition to physicians' core competencies, so that medical staff have more time for value-added activities and patients in turn benefit from improved experience and, thus, satisfaction. [ABSTRACT FROM AUTHOR]

Health care should address the holistic gap between health outcomes, spirituality, religion, and humanistic care to optimize patient care. Treating the whole person encompasses both physical and metaphysical elements. Patients want health care professionals to recognize their spiritual and religious preferences, because these matter in their approach to illness, coping, and long‐term outcomes. [ABSTRACT FROM AUTHOR]

This article aims to discuss the use of telemedicine in doctor-patient communication in the context of consultations and aims to assess the perception of clinical professionals from Portuguese private hospitals about the use of telemedicine by videoconferencing. We used the unified theory of acceptance and use of technology 2 (UTAUT 2) to reflect on the topic and analyze the research results. We applied deepened semi-structured interviews to nine doctors, from seven different specialties, from private hospitals, which provide consultations through videoconferencing, namely Hospital da Luz and Trofa Saúde. The interviews were conducted in May and June 2022. The participants referred to telemedicine as a complementary tool to face-to-face consultations, with occurrence limitations according to the medical specialty and pathology. We concluded that the tool, along with technological developments that support it, will become part of medical consultations in the future, and the high motivation of health professionals is necessary for the successful implementation of these tools. The contribution of this study is to show the relevance of the professionals' motivation for the adoption of videoconferencing technology tools. [ABSTRACT FROM AUTHOR]

The post-COVID-19 pandemic era has placed new demands on physicians. One of these demands is the need to use targeted knowledge and soft communication skills, to address the psychosocial problems (e.g. vaccine hesitancy, fears) of individuals with Chronic Physical Illnesses (CPIs). Focusing on training physicians in targeted soft communication skills can help health care systems to address psychosocial-type problems. Yet, such training programs are rarely implemented, effectively. This study aimed to (a) understand physicians' implementation challenges when using soft communication skills during the COVID-19 pandemic; (b) identify beliefs, barriers, and facilitators that can influence physicians' behaviours to use soft communication skills; and (c) inform the content of the LeadinCare; a new digital training platform, designed to improve physicians' soft communication skills, by leveraging the TDF Theoretical Domain Framework (TDF). We conducted 14 in-depth semi-structured interviews with physicians in Greece, supporting non-COVID-19 cases with CPIs. We analyzed their data using inductive and deductive approaches. Physicians highlighted time, inability to see patients in person, absence of space for non-COVID-19 cases, and poor organizational procedures as barriers to using soft communication skills. Five TDF domains (beliefs) were identified as the most salient to inform the LeadinCare platform: (1) practical and well-organized knowledge; (2) skills that support patients and their relatives; (3) physicians' beliefs about capabilities to use the skills; (4) beliefs about consequences of using the skills (job satisfaction); and (5) the use of digital, interactive, and on-demand platforms (environmental context & resources). We mapped the domains in six narrative-based practices that informed the content of the LeadinCare. Physicians need skills that go beyond talking and towards cultivating resilience and flexibility. [ABSTRACT FROM AUTHOR]

The rapid advancement of digital technology has transformed the media landscape, with platforms e.g., WeChat, Weibo, TikTok, and online platforms are gaining popularity for healthcare services and information dissemination platform in China. Traditional media e.g., newspapers, television, and radio, once dominant, now face challenges and transitions, leading to insufficient healthcare communication. As one of the major alternatives, WeChat offers official accounts for hospitals to enhance their healthcare quality and promote their medical services. Hospitals now must rely on diverse and content-rich digital media to enhance their reputation. Addressing privacy concerns and user preferences will enhance the adoption and utilization of digital healthcare services, meet users' ever evolving needs, and promote the sustainable development of healthcare quality. User interactions and social engagement are crucial in shaping brand trust within the scope of doctor-patient relationships. Building trust and addressing privacy concerns are essential for successful adoption of digital healthcare services. Perceived ease of use and usefulness are among critical factors in technology adoption by the respective society. Future research should explore the adoption of digital branding platforms in different healthcare settings and cultures to provide a more comprehensive digital branding strategies for healthcare providers. The adoption of hospital WeChat Official Accounts as digital branding platforms is influenced by user interactions, trust, ease of use, and perceived usefulness. Addressing privacy concerns and focusing on usability and relevance are key for successful implementation. [ABSTRACT FROM AUTHOR]

The article focuses on ethics consultations dealing with conflicts between clinicians and families regarding end-of-life care, particularly addressing the challenge of differing views on what constitutes "futile" care. It mentions doctor Abenamar Arrillaga emphasizes the importance of recognizing a point, termed "Point Y," where continued aggressive care may prolong the dying process instead of improving the quality of life.

Copyright of Revista Ciencias de la Salud is the property of Colegio Mayor de Nuestra Senora del Rosario 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.)

Moral injury is a relatively new concept with varying definitions that attempts to define a profound and lasting insult to one's conscience caused by perpetration of or directly witnessing harm to another person in a high-pressure situation. This entity is separate from posttraumatic stress disorder (PTSD), but it can coexist with PTSD. This article provides psychotherapeutic examples of the diagnosis of moral injury from a psychodynamic perspective, focusing on morally challenging situations related to warfare and the healthcare system. [ABSTRACT FROM AUTHOR]

The purpose of the article is to analyse the shortcomings of the state-run healthcare systems and to substantiate the need for and feasibility of transition to a patient-controlled model. It is shown that patient-controlled health care, free from centralised domination, can provide timely, high-quality, compassionate medical care at an affordable price for both individuals and the nation. It significantly expands the patient's rights and opportunities to choose a doctor according to their own preferences and financial capabilities. The patient pays for the medical service provided directly to the doctor, who no longer has restrictions on choice of treatment protocols or prescription of medicines. The analysis in the article is based mainly on the example of the United States, where federal control for residents is both direct (194 million Americans are covered by Medicaid, Medicare, Tricare or EMTALA) and indirect (138 Americans have private insurance). In addition, aspects of the article analysis also apply to single-payer countries (Canada, the United Kingdom, France and Spain). The article examines the shortcomings of the current US model of its healthcare system in terms of its compliance with the Constitution. It is noted that, according to the Tenth Amendment to the US Constitution, healthcare powers are not among the 18 powers delegated to the federal government. Also, noncompliance with the law is also observed: government control or administration of state Medicaid programmes is contrary to US law; medical autonomy as the patient's ability to make personal medical decisions without undue influence from the state. Another disadvantage of state-run healthcare system is that state-controlled healthcare payment structure violates the fiduciary relationship between doctor and patient, as doctors' authority to make medical decisions is limited. It also calls into question the observance in the United States of the citizen's "right" to receive medical care in its interpretation as a personal service of a professional caregiver when a patient can demand the desired care and the service provider cannot refuse. The article emphasises that state-run healthcare systems create a conflict between efficient use of financial resources and effective provision of medical care. This issue is considered through the prism of the interests of the main stakeholders: shareholders of companies operating in this area, politicians, patients, healthcare providers and administrators. As evidence of the inefficiency of the existing US healthcare system in comparison with other countries, comparative data for different countries on life expectancy and incidence rates of a number of diseases are provided. The author also discusses the problem of limiting access to medical care (rationing) for patients with public health insurance due to a shortage of healthcare professionals accepting new Medicaid patients. This is caused by low reimbursement rates, overly bureaucratic verification procedures for obtaining payment, overregulation of requirements for doctor-patient relations and procedures for reviewing medical errors, the need to comply with population-based clinical algorithms, etc. It leads to a decrease in the quality of medical care, an increase in patient deaths while waiting for medical care, the risk of disease complications due to delays in diagnosis and timely treatment, ignoring the needs of unique, individual patients, and an increase in the likelihood of medical errors. All of the above disadvantages of state-run healthcare are obviated when the patient is in charge, patient-controlled health care. [ABSTRACT FROM AUTHOR]

Aim: The idiographic case study aimed to explore the trust of a person with chronic pancreatitis in healthcare professionals. Design: An interpretive phenomenological idiographic case study. Methods: Data collection was carried out through a semistructured in-depth interview with a 29-year-old man with chronic pancreatitis. The purposive sampling of the participant was carried out according to feasibility criteria. Interpretative phenomenological analysis was used with the assistance of Atlas.ti 9 for data analysis. Results: Five interconnected personal experiential themes reflecting the trust of the participant in healthcare professionals were identified: Trust in healthcare professionals as an inner feeling; Active and partnership approach of healthcare professionals; Paternalistic approach and lack of interest of healthcare professionals in the patient; Expertise of healthcare professionals; and Linking trust in health professionals with the hospital ward environment, with 22 experiential statements. Conclusion: The participant considered trust to be an internal feeling of expectation that healthcare professionals would help him actively solve his health problems. The findings promote the implementation of patient-centered care and the partnership approach in the care of patients with chronic pancreatitis. The personal experience themes identified provide information for further qualitative research aimed at a deeper understanding of the lived experience of trust for patients with chronic pancreatitis. [ABSTRACT FROM AUTHOR]

This article discusses the occupational risks faced by emergency physicians in China. The study found that emergency physicians in China face high occupational risks due to factors such as an increasing number of patients with acute and severe diseases, a high workload, and the potential for medical malpractice. The study also highlighted the challenges faced by emergency physicians, including mental stress and a lack of occupational satisfaction. The article suggests that measures should be taken to improve working conditions for emergency physicians and decrease occupational risks. [Extracted from the article]

The acquisition of private medical practices by large health-care corporations is transforming clinical practice in many Western countries. The growing influence of health administration on medical practice is increasingly perceived as a danger by the public and health professionals. Health-care administrators should not replace doctors or invade their competencies. Back to principles, the patient-doctor relationship must be funded in trust. Representing society, governments must try to ensure health care to all citizens, serving one of the fundamental human rights. Using the principle of subsidiarity, administrators should fill gaps in the provision of health care to all patients by doctors. [ABSTRACT FROM AUTHOR]