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À partir de deux enquêtes au sein d’établissements pour personnes âgées dépendantes, une ethnographie de la relation soignant-soigné tente de décrypter la cinétique relationnelle durant l’acte de la toilette. Loin de l’évidence, le refus exprimé parfois violemment par des personnes atteintes de maladie d’Alzheimer, est ressenti par les équipes comme une offense à l’aide proposée. Pourtant ce geste quotidien de bien-être et de confort, par sa fonction de modelage et d’apprivoisement corporel devient un espace de communication sensible permettant de renouer un lien identitaire en cours d’amoindrissement. La présente recherche propose une analyse sur les formes de contractualisation relationnelle des intimes en situation de maladie et d’accompagnement. Dégageant les influences sécuritaires d’une organisation médico-sociale, le temps de la toilette devient un soin protégé relevant d’un espace transitionnel. L’étude particulière d’un soin de toilette permettra de comprendre les processus relationnels dans le temps et l’espace à partir du travail des émotions. L’intime s’intersubjective dans des présences jusqu’au bout de la vie, interrogeant des interactions de reconnaissances mutuelles en mouvement.La méthodologique adoptée traduit ce parcours aux frontières des intimes d’un sujet et d’une démarche dans un contexte de configuration gérontologique. / From two surveys in institutions for the elderly, an ethnography of the doctor-patient relationship attempts to decipher the relational dynamic during the act of personal hygiene for the patient. Not at all obvious, the sometimes violent refusal from people with Alzheimer's disease, is interpreted as offensive to the proposed care. Yet this daily gesture of care-giving and comfort by the creation of familiarity and trust becomes a moment of communication that can strengthen a weakening bond.This research presents an analysis of the types of relationships in the personal context of the disease and of accompaniment. Setting aside the safety imperatives of a medico-social organization, the moment of personal hygiene is a priviledged transistional act. This particular approach to care-giving in personal hygiene can, over time, identify the relational processes from an emotional perspective. The intimate inter-subjectivity lasting until the end of life creating a dialogue of mutual respect and acknowledgement.An appropriate methodology traces this journey to the beginnings of intimacy, a topic and an approach in a context of a gerontological structure.

xii, 163 p. / The principle of respect for autonomy has been the center of gravity for the doctor-patient relationship for forty years, replacing the previous defining concept of physician paternalism. In this work, I seek to displace respect for patient autonomy with narrative and phronesis as the skills that must be mastered by the physician to engender a successful therapeutic clinical relationship. Chapter I reviews the current state of affairs in the philosophy of medicine and the doctor-patient relationship and explains how and why autonomy has become so central to physicians' understanding of how to conduct a clinical encounter with a patient. Chapter II argues that "respect for autonomy," while remaining a valid rule to be considered in some clinical relationships, cannot be the central concept that defines the relationship both because it fails to describe accurately human selfhood and also because it empirically lacks universal applicability--many humans, and most seriously ill patients, actually lack autonomy. Shared decision making, an autonomy-based model of the doctor-patient relationship, suffers from this critique of autonomy as well as its own shortcomings in that it maintains a strict fact/value distinction that is untenable. Chapter III introduces narrative philosophy and its extrapolation, narrative medicine, as a possible alternative to an autonomy model of care. I defend a narrative view of selfhood, while recognizing that even if we are in some sense narratively constituted, this still leaves many questions regarding the relationship between story and self, particularly in a clinical encounter. In Chapter IV, I seek to limit the claims of narrative by arguing that story and self can never be fully equated and that narrative must be understood as demonstrating alterity rather than eliminating it. In Chapter V, a new conception of the physician's role in the doctor-patient relationship is presented, combining phronesis, or practical wisdom, with narrative skill in four aspects of the clinical encounter: diagnosis, treatment, assistance in medical decision making, and emotional support of the patient. / Committee in charge: Naomi Zack， Chairperson； Cheyney Ryan， Member； Mark Johnson， Member； Mary Wood， Outside Member

The purpose of this study was to investigate the attitudes and treatment knowledge of medical student professionals regarding rape victims. In addition to generating normative data for a population which, as a function of their vocation may come in contact with victims, comparisons were made between a sample of those beginning their medical education process and those at the end of training in order to measure change in treatment knowledge and attitudes towards rape victims which occur during medical school. Also investigated were differences which exist in the attitude and treatment knowledge measures for rape victims compared to other emergency room patient populations, and the effect of gender of the physician upon those measures. A final element investigated the physicians' perceptions of a "real" rape as it relates to those measures.

The medical practice today requires an open and frank dialogue between the two poles of the relationship: physician and patient. This dialogue is the main form and source of information for the patient in treatment. The relationship between the doctor and no matter which level of attention requires more care, attention and ethics. In obstetrics, the medical-mother-fetus relationship is unique due to the complete physiological dependence of the fetus towards his/her mother. Moreover, both are considered patients by the obstetrician. All the above should be kept in mind to undertake seriously one of the first procedures to compose a true committed physician-patient relationship. Furthermore the patient needs always to be informed of the reasons of being hospitalized. This information should include: the most usual course of the process of health and disease, the possible diagnostic and therapeutic procedures that will be instituted in the case and the reasonable alternative procedures. It is highly important to inform the patients about their rights and queries, in a way that would strengthen their autonomy. The objective of this dissertation is to understand the perception of women wards at the University Hospital of Santa Maria (HUSM), about the quality and adequacy of information provided to them during their stay. Moreover, this study seeks to under their stand and their knowledge and believes about the process of health/disease. This study was designed as both: quantitative research and qualitative research. Therefore, the following research question was used to construct this dissertation: what is the vision/perception of patients admitted in the second floor of HUSM on the quality of information on the process of health-disease by professionals who care for them? / A atividade médica hoje requer diálogo aberto e franco entre os dois polos do relacionamento: médico e paciente. Esse diálogo é então a principal forma e fonte de informação para o paciente em tratamento. Tendo em mente isso se deve, seriamente, realizar um dos primeiros procedimentos a compor uma relação médico-paciente compromissada e veraz: a paciente precisa ser esclarecida dos motivos pelos quais está sendo internado, qual o desenrolar mais habitual do seu processo de saúde-doença, quais os possíveis procedimentos diagnósticos e terapêuticos que serão instituídos no caso e sobre os procedimentos alternativos cabíveis. Sobremaneira deve ser orientado, da mesma forma, sobre seus direitos e deveres, sobre as dúvidas que apresenta, num enfoque fortalecedor de sua autonomia. O objetivo dessa dissertação é apresentar, sob o ponto de vista das mulheres que estão em tratamento ginecológico ou obstétrico no segundo andar do Hospital Universitário de Santa Maria (HUSM), a qualidade e adequação das informações prestadas a elas durante a sua internação e o que sabem e como percebem seu processo de saúde-doença pelos profissionais que as assistem. O presente estudo foi realizado por meio da coleta de informações que preencheram dois requisitos: a realização de uma pesquisa quantitativa e uma pesquisa qualitativa. Na parte quantitativa da pesquisa 399 pacientes aceitaram responder a um questionário fechado e posteriormente foram dividas em três grupos para apresentação e analise dos resultados. Na parte qualitativa da pesquisa dez mulheres aceitaram ser entrevistadas. Com os dados e resultados das duas partes da pesquisa observa-se que houve falhas na relação médico-paciente, com erros principalmente no diálogo do médico para com a paciente. O médico falta ao dar informações e atenção devida à paciente. A paciente tem dúvidas, deseja saber mais e queixa-se da indisponibilidade médica em conversar. Mesmo internada, em instituição hospital universitária, há pacientes que não sabem o diagnóstico, não participam da decisão de tratamento, não têm autonomia.

It has been well established, in the literature, the association between low health literacy rates and poor health outcomes. With the increase of technology dependence, more people are using the internet to look up health information. Research has shown that shared decision making between providers and patients can improve patients' health outcomes. This research aims to examine whether electronic health (eHealth) literacy impacts patient-provider relationships. This research will also examine how geography specifically state residency impacts eHealth literacy rates. Data collected from a national sampling of online health and medical information users who participated in the Study of Health and Medical Information in Cyberspace (N=710) is used to construct structural equation models from SPSS AMOS v. 20.0. After path analysis, the results shown that white males with higher education were more likely to have higher eHealth literacy rates and that eHealth literacy rates are associated with better self-care, higher patient satisfaction and increased trust in provider. Also, state residency does not have an impact on eHealth literacy rates. eHealth literacy will be significant in patient-provider relationships. Program development should be established on focusing on eHealth literacy across the lifespan. Also, it will be important to review federal policy on technology disbursements in order to achieve national goals on eHealth literacy rates.