Abstract not available

Medical error and patient safety have become important issues. It is clear that medical error is more influenced by systemic factors rather than human characteristics. Communication patterns, in particular interruptive communication, maybe one of the systemic factors that contribute to the burden of medical error. Objective: An exploratory study to examine interruptive communication patterns of healthcare staff within an intensive care unit during ward rounds. Methods: The study was conducted in a tertiary hospital in Sydney, Australia. Nine participants were observed individually, for a total of 24 hours, using the Communication Observation Method (COM). The amount of time spent in conversation, the number of conversation initiating and number of turn-taking interruptions were recorded. Results: Participants averaged 75% [95% confidence interval 72.8-77.2] of their time in communication events during ward rounds. There were 345 conversation-initiating interruptions (C.I.I.) and 492 turn-taking interruptions (T.T.I.). C.I.I. accounted for 37% [95%CI 33.9-40.1] of total communication event time (5hr: 53min). T.T.I. accounted for 5.3% of total communication event time (56min). Conclusion: This is the first study to specifically examine turn-taking interruptions in a clinical setting. Staff in this intensive care unit spent the majority of their time in communication. Turn taking interruptions within conversations occurred at about the same frequency as conversation initiating interruptions, which have been the subject of earlier studies. These results suggest that the overall burden of interruptions in some settings may be significantly higher than previously suspected.

The most ordinary man or woman has means of knowledge concerning his own feelings and circumstances that immeasurably surpass those that anyone else can have.-John Stuart Mill, On Liberty / One feature that varies within competing conceptions of medical shared decision-making is how a patient's values are to be engaged by a physician. One detail that can be overlooked under "shared" decision-making is whether or not a physician ought (or be allowed) to attempt to persuade the patient to adopt particular health-related values. Some argue that it is incumbent on a physician to share her privileged understanding of medicine so as to help her patient embrace "better" values. This thesis argues that it is dangerous to patient autonomy for a physician to exert moral suasion on her patient to attempt to influence or change those values; the danger lies in the power imbalance between patients and physicians that seems inherent in medical encounters, and is exacerbated by the sick role. Thus, while a physician ought to help her patient articulate his health-related values, she ought not try to change them.

Thesis (PhD)--Macquarie University, Division of Linguistics & Psychology, Department of Linguistics, 2003. / Bibliography: p. 397-424. / Introduction -- Models of shared decision-making in medicine -- Framing the study -- The analytic goals of modelling agency -- The context of treatment decision-making in HIV -- Agency and alignment -- Study conclusions and implications. / The quality of doctor-patient communication has been shown to influence treatment uptake, adherence and effectiveness in HIV medicine and elsewhere. Increasingly, it is considered essential that doctors and patients jointly participate in decisions concerning treatment. There is a growing body of literature describing joint decisionmaking and suggesting guidelines for its practice. Few of these studies, however, relate their descriptions of medical decision-making as a social process to the ways in which patterns of verbal interaction realize or foreclose on joint decision-making. -- Dominant models of medical decision-making view shared decision-making as a midpoint between enlightened paternalism and informed choice. Based on a corpus of HIV consultations audio-recorded in Sydney in the late 1990s, this thesis argues that it can be better modelled as a particular type of social process, which differs across a number of dimensions from other styles of medical decision-making, specifiable as contextual parameters of meaning. The thesis then identifies ways in which specific discursive practices realize these contextual parameters. -- A major component of the thesis focuses on agency, and a model is presented in the form of a socio-semantic network, drawing on work by van Leeuwen (1996) and others, which relates a range of grammatical features, not only transitivity patterns, to ways of construing social agency. The thesis then considers the way in which doctors and patients mobilise these and other resources for bringing together potentially conflicting points of view in framing and articulating treatment decisions. Here I draw on notions of mutual alignment (e.g., Goffman 1981) but expand the analysis of what is aligned to account for speakers' implicit discourse orientation, as well as more overt markers. -- Findings emphasise the relationship between representing and enacting agentive roles; the importance of doctors and patients mutually projecting each other's voices; and the variable and iterative character of shared decision-making. The research demonstrates how doctors and patients negotiate a complex, interactionally and symbolically mediated agency, and shows that patients often take the lead in developing more collaborative decision-making practice. There are still institutionally and socially determined limits to the degree of control patients may exercise within the consultation, many of which are of course well founded. / Mode of access: World Wide Web. / xvii, 533, [22] p. ill

Thesis (Ph.D.)--University of Melbourne, Dept. of General Practice and Centre for Health and Society, 2007. / Typescript. Includes bibliographical references (leaves 252-278).

This dissertation explored mistrust through focus group discussions (study 1), responses to standardized laboratory vignettes (study 2), and survey questionnaires (study 3). In the first study, I found that African American community members (N=60) experienced perceived discrimination, medical mistrust, and poor communication in numerous and interrelated ways. For example, medical mistrust occurred when clinicians did not convey respect to patients, leaving patients to wonder whether their clinician's treatment was discriminatory or not. Based on these findings, I wanted to see whether these experiences of perceived discrimination and mistrust were related to other dimensions of Black experience, such as racial identity. I conducted a secondary analysis of data from a laboratory study (Somnath Saha, PI) in which 104 primary care patients viewed video-recorded, standardized vignettes depicting a cardiologist recommending heart bypass surgery to a patient diagnosed with angina and 3-vessel coronary artery disease. In this study, those who viewed a video of European American cardiologist-actors had lower physician mistrust and lower hypothetical likelihood of having bypass surgery compared to those who viewed the video of African American cardiologist-actors. However, racial centrality did not moderate the relationship between ethnicity of the cardiologist-actor and patients' decision making. The third study explored other dimensions of racial identity (e.g., unfavorable public regard for African Americans) and mistrust (e.g., medical mistrust), while also exploring their association with perceived healthcare discrimination among African American community members (N=210). In this study, perceived discrimination was positively associated with racial centrality, but not associated with unfavorable public regard. Perceived discrimination was also positively associated with medical mistrust and physician mistrust. Although racial centrality and unfavorable public regard were not significant moderators between perceived discrimination and the two dimensions of mistrust, they were positively associated with medical mistrust. Together, these studies provide a better understanding of African Americans' healthcare attitudes and experiences, particularly mistrust toward medical institutions and clinicians. For example, the association between racial centrality and perceived discrimination may suggest that past experience of discrimination in healthcare may influence a person to seek others who experience similar stressors, giving way to identifying more with her or his racial group. Racial centrality may influence a person's trust towards healthcare, prior to entering the doctor's office. However, once the person enters the doctor's office, racial centrality may play a less significant role the patient's trust towards her or his provider. These findings generated new questions to explore for future studies. For example, future studies should explore the relationship between racial centrality and African Americans' healthcare behavioral responses. In addition, the current studies only focused only on attitudes and perspectives; future studies should investigate how the construct medical mistrust may influence health-related outcomes such as adherence in race-discordant patient-provider relationships.

Thesis (M.A. (Communication Studies)) -- University of Limpopo, 2020 / Health communication is one of the interventions used to overcome health issues in society. Behavioural change is a process that relies on influence, and carefully designed messages about a desired outcome. These messages are captured from health communication interventions such as health communication campaigns about HIV/AIDS. This study empirically measured behavioural intention and followed the introduction of the health communication campaigns at the University of Limpopo (UL) campus amongst students from all faculties. In order to evaluate these campaigns, a positivist research paradigm was chosen, and the quantitative approach was used to measure and determine the relationship between the constructs of the Theory of Planned Behaviour (TPB). The constructs (or predictor variables) of the TPB model are deterministic of behavioural change. They work together to achieve change in behaviour, where the outcome variable is the behavioural intention. This study used the TPB model to guide the literature and methodology when it came to the formulation of questions for data collection. The target population sampled was aged between 18 and 28, and all the participants belonged to various schools across all faculties at the University of Limpopo. The researcher used of the Stratified random sampling method which is classified under probability sampling; 401 questionnaires were coded, and analysed. SPSS® version 25 was used to analyse the data. The results were-drawn descriptively and inferentially. This was done in order to define the relationship between the theory’s variables. The researcher used both Pearson Correlations and Regression Analysis to define the relationship between the variables. Descriptively, the majority of 148 (36.9%) participants strongly agreed while 174 (43.4%) agreed that they intended to participate in health communication campaigns in the future, as the predictor variable. Inferential findings showed that the behavioural intention variable amongst the students proved to be the one that contributed most towards behavioural change. The researcher suggests that further research should focus on message development. Health campaign messages should be developed that trigger intention, in order to achieve behavioural change for individuals so that they can ultimately participate in health campaigns.

The purpose of this study is to investigate in what ways cultural value differences between Alaskan Native clients and non-Native health professionals affect the communicating of "wellness" concepts. Specifically, this study focuses on possible difference in the cultural value orientation of "Man's Relationship to Health."

No description available.

As alterações ocorridas no ambiente de prestação de serviços médicos nos últimos anos são profundas. Como em outras áreas profissionais, a pressão por produtividade, o aumento do volume de informações, a interferência de novas tecnologias, a elevação do custo dos serviços e a concomitante redução do orçamento das fontes pagadoras causam um profundo impacto na relação entre o profissional e seu cliente, o paciente. Esta relação é fundamental para uma boa evolução do tratamento, e para a satisfação e recomendação dos serviços por parte do paciente. Diante do cenário de mudanças sem precedentes nessa delicada relação, a presente dissertação teve por objetivo apresentar formas de aprimorar a relação médico-paciente através da melhora da comunicação entre ambos durante os instantes em que ocorre a interação entre eles, por ocasião da consulta. Para tanto, realizou-se uma revisão teórica e um trabalho de campo exploratório. Na bibliografia consultada, foram apresentados alguns fatores com impacto negativo no atual exercício da profissão médica junto ao paciente, e sua importância foi discutida. A revisão teórica também explorou as expectativas dos pacientes quanto ao atendimento, e o impacto de tais expectativas na percepção do paciente sobre o serviço recebido e no seu comportamento após o atendimento. Com base nos artigos pesquisados, foram apresentados alguns conceitos importantes para a melhora desta relação e da comunicação entre médico e paciente. O trabalho de campo foi realizado por meio de uma pesquisa exploratória e qualitativa, que utilizou como método o estudo de caso único com confrontação teórica. A organização estudada foi o Instituto Dante Pazzanese de Cardiologia, e a unidade de análise estudada foi o processo de comunicação médico-paciente dentro do contexto da organização, e seu impacto na satisfação dos pacientes atendidos. As evidências foram colhidas paralelamente junto a um grupo de médicos residentes e um grupo de pacientes. Em seguida, cada grupo teve suas evidências analisadas individualmente. Foi também realizada a comparação das evidências colhidas de ambos os grupos com a revisão teórica, e identificação dos gaps. Verificou-se que embora o atendimento no Instituto Dante Pazzanese de Cardiologia seja muito bem avaliado, a maioria de seus pacientes menciona a existência de graves problemas em outros centros de atendimento, relacionados à falta de comunicação empática durante a interação médico-paciente, com importantes consequências. Os médicos residentes, por sua vez, mencionaram vários fatores estressores com impacto para médicos, pacientes e seus familiares. A pesquisa concluiu que o paciente se sente satisfeito quando se sente acolhido, quando o médico olha nos seus olhos e fala o seu nome, quando percebe o interesse dele por seu estado de saúde, recebe atenção e informações honestas - adequadas ao seu nível de compreensão. Os conceitos e propostas apresentados na revisão teórica, bem como as conclusões obtidas com este trabalho, podem contribuir para o desenvolvimento de estratégias e treinamentos práticos para os profissionais médicos desenvolverem uma abordagem mais empática com seus pacientes, aumentando o potencial terapêutico da interação. A pesquisa mostrou aplicação prática e impacto social, uma vez que corrobora para o efetivo aumento da intenção de adesão às recomendações médicas. / Changes that have taken place in the medical service environment in recent years are profound. As in other professional areas, the pressure for productivity, the increase in the volume of information, the interference of new technologies, the increase in the cost of services and the concomitant reduction of the budget of paying sources have an essential impact on the relationship between the professional and his client, the patient. This relationship is fundamental for a good evolution of the treatment, and the satisfaction and recommendation of the services by the patient. Given the unprecedented scenario of changes in this delicate relationship, the present dissertation aimed to present ways of improving the doctor-patient relationship through better communication between both during the moments in which the interaction between them occurs. For that, a theoretical review and exploratory fieldwork were carried out. In the bibliography researched, some factors in the current medical profession exercise with a negative impact on patients were presented, and their importance was discussed. The theoretical review also explored patients\' expectations regarding medical service, the impact of such expectations on the patient\'s perception of the service received, and their behavior after that. Based on the articles researched, we presented some important concepts for the improvement of this relationship and the communication between doctor and patient. The fieldwork was carried out through exploratory and qualitative research, which used a single case study method, with theoretical confrontation. The organization studied was Dante Pazzanese Institute of Cardiology, and the unit of analysis studied was the physician-patient communication process within the context of the organization, and its impact on the satisfaction of patients attended. Evidence was collected in parallel with a group of resident physicians and a group of patients. Then, each group had its evidence analyzed individually. The evidence collected from both groups were compared with the theoretical review, and gaps were identified. Although the medical care in Dante Pazzanese Institute of Cardiology is very well evaluated, most of its patients mention the existence of severe problems in other care centers, related to lack of empathic communication during doctor-patient interaction, with significant consequences. Resident physicians mentioned several stressors that had an impact on physicians, patients, and their families. The research concluded that the patient is satisfied when he feels welcomed, when the doctor looks into his eyes and speaks his name, when he realizes doctor\'s interest in his health, and receive honest information and attention - appropriate to his level of understanding. The concepts and proposals presented in the theoretical review, as well as the conclusions obtained with this work, can contribute to the development of strategies and practical training for medical professionals to develop a more empathic approach with their patients, increasing the therapeutic potential of the interaction. This research has practical applications and social impact, as it contributes to increase the intention to adhere to medical recommendations