Abstract This study deals with the phenomenon of a doctor-patient relationship from a relationship-centered care point of view. Relationship-centered care is viewed as an opportunity for the doctor to enhance comprehensive care of the patient and to improve the quality of primary health care. The research was conducted in the context of General Practice-education aimed at physicians specializing in general medicine. The training was organized by the General Practice Unit of Northern Ostrobothnia Hospital district (PPSHP) and the Department of Medicine and Health Sciences at the University of Oulu. The aim of the research is to increase understanding of the phenomenon of a patient-doctor relationship. The phenomenon is examined by looking at the possibilities for a doctor specializing in general medicine to have a personal doctor-patient relationship with dialogical orientation. With the help of personal reflection the doctor specializing in general medicine can develop ways to prepare for the relationship and be in it. The possibility for a patient to encounter valuable care is constructed through reflection and introduction of dialogue. A doctor working in relationship-centered care strategically receives information about the patient's personal experiences. Combining this information with the latest biomedical knowledge assists in the general recommendations of the Current Care Guidelines, when applying them individually. The research is qualitative. The data comprises 16 doctors who participated in the General Practice-education, their semi-structured thematic interviews with transcribed texts, as well as the findings from questionnaires completed at the end of the education. The data is analyzed using qualitative methods. The results showed that subjects felt that the core of general medicine is a personal doctor-patient relationship, in which it is essential to listen to the patient's concerns, experiences, thoughts and expectations when making treatment decisions and deciding on the correct diagnosis. Personal readiness is increased by the doctor-patient relationship when outlining the theoretical content, practicing situations of interaction, handling challenges that have emerged from work in a peer group, as well as the doctor's awareness based on previous work experience in medicine. There can be barriers, attitudes, beliefs and non-processed emotions that emerge from one's personal history of experiences; processing these strengthens the belief in one’s own abilities to work according to internal information and to be more personally present in relationships. The results could be utilized during basic medical education and post-graduate training, as well as in supervision. / Tiivistelmä Tutkimus käsittelee potilas-lääkärisuhteessa olemisen ilmiötä suhdekeskeisyyden näkökulmasta. Suhdekeskeisyyttä tarkastellaan lääkärin mahdollisuutena tehostaa potilaan kokonaisvaltaista hoitamista ja hoidon laatua. Tutkimus toteutettiin prosessiluontoisessa General Practice -koulutuksessa, joka oli suunnattu yleislääketieteeseen erikoistuville lääkäreille. Koulutuksen järjestivät Pohjois-Pohjanmaan sairaanhoitopiirin kuntayhtymän (PPSHP) yleislääketieteen yksikkö ja Oulun yliopiston lääketieteellisen tiedekunnan terveystieteiden laitos. Tutkimuksen tavoitteena on lisätä ymmärrystä potilas-lääkärisuhteessa olemisen ilmiöstä. Ilmiötä lähestytään tarkastelemalla yleislääketieteeseen erikoistuvan lääkärin mahdollisuuksia olla potilas-lääkärisuhteessa persoonallisesti ja dialogisuutta tavoitellen. Persoonallisen reflektion avulla yleislääketieteeseen erikoistuva lääkäri voi kehittää valmiuksiaan asettua suhteeseen ja olla siinä. Reflektiivisyyden käynnistyminen ja dialogisuuden omaksuminen mahdollistavat potilasta arvostavien hoitokohtaamisten rakentumisen. Suhdekeskeisesti työskentelevä lääkäri saa henkilökohtaista tietoa potilaan kokemusmaailmasta. Tämän tiedon yhdistäminen uusimpaan biolääketieteelliseen tietoon auttaa yleisten Käypä hoito -suositusten soveltamisessa yksilöllisesti. Tutkimus on laadullinen tutkimus, jonka aineisto koostuu 16:n General Practice -koulutukseen osallistuneen lääkärin puoli-strukturoiduista teemahaastatteluista litteroiduista teksteistä, heidän reflektiopäiväkirjoistaan sekä koulutuksen lopussa suoritetusta palautekyselystä. Aineisto analysoidaan laadullisin menetelmin. Tulosten mukaan tutkittavat pitävät yleislääketieteen ytimenä persoonallista potilas-lääkärisuhdetta, jossa oikean diagnoosin ja potilasta hyödyttävien hoitopäätösten tekemisen kannalta on oleellista kuunnella potilaan huolia, kokemuksia, ajatuksia ja odotuksia. Persoonallisia valmiuksia lisäävät potilas-lääkärisuhteen sisältöjen teoreettinen jäsentely, vuorovaikutustilanteiden harjoittelu, työstä nousevien haasteellisten tapausten käsittely vertaisryhmässä sekä lääkärin kokemushistoriasta kumpuavien asioiden tiedostaminen ja käsittely. Omasta kokemushistoriasta kumpuavien esteiden, asenteiden, uskomusten ja tunteiden käsittelemättömyyden työstäminen vahvistaa uskoa omiin kykyihin toimia sisäisen informaation mukaan ja olla persoonallisemmin läsnä suhteissa. Tutkimuksen tuloksia voidaan hyödyntää lääkäreiden perus- ja jatkokoulutuksessa sekä lääkäreiden työnohjauksessa.

Submitted by Kely Alves (kely.alves@unifenas.br) on 2018-07-31T18:14:09Z No. of bitstreams: 1 Dissertação Edson Dell Amore Filho.pdf: 708297 bytes, checksum: d624f6ac7e0eb9fcbdcd4058c5e05da6 (MD5) / Made available in DSpace on 2018-07-31T18:14:09Z (GMT). No. of bitstreams: 1 Dissertação Edson Dell Amore Filho.pdf: 708297 bytes, checksum: d624f6ac7e0eb9fcbdcd4058c5e05da6 (MD5) Previous issue date: 2018-03-12 / The medicine dehumanization has been largely attributed to the medicine schools, which privilege scientific aspects to the detriment of those theoreticians and focus on the humanism. The medicine schools were driven to review their curricula, emphasizing disciplines and organizing interventions for recovering of the humanism in medical practice. The general objective of the dissertation was to identify the actions proposed or developed in medicine courses for resumption of humanization in the medical practice. The specific objectives were to highlight the main attributes of the humanism and to describe the main educational interventions adopted for the humanism development in medical practice. A systematic revision of the literature was carried out for the attainment of the study objectives, by means of researching in the databases of the Latin American and Caribbean Health Sciences Literature and Pub Med, from 2010 to 2016, in Portuguese and English languages. The research resulted in the selection of 23 publications. The results showed that the humanism main attribute is the empathy, which the schools of medicine are developing as main actions the changes in the curriculum of the courses. The main educational implemented actions involve, besides the curricular changes, exchanges and extension programs, through the inclusion of new disciplines, the use of play activities and cultural contexts that are distinct from those of the students' origin. It was concluded that the range of the measures is still small, considering the universe of the medicine courses and its lack of results for more objective analysis. / A “desumanização” da medicina tem sido atribuída em grande parte às escolas de medicina, que privilegiam aspectos científicos, em detrimento daqueles teóricos e voltados ao humanismo. As escolas de medicina se viram impelidas a rever seus currículos, enfatizando disciplinas e organizando intervenções para retomada do humanismo na prática médica. O objetivo geral da dissertação foi identificar as ações propostas ou desenvolvidas nos cursos de medicina para a retomada da humanização na prática médica. Os objetivos específicos foram evidenciar os principais atributos do humanismo e descrever as principais intervenções educacionais adotadas para o desenvolvimento do humanismo na prática médica. Para a consecução dos objetivos do estudo, foi realizada uma revisão sistemática de literatura, mediante pesquisa nas bases de dados da Literatura Latino-Americana e do Caribe em Ciências da Saúde e PubMed, no período de 2010 a 2016, nos idiomas português e inglês. A pesquisa resultou na seleção de 23 publicações. Os resultados mostraram que o principal atributo do humanismo é a empatia e que as escolas de medicina estão desenvolvendo como principais ações alterações nos currículos dos cursos. As principais ações educacionais implementadas envolvem alterações curriculares, intercâmbios e programas de extensão, mediante a inclusão de novas disciplinas, uso de atividades lúdicas e atuação em contextos culturais distintos dos de origem dos estudantes. Concluiu-se que a abrangência das medidas ainda é pequena, considerando-se o universo dos cursos de medicina, e seus resultados carecem de análise mais objetiva.

This thesis investigates the legal validity of living wills (advance directives) in South Africa. The study explores the current status of living wills in South Africa and contains recommendations on how legal enforceability of living wills can be improved in the South African context. The Constitution of the Republic of South Africa, 1996, the common law and the National Health Act, 61 of 2003, serve as basic points of departure for this investigation. Shortcomings in the current South African legislation and proposed draft legislation including the Law Commission’s Draft Bill on End of Life Decisions, 1998, and The National Health Amendment Bill, 2019, as well as shortcomings in the common law, the field of medical ethics and medical practice are indicated and recommendations for an improved framework are made. For purposes of a legal comparative methodology, the legal frameworks of living wills in the Netherlands, England and Canada are investigated. Specific circumstances which could potentially hamper the legal enforcement of living wills are discussed, including: emergency situations, do-not-resuscitate orders, permanent vegetative states, dementia, cessation of artificial hydration and feeding, pregnancy, euthanasia, assisted suicide, palliative care, pain relief and organ donation. It is argued that a living will could be an important tool in enhancing the doctor-patient relationship, not only to the benefit of the autonomous patient whose dignity and other fundamental human rights should be protected, but also to the benefit of the doctor as the medical care provider. / Thesis (LLD)--University of Pretoria, 2019. / Public Law / LLD / Unrestricted

Tekniken är en stor del av dagens samhälle. Allt fler tjänster och saker blir digitaliserade, nu även sjukvården. Denna avhandling kommer att introducera dig till e-hälsa och hur digitaliseringen av sjukvården påverkar relationen mellan doktor och patient samt vilka förtroendeproblem som kan uppstå.E-hälsopplikationerna behöver vara användarvänliga och enkla att använda för patienterna. Patienterna behöver känna sig trygga och säkra. För att undersöka användarupplevelsen i de olika kanalerna jämförde vi de två olika flödena: personligt möte med videosamtal.Det finns många olika leverantörer av e-hälsoapplikationer i Sverige, Kry och Min Doktor är två av de mest populära. Digitaliseringen av sjukvården påverkar inte bara patienterna utan läkarna är lika involverade. För att få en läkares åsikt ställde vi ett par frågor till läkare om bedömning av patienter via videosamtal. Ett frågeformulär gjordes för att samla in information om patienternas förhållande, användning och erfarenhet av e-hälsoapplikationer.Frågeformuläret visade att det finns delade åsikter om e-hälsoapplikationerna. Vissa patienter tror att e-hälsapplikationerna kommer att gynna samhället och kan själva tänka sig att använda en e-hälsoapplikation för mindre åkommor. Andra patienter är starkt emot e-hälsa och de flesta av dem instämmer i att det är ett slöseri med skattepengar. En annan vanlig orsak emot e-hälsa är att patienter tycker att deras åkommor är för komplexa eller att de inte litar på att läkaren ger dem korrekt vård genom en applikation. / Technology is a big part of today's society. At this time more things and services become digitized, now even healthcare. This thesis will introduce you to e-health and how to digitize healthcare will affect the doctor-patient relationship and the trust issue that may occur. E-Health applications need to be user-friendly and easy to use. The user needs to feel comfortable and safe. To investigate the cross-channel user experience we compared the two different flows: in-person appointment and video conference. There are many different providers for e-health applications in Sweden, most popular are Kry and Min Doktor. This digitizing not only affects the patients, but the doctors are also equally involved. We questioned doctors about their approach towards assistance through an application. A questionnaire was done to gather information about the patient's relationship and usage of e-health applications. The questionnaire showed that there are some divided opinions regarding e-health applications. Some patients think that e-health applications will benefit society and may use an e-health application for minor complaints. Other patients are strongly against e-health, and most of them agree that it is a waste of tax money. Another common reason against e-health is that patients think that their complaints are too complex or that they do not trust the doctor to provide them the accurate assistance through an application.

Etiniai bendravimo aspektai tarp gydytojo ir paciento visuomet buvo ir išlieka viena svarbesnių visuomenės aukšto išsivystymo ir sąmoningumo moralinių aspektų. Faktoriai apibūdinantys paciento požiūrį į gydytoją lemia lygiavertį bendravimą tarp paciento ir gydytojo, o gydytojo sąmoningumo, žmogiškųjų sąvybių ir darbo kokybės gerinimas yra vienas iš prioritetinių sveikatos sistemos priežiūros uždavinių. Šiuolaikinės sveikatos priežiūros paslaugų teikimas turi būti atliekamas tokiame lygmenyje, kad nebūtų pacientų nusiskundimų gydytojais, o pastarieji nevengtų „rizikingų“ pacientų. Šiame darbe analizuojami faktoriai, turintys arba galintys turėti įtakos gydytojo ir paciento tarpusavio santykiams, pateikiamos rekomendacijos būtinių veiksnių ar faktorių kuriuos būtina įgyvendinti siekiant abipusiai naudingo gydytojo ir paciento bendravimo. Darbo tikslas - Įvertinti gydytojų nuomonę apie bendravimo su pacientais ypatumus ir etinius šio bendravimo aspektus gydytojo santykiuose su pacientu. Tyrimo metodai. 2011 metais „Gydytojų sąjungos“ organizuotose specializuotuose mokymose Druskininkų ligoninėje buvo įvykdyta anoniminė anketinė gydytojų apklausa, kurios metu buvo apklausta 2440 įvairių specialybių gydytojų. Anketiniai duomenys buvo apdoroti ir analizuojami naudojant statistinį duomenų analizės paketą SPSS 17.0. Hipotezės apie dviejų požymių nepriklausomumą buvo tikrinamos naudojant chi kvadrato (χ2) kriterijų (97). Rodiklių skirtumai laikyti statistiškai reikšmingais, kai p<0,05... [toliau žr. visą tekstą] / Ethical aspects of doctor-patient communication have always been and remain some of the major moral issues of high public development and awareness. The factors characterizing the patient's attitude to the doctor determine the equivalent communication between the patient and the physician, and physician’s awareness, human qualities and quality improvement is one of the priority health care challenges. Delivery of modern health care services must be performed at a level that would not be patient complaints about doctors, but they do not avoid "risky" patients. This paper analyzes the factors which have or may have an impact on doctor-patient relationships, presents recommendations on necessary factors or actions that need to be implemented in order to establish a mutually beneficial doctor-patient communication. Aim of the work: to evaluate doctors opinion regarding the doctors-patients communication peculiarity and ethical aspects of such communication in doctors relationships with patient. Methods of the research: the anonymous questionnaire survey of physicians was organised in Druskininkai hospital at 2011, on the specialized trainings organised by “Medical Association”. 2440 doctors of various specialties participated in the survey. The questionnaire data were processed and analyzed using the statistical data analysis package SPSS 17.0. Hypotheses about the independence of two signs were tested using the chi-square (χ2) test (97). Differences of indicators were considered... [to full text]

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

This thesis focuses on issues of communication between doctor and patient. After a brief introduction of communication in general, the theoretical part focuses on the specifics of doctor-patient communication. It then deals with different factors that influence communication and selected topics connected to communication. The last chapter summarizes several studies focusing on communication training of doctors and its effect. In the empirical part, the semi-structured interviews were used to explore opinions, attitudes and experiences of doctors concerning their communication with patients. The results suggest, that doctors perceive communication with patients as an important part of their work (even though they differ in the amount of importance they attribute to communication). In accordance with this finding is the fact, that the description of a "good doctor" and "good communication" were quite similar. Almost all respondents considered the undergraduate training in communication as useless, suggesting that the main reason may be the perceived unimportance of this subject at medical school. Some of the communication barriers generally seen by the patients were also seen as important by the doctors (such as time pressure or lack of privacy while consulting with patients), important...

Objetivos: verificar se indivíduos que acessam a Internet a utilizam para consultar informações sobre saúde e doenças; se o paciente, acessando a Internet muda sua atitude de paciente e se verifica mais ativo e mais participante do processo de decisão sobre sua saúde; e se, do ponto de vista do paciente, houve mudança na atitude do profissional médico frente ao maior uso da Internet por parte desse paciente. Metodologia: pesquisa com abordagem qualiquantitativa. A técnica empregada foi a do Discurso do Sujeito Coletivo – DSC, que possibilita a identificação e a construção de sujeitos e discursos coletivos distintos, por meio da análise de material individual e da extração das idéias centrais, compondo-se, com o conteúdo das idéias centrais semelhantes, discursos-síntese que expressam as representações sociais de uma coletividade. Para a coleta de dados foi publicado na Internet um questionário on-line que ficou disponível por três meses. Resultados: A maioria dos entrevistados acessa a Internet com freqüência de pelo menos uma vez por semana, a utiliza para consultar informações sobre saúde e doenças, informações relacionadas a casos vivenciados por eles ou por aqueles que os afetam diretamente (familiares) e, após alguma consulta médica, para verificar, entender ou complementar as informações oferecidas por seus médicos. Parte significativa dos entrevistados considera que as informações acessadas na Internet sobre saúde e doenças são úteis, utiliza tais informações para conversar com seus médicos em consultas posteriores e demonstra mudança de atitude, para uma postura mais participativa no processo de decisão sobre sua saúde. Conclusão: identificou-se uma diversidade de discursos coletivos distintos que, analisados e organizados em tipos e escalas, auxiliam na compreensão de questões tais como o tipo de participação do paciente durante a consulta médica, o grau de autonomia do paciente, os tipos de interação entre médico e paciente e os tipos de reações produzidas pelos profissionais médicos durante tal processo. / This research aims to verify whether individuals who have access the Internet use it to consult information on health and diseases; whether accessing the Internet changes the attitude of the patient and whether he becomes more active and more participant in the decision process about his health; and whether from the standpoint of the patient there were changes in the attitude of the medical professional as a consequence of the more intense use of the Internet by this patient. Procedure: research with quali-quantitative approach. The employed technique was the Speech of Collective Citizen - DSC, which allows the identification and construction of distinctive citizens and collective speeches through the analysis of individual material and the extration of the main ideas, composing, with the content of similar central ideas, speech-synthesis which express the social representations of a collective. For the data collection an on-line inquiry was published in the Internet and it was available for three months. Results: most of the interviewed individuals had frequent access to the Internet at least once a week, use it to consult information about health, diseases and information regarding medical cases experienced by them or by other people who affect them directly (relatives), and after some medical consultation, to verify, to understand or to complement the information offered by their doctors. A significant part of the interviewed ones consider that the information accessed in the Internet about health and diseases is useful, use such information to talk to their doctors in subsequent consultations and manifest an attitude change towards a participating position in the decision process about their own health. Conclusion: there is a diversity of distinctive collective speeches that, analyzed and organized in types and scales, assist in the understanding of questions such as the type of participation of the patient during the medical consultation, the degree of autonomy of the patient, the types of interaction between doctor and patient and the types of reactions produced for the medical professionals during such process.

O presente trabalho tem por escopo o estudo do princípio do respeito à autonomia do paciente à luz das recentes alterações trazidas pelo novo CEM Resolução do Conselho Federal de Medicina nº 1.931, de 17 de setembro de 2009 , que prestigia a autonomia do paciente e propõe um novo formato para a relação médico-paciente, impondo novas posturas tanto ao médico como ao paciente, e privilegia sua autodeterminação, ao mesmo tempo em que o obriga à tomada de decisões e à assunção de responsabilidade compartilhada quanto ao processo terapêutico. O objeto do estudo é a nova relação médico-paciente sob o enfoque da autonomia do último, ressaltando-se a responsabilidade compartilhada com o médico em relação à tomada de decisões atinentes ao processo terapêutico, às escolhas terapêuticas, bem como os limites e o conteúdo do poder de decidir e sua autonomia diante da enfermidade e da terminalidade da vida. Nesta hipótese, a reflexão concentra-se nos cuidados paliativos e na adoção de diretivas prévias estatuídas pelo paciente a serem observadas pelo médico e por eventual terceiro responsável por aquele, caso ele não possa manifestar sua vontade durante cuidados paliativos ou situações que revelem iminente terminalidade. / This proposal aims to study the principle of respect for patient autonomy in light of recent changes introduced by the new CEM Resolution of the Federal Medical Council nº 1931 of September 17, 2009 which honors the patients autonomy and proposes a new format for the doctor-patient relationship, imposing new attitudes to both the patient and physician, emphasizes self-determination and, at the same time that forces decision making and the assumption of shared responsibility as to the therapeutic process. The object of the study is the new doctor-patient relationship from the perspective of this autonomy, emphasizing shared responsibility with the physician regarding decisions pertaining to the therapeutic process, the therapeutic choices, and the limits of power and content and their autonomy to decide on the terminally ill and life. In this case, reflection focuses on palliative care and the adoption of policies laid by the previous patient to be seen by the doctor and by any third party responsible for that, if he can not express his desire for palliative care or situations that reveal impending finality.

Made available in DSpace on 2016-04-28T20:37:53Z (GMT). No. of bitstreams: 1 FATIMA APARECIDA GOMES MARTUCELLI.pdf: 201401 bytes, checksum: 2eb7ca77f03c21483bef1e957549620f (MD5) Previous issue date: 2011-10-20 / Conselho Nacional de Desenvolvimento Científico e Tecnológico / The present study about the doctor-patient relationship aims to use the bibliographic review to present a historical overview on the behaviors of the doctor-patient relationship, the quality of hearing and presence in times of pain and suffering from the beginning of medicine to the current days. Study analysis prove advances in medical and technology fields do not replace the doctor-patient relationship. Such relationship is taken as a first and essential source to adhere to treatments, support to face the obstacles arising out of acute and chronic illnesses. We also discuss the Fritz Perls Gestalt-therapy approach, focusing on the theoretical scope of the individual relationship to its environment. The main concepts of the Gestalt-therapy are: contact, contact roles, contact limits, support and awareness, and they are part of men s relationship to his environment, favoring an integrative presence in the self and the world. We believe such approach may provide facilitating instruments to improve the quality of presence, hearing and integrating understanding of the doctor-patient relationship. Buber s Dialogic Relationship inserts the dialogue in the between and the alternation of the encounter. It indicates a therapeutic attitude based on Inclusion, Presence and Commitment to the dialogue, as well as the conditions required to have a high-quality encounter. Those are suggestions for a better clinical practice of the doctor-patient relationship / Por meio desse estudo sobre a relação médico-paciente, pretende-se usar uma revisão bibliográfica para obter um panorama histórico desde os primórdios da medicina, com foco na atitude da relação médico-paciente e a qualidade da escuta e presença diante da dor e sofrimento, até a atualidade. A análise dos estudos demonstrou que os avanços da medicina e da tecnologia não substituem a relação médico-paciente, considerada uma fonte primeira e fundamental para adesão de tratamentos, suporte para o enfrentamento das adversidades advindas das doenças agudas e crônicas. Apresenta-se a abordagem Gestalt-terapia de Fritz Perls com escopo teórico cuja ênfase é na relação do indivíduo com o seu meio, e uma abordagem que visa a relação. Os conceitos principais da Gestalt-terapia são: contato, funções de contato, fronteira de contato, suporte e awareness, e os conceitos são compreendidos na relação do homem com o seu meio, favorecendo uma presença integrativa no seu ser e estar no mundo. Acredita-se que essa abordagem pode oferecer instrumentos facilitadores para a qualidade na presença, escuta e compreensão integrativa da relação médico-paciente. A Relação Dialógica de Buber insere o diálogo no entre e na alteridade do encontro. Apresenta uma Atitude terapêutica com base na Inclusão, Presença e Compromisso com o Diálogo, bem como condições necessárias para estabelecer um encontro de qualidade, caminhos sugeridos para uma melhor prática clínica na relação médico-paciente