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OBJECTIVE: To determine the proportion of health care professionals at our community-based cancer center who had completed advance directives (ADs) and to identify barriers to their doing so. PARTICIPANTS AND [...]

Introduction An international partnership of training organisations has developed a competency-based training programme in intensive care medicine for Europe (CoBaTrICE, http://www.cobatrice.org) and other world regions [1]. This project used consensus [...], Objective: This study examined the views of adult patients and relatives about desirable characteristics of specialists in intensive care medicine (ICM) to incorporate these into an international competency-based training programme, CoBaTrICE. Design: Convenience sample of patients and relatives administered after discharge from 70 participating ICUs in eight European countries (1,398 evaluable responses). The structured questionnaire included 21 characteristics of medical competence categorised as 'medical knowledge and skills', 'communication with patients', and 'communication with relatives'. It was available in the national languages of the countries involved. Questions were rated by respondents for importance using a four-point Likert scale. Responses to open questions were also invited. Results: Most characteristics were highly rated, with priority given to medical knowledge and skills. Women were more likely to emphasise communication skills. There were no consistent regional differences. Free-text responses welcomed the opportunity to participate. Conclusions: Patients and relatives with experience of intensive care in different European countries share similar views on the importance of knowledge, skills, decision making and communication in the training of intensive care specialists. These generic patient-centred components of training have been incorporated into the international competency-based ICM training programme, CoBaTrICE. Keywords Intensive care * Critical care * Professional competence * Training * Physician-patient relations * Professional-family relations

The study has two main objectives: (1) to determine the proportion of adults [greater than or equal to] 50 years of age who prefer to have their physician inquire about their functional and emotional health status, and (2) what physician, patient, and medical care system factors are associated with these preferences. The findings suggest that 76% of patients want their physician to inquire about their functional health and 72% want their physician to inquire about their emotional health during the medical encounter. Further analyses show that type of inquiry is strongly associated with patient's preference. Multiple regression models showed congruence regarding physician inquiry about functional and emotional health and patients' preferences for this type of inquiry. The current study is valuable because it highlights the importance of communication exchange during the medical encounter. Physicians are encouraged to inquire into older patients' functional and emotional health status. Keywords: health inquiry; prevention; aging; health care

We examine whether racial/ethnic/language-based variation in measured levels of patients' trust in a physician depends on the survey items used to measure that trust. Survey items include: (1) a direct measure of patients' trust that the doctor will put the patient's medical needs above all other considerations, and (2) three indirect measures of trust asking about expectations for specific physician behaviors, including referring to a specialist, being influenced by insurance rules, and performing unnecessary tests. Using a national survey, we find lower scores on indirect measures of trust in a physician among minority users of health care services than among non-Hispanic white users. In contrast, the direct measure of trust does not differ among non-Hispanic whites and nonwhites once we control for potential confounding factors. The results indicate that racial/ethnic/language-based differences exist primarily in those aspects of patients' trust in a physician that reflect specific physician behaviors.

Personal attire is an important part of being a professional. This survey is an attempt to determine the patient's and psychiatrists view point about how a psychiatrist should dress to work. A human subjects research board approved survey of seven questions was offered to patients and a similar survey of nine questions was offered to psychiatrists. The replies obtained were combined and tabulated. One hundred patients and 77 psychiatrists responded to the survey. Both the patients and psychiatrists considered dress to be an important part of the doctor-patient relationship. The psychiatrists appear to be more concerned and critical about their dress as compared to patients. KEY WORDS: dress; patient; psychiatrist; relationship; white coat.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2005.03.024 Byline: Judith A.C. Rietjens (a), Agnes van der Heide (a), Bregje D. Onwuteaka-Philipsen (b), Paul J. van der Maas (a), Gerrit van der Wal (b) Abstract: In The Netherlands, there has been a continuing public debate about the acceptability and regulatory system for medical decision-making concerning the end of life. We studied attitudes of the Dutch general public towards different types of end-of-life decisions in various situations and compared them to attitudes of physicians. Questionnaires were mailed to 1777 members of the Dutch general public (response: 78%). A total of 391 Dutch physicians, including general practitioners, nursing home physicians and clinical specialists, were interviewed in person (response: 81%). In both the survey and physician interviews, questions were asked about attitudes towards active ending of life, terminal sedation, and increasing morphine with premature death as a likely consequence, using hypothetical cases of different patients. By logistic regression analysis, the differences between public and physicians' attitudes were assessed, as well as the associations between attitudes of the general public and their personal characteristics. Acceptance of active ending of life at the request of a terminally ill cancer patient was higher among the general public (85%) than among physicians (64%). For physicians, acceptance decreased to 36% for an incompetent adult, 11% for a patient without a serious disease, and 6% for a patient with dementia. For the general public, these percentages were 63%, 37%, and 62%, respectively. Between both groups, no differences were found in acceptance of terminal sedation and increasing morphine. For the general public, determinants of support for active ending of life were being non-religious, lower education, and having a single household. Acknowledging the observed differences in appreciation of end-of-life decision-making between the general public and physicians is important in doctor-patient communication and in public debate and policymaking. Continued monitoring of practices and informing the general public and policymakers about the clinical and ethical consequences of different types of end-of-life decisions is important. Author Affiliation: (a) Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands (b) VU University Medical Center, Department of Public and Occupational Health and Institute for Research in Extramural Medicine, Amsterdam, The Netherlands Article Note: (footnote) [star] Grant support: This study was supported by a grant from the Ministry of Health, Welfare and Sports and the Ministry of Justice.

Although the triadic encounter of physician, patient, and an accompanying family member is a common phenomenon in geriatrics, previous research on the communication in medical encounters has primarily focused on dyadic interactions between physician and patient. This study aimed to explore the triadic communication and communication roles of patient companions in Japanese geriatric encounters. Among elderly patients aged 65 or over who were under continuous care of nine attending physicians at a university affiliated geriatric clinic in Tokyo, 63 accompanied patients and 82 unaccompanied patients were included for this study. The consultation was audiotape recorded and analyzed using the Roter Interaction Analysis System (RIAS) with additional categories developed to code aspects of companion communication. In dyadic encounters, the average proportions of physician's talk and patient's talk were 54% and 46%, respectively, while in triadic encounters the average talk proportions of physician, patient, and companion were 49%, 29%, and 22%. Companions made a significant contribution to the communication during the visit by providing information and asking the physician questions, as well as facilitating patient's talk. The companion's communication may influence not only the patient's but also the physician's communication. The patient's expectation of the companion's role during the visit and the companion's intention regarding their role were generally related to one another, and had positive associations with the companion's actual behavior during the visit. Nevertheless, companions often anticipated playing a more direct communication role during the visit, including the provision of information and asking of questions, than patients expected of them. Further investigation is needed to explore the communication dynamics in triads and dyads, and its relation to patient outcomes. Keywords: Companion; Elderly; Family; Japan; Physician-patient communication

Objectives. We examined the association between patient race/ethnicity and patient-physician communication during medical visits. Methods. We used audiotape and questionnaire data collected in 1998 and 2002 to determine whether the quality of medical-visit communication differs among African American versus White patients. We analyzed data from 458 African American and White patients who visited 61 physicians in the Baltimore, Md-Washington, DC-Northern Virginia metropolitan area. Outcome measures that assessed the communication process, patient-centeredness, and emotional tone (affect) of the medical visit were derived from audiotapes coded by independent raters. Results. Physicians were 23% more verbally dominant and engaged in 33% less patient-centered communication with African American patients than with White patients. Furthermore, both African American patients and their physicians exhibited lower levels of positive affect than White patients and their physicians did. Conclusions. Patient-physician communication during medical visits differs among African American versus White patients. Interventions that increase physicians' patient-centeredness and awareness of affective cues with African Americans patients and that activate African American patients to participate in their health care are important strategies for addressing racial/ethnic disparities in health care.

Objective: To assess whether some demographic and practice characteristics of general practitioners (GPs) are associated with the use of bulk billing. Methods: A cross-sectional postal survey was conducted in late 2002 with a 15% stratified random sample, based on sex and area of practice, of currently practising GPs in New South Wales. Multinomial logistic regression was used to look at GPs' characteristics associated with their self-reported use of bulk billing. Results: Of the 494 GPs who participated in the study, 44% bulk billed for all patient consultations, 34% for selective patients, while 22% did not bulk bill for any patient. Multivariate analysis revealed that GPs practising in metropolitan areas were six times more likely to bulk bill for all patients compared with GPs in rural areas (OR 6.7, 95% CI 3.8-11.9). Overseas-trained GPs were twice as likely to bulk bill for all patients compared with locally trained GPs (OR 2.3, 95% CI 1.2-4.3). The likelihood of bulk billing for all patients also increased with an increase in GPs' caseload. Conclusions: This paper discusses some of the policy and programmatic implications of the changing pattern of bulk billing. Special efforts are needed to provide increased practice support for GPs in rural and remote areas in order to ensure affordable and accessible GP services.

Most research studies identifying non-clinical factors that influence the choice of Cesarean Section as a method of obstetric delivery assume that the physician makes the decision. This paper arguably shows the role played by the mother. Owing to the fact that Chinese people generally believe that choosing the right days for certain life events, such as marriage, can change a person's fate into a better one, the hypothesis is tested that the probability of Cesarean Sections being performed is significantly higher on auspicious days and significantly lower on inauspicious days. By employing a logistic model and utilizing 1998 birth certificate data for Taiwan, we are able to show that the hypothesis is accepted. Keywords: Cesarean sections; Culture; Patients' attitude; Maternal requests; Taiwan

For some, the search for the ideal care provider can be elusive. This study explored female adolescents' accounts of the ideal health care provider. One hundred fifty-seven female high school students responded to the following question: "Can you describe what the ideal doctor would be like?" Content analysis of their descriptive narratives yielded 272 references to communication competence versus 30 references to medical competence (10 references were unrelated to either communication or medical competence). Based on their responses, it is clear that while young women appreciate the importance of medical skill, it is the communicatively competent care provider that they most seek., Effective physician-patient communication is consubstantial to high-quality health care and to patient well-being. Patient compliance, morbidity, mortality, and risk behaviors all have been linked with the medical encounter, highlighting the […]

To what extent do personal constructs affect the relationship between doctor and patient when the ill patient does not readily recover with treatment? Questionnaires were returned anonymously by 609 patients with a self-reported diagnosis of chronic fatigue syndrome, who were considered chronically ill. Findings were compared with those of an earlier study of a population of 397 general medical patients. The chronically ill patients lost an average of 65 days of work per year due to illness compared to general medical patients who missed six or fewer days per year because they were ill. The chronically ill patients also reported a 66% higher frequency of iatrogenic illness, spent more money on health care, took more medication, saw more specialists, and were more litigious than the general medical population. Research suggested several patterns of relationships between doctors and patients, and attitudes to health and illness, which may alert doctors to patients' perceptions, beliefs, encoded constructs, and patterns of relating that affect responses to treatment. More attention by doctors to patients who are experiencing the stress of chronic illness is indicated.