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

Made available in DSpace on 2016-07-27T14:19:51Z (GMT). No. of bitstreams: 1 Ceres Regina Dias Fernandes.pdf: 381666 bytes, checksum: df04db79c06dc0f4eb6943aac484b29f (MD5) Previous issue date: 2005-06-29 / This study emphasizes the importance of the doctor-patient relationship as a group of multiple influences, besides being a predictive factor for the good results of the treatment and adherence of HIV patients to anti-retroviral medicines. It enhances the importance of analyzing the behavioral patterns presented in this relationship to make it possible for the patients to get a broader understanding of the treatment and cares they should take. The goals of the present study were to describe the doctor role when preparing the patient for the treatment and to identify the functions of these acts by analyzing the verbal reports and non-verbal behaviors found out in their different forms of occurrence. Four dyads doctor-patient, from a reference hospital for this type of treatment, participated in this research. This study has an exploratory character and it is an empiric investigation of the doctor-patient relationship, through actions that occur in an ambulatory context, a circumstance in which descriptive methodology is used to analyze this relationship as to the multiple influences in the ambulatory/hospital context. Among the results it was possible to highlight that the participant doctors guided the patients enlightening them about the risks of contamination by HIV via sexual intercourse without preservative and about the side effects of the medicines, and also informed them about the health services. The verbal and non-verbal behaviors that facilitate adherence, emitted from both doctors and patients, were investigated and the behavioral patterns presented in the doctor-patient relationship were also analyzed in their different functions. The results were discussed in terms of applied methodology. The data obtained in the present study alert to the importance of the doctor role when explaining to the patient the behaviors needed in the adherence to anti-retroviral medicines, as well as the benefits of this therapy to the quality of life of HIV positive patients. / Este trabalho enfatiza a importância da relação médico-paciente como um conjunto de múltiplas influências, além de ser um fator preditivo para os bons resultados no tratamento e adesão dos pacientes portadores do vírus HIV aos medicamentos antiretrovirais. Ressalta a importância de analisar os padrões comportamentais apresentados na relação para possibilitar que esses pacientes tenham maior compreensão sobre o tratamento e os cuidados que devem ter. Os objetivos deste estudo foram descrever a atuação do médico no preparo do paciente para o tratamento e em identificar as funções desta atuação a partir da análise dos relatos verbais e comportamentos não-verbais encontrados em suas diferentes formas de ocorrência. Participaram desta pesquisa quatro díades médico-paciente provenientes do ambulatório de um hospital de referência para este tipo de tratamento. Este estudo possui caráter exploratório e é uma investigação empírica da relação médico-paciente por meio das ações que ocorrem em contexto ambulatorial, circunstância em que se faz uso de metodologia descritiva para a análise desta relação no que diz respeito às múltiplas influências no contexto ambulatorial/hospitalar. Foram analisados os padrões comportamentais apresentados pelo médico durante o atendimento ao paciente em suas diferentes funções verbais: informar sobre a transmissão e a não transmissão do HIV, investigar comportamentos de risco, preparar para os efeitos dos medicamentos anti-retrovirais, entre outros. Dentre os resultados foi possível destacar ainda que os médicos participantes orientaram os pacientes sobre os riscos da contaminação pelo HIV por via sexual sem preservativo e sobre os efeitos colaterais dos medicamentos e os informaram sobre os serviços de saúde. Foram investigados os comportamentos verbais e não-verbais facilitadores de adesão, tanto dos médicos quanto dos pacientes, e também foram analisados os padrões comportamentais apresentados na relação médico-paciente em suas diferentes funções. Os resultados foram discutidos em termos de metodologia aplicada. Os dados do presente estudo alertam para a importância da atuação médica ao explicar ao paciente os comportamentos necessários na adesão ao tratamento com os anti-retrovirais, bem como os benefícios desta terapia para a qualidade de vida do portador de HIV.

Constitui objeto do presente trabalho o estudo da relação entre médico e paciente, com especial atenção ao problema da capacidade de que este último deve gozar quando instado a participar de atos e negócios que, referentes ao tratamento médico que lhe é proposto, possam repercutir sobre sua personalidade, especialmente considerada em seu aspectofísico. A fim de delimitar nossa pesquisa, consideraremos essa relação unicamente no âmbito dos tratamentos médicos que visem proporcionar ao paciente uma oportunidade de cura, isto é, de recondução ao estado anterior ao da doença, a qual constitui, por assim dizer, a causa final da relação entre médico e paciente. Portanto, não abordaremos, ao menos não profundamente, a relação havida entre o médico, enquanto pesquisador responsável por estudo ou ensaio clínico de novos medicamentos ou procedimentos, e o paciente, considerado sujeito de pesquisa. Tampouco trataremos da relação médico-paciente em sentido lato, assim consideradas as relações\' tipicamente de consumo, nas quais o paciente assume nitidamente a posição de contratante de serviços de saúde, geralmente prestados por hospitais ou clínicas das mais variadas especialidades médicas, entidades às quais perfeitamente se pode atribuir a definição de fornecedor de serviços, conforme o artigo 3° do Código de Defesa do Consumidor . / Sem resumo.

Made available in DSpace on 2016-04-26T20:22:51Z (GMT). No. of bitstreams: 1 Patricia Rizzo Tome.pdf: 956478 bytes, checksum: 8b7745d8862516a4b7bf24746a07067a (MD5) Previous issue date: 2014-04-22 / Conselho Nacional de Desenvolvimento Científico e Tecnológico / Our research aims to analyze the liability of the physician for injuries caused on account of errors made during his/her professional practice. These errors may result from their own acts or third parties ones, such as injuries caused by nurses working in compliance with doctors' demands. In this dissertation, the study of the contractual relationship of compromise established between doctor and patient is essential. Of special note here is the approach for full compliance of medical duties. This refers especially to the duty to provide full and clear information on an individual basis, considering each patient and his/her respective sickness. Thus, patients would be made fully aware about their particular situation and would be able to better decide whether they consent on performing surgeries or risky treatments / Nossa pesquisa tem por objetivo analisar a responsabilidade civil do médico por danos efetivamente causados em virtude de erros cometidos durante a atuação profissional. Erros estes que podem decorrer de atos próprios ou de atos de terceiros, como é o caso de danos ocasionados por enfermeiros que atuam em cumprimento de ordens médicas. Nesta dissertação, o estudo da relação contratual de meio estabelecida entre o médico e o paciente é fundamental. Destaca-se, sobretudo, o enfoque do cumprimento integral dos deveres médicos, em especial, o dever de prestar a informação completa e transparente de maneira individualizada, considerando cada paciente em relação a sua doença, para que as pessoas possam daí sim, amplamente esclarecidas, consentirem sobre a realização de cirurgias ou tratamentos de risco

O presente trabalho construiu-se a partir dos novos paradigmas que permeiam a relação médico-paciente. Se o profissional não mais se encontra em uma posição de superioridade (ao menos do ponto de vista fático) em face de seu paciente, que por sua vez está mais sensível em virtude das transformações oriundas da sociedade de massa, o elemento informação ganhou contornos importantíssimos, inserindo-se no núcleo principal da prestação, ao lado dos cuidados relativos à saúde propriamente ditos. Nesse contexto, foi proposta uma nova visão do dever de informar na relação médico-paciente, tratando a informação como uma obrigação autônoma, que gera de per se em caso de ausência ou vício responsabilização civil. A reparação, em tal perspectiva, surge a partir da violação do direito à liberdade: se a autodeterminação é um atributo da personalidade do paciente, a afronta a esse direito acarreta danos indenizáveis. Os limites do dever de informar, assim, desempenham relevante papel, pois demarcam a tênue linha que distingue a informação viciada (que ensejará responsabilização civil) daquela transmitida diligentemente. Assim, o conteúdo e a extensão da informação foram abordados, confrontando-se aspectos subjetivos, objetivos e buscando uma solução ao mesmo tempo viável (do ponto de vista prático), jurídica e justa. Como o trabalho trata essencialmente do dever de informar na relação médico-paciente e das consequências jurídicas derivadas do inadimplemento dessa obrigação, foram destrinchados todos os elementos que compõem esse complexo vínculo, passando por sua evolução histórica, pelos princípios, valores e direitos que permeiam e iluminam esta relação e, finalmente, pelos sujeitos que a compõem. Aspectos processuais atinentes à prova do cumprimento do dever de informação foram, ainda, examinados. Diversas questões polêmicas, tais como recusa de tratamento, direito a não saber, privilégio terapêutico, dentre outros, foram também debatidos. / This study is based on the new paradigms that permeate the doctor-patient relationship. If the medical professional no longer holds a superior position (at least from the factual point of view) vis a vis the patient who, on the other hand, is more aware to changes originating from doctor-patient relationship in the mass society, information availability has gained highly important contours, inserting itself into the core of services rendered, together with health care services themselves. In this context, this study proposes a new vision of the duty to inform in a doctor-patient relationship, treating information as an autonomous obligation, that, per se, results in liability in the case of its absence or flaws. The compensation, in such perspective, arises from breach of the right to autonomous choice: if self-determination is a characteristic of the patients personality, the disrespect of this right results in damages subject to indemnification. Therefore, the limits of the duty to inform perform a relevant role since they demarcate the fine line that distinguishes flawed information (that can incur liabilities) from that transmitted diligently. Thus, the contents and the extension of the information were addressed, comparing subjective and objective aspects and seeking a solution at the same time viable (from the practical viewpoint), legal and just. Since this study essentially deals with the duty to inform in the doctorpatient relationship and of the legal consequences derived from noncompliance of this duty, all factors that compose this complex link were carefully examined, reviewing its historical evolution, the principles, values and rights that permeate and elucidate this relationship and, finally, the parties involved. Legal evidential procedures related to fulfillment of the duty to inform were also examined. Various controversial topics such as the refusal to undergo treatment, the right to not be informed, therapeutic privilege, among others, were also discussed.

This qualitative research study examined the patient education experience from the point of view of health care professionals, namely doctors of chiropractic in the Greater Toronto Area practicing for up to ten years. Health care professionals’ views and beliefs of this important aspect of health care have not been well studied. Patient education is defined as, “the process by which patients learn or acquire knowledge about his/her health status or condition and may involve learning in the cognitive, affective, and/or psychomotor domains.” The study explored eight participants’ views on the nature of patient education in their early and current practices by examining their feelings, beliefs, and use of patient education, its role in their practices, as well as the perceptions of their roles as patient educators. Two semi-structured interviews were conducted with each of the participants. The transcribed interviews underwent detailed qualitative analysis to determine response trends and consensus. The key findings revealed that the participants felt that, while they were well prepared in their undergraduate curricula to diagnose and treat patients, they were not as well prepared to be effective patient educators when they entered practice. Early in their careers, they did not understand or appreciate patient education’s importance and value as a component of their practice. Over time, their beliefs and understanding of patient education changed and participants reported that with experience, they began to value patient education to a greater extent. Changing values reflected changing behaviours. For example, participants increased their time and efforts related to patient education with increased clinical experience. A variety of teaching aids were used with wall charts/posters, three dimensional anatomical models, printed materials and images from textbooks being among the most common. Most of the teaching described by the participants would be characterized as transmission with a one-way flow of information from the doctor to the patient. To a great extent, patient education involved speaking with individual patients. Participants reported encountering, throughout their careers, intrinsic and extrinsic barriers that interfered with the effectiveness of their patient education. The findings suggest that curricular planners for health care professional programs, and specifically for chiropractors, might consider developing content aimed at improving students’ patient education knowledge and skills.

This qualitative research study examined the patient education experience from the point of view of health care professionals, namely doctors of chiropractic in the Greater Toronto Area practicing for up to ten years. Health care professionals’ views and beliefs of this important aspect of health care have not been well studied. Patient education is defined as, “the process by which patients learn or acquire knowledge about his/her health status or condition and may involve learning in the cognitive, affective, and/or psychomotor domains.” The study explored eight participants’ views on the nature of patient education in their early and current practices by examining their feelings, beliefs, and use of patient education, its role in their practices, as well as the perceptions of their roles as patient educators. Two semi-structured interviews were conducted with each of the participants. The transcribed interviews underwent detailed qualitative analysis to determine response trends and consensus. The key findings revealed that the participants felt that, while they were well prepared in their undergraduate curricula to diagnose and treat patients, they were not as well prepared to be effective patient educators when they entered practice. Early in their careers, they did not understand or appreciate patient education’s importance and value as a component of their practice. Over time, their beliefs and understanding of patient education changed and participants reported that with experience, they began to value patient education to a greater extent. Changing values reflected changing behaviours. For example, participants increased their time and efforts related to patient education with increased clinical experience. A variety of teaching aids were used with wall charts/posters, three dimensional anatomical models, printed materials and images from textbooks being among the most common. Most of the teaching described by the participants would be characterized as transmission with a one-way flow of information from the doctor to the patient. To a great extent, patient education involved speaking with individual patients. Participants reported encountering, throughout their careers, intrinsic and extrinsic barriers that interfered with the effectiveness of their patient education. The findings suggest that curricular planners for health care professional programs, and specifically for chiropractors, might consider developing content aimed at improving students’ patient education knowledge and skills.