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Compared to the general population, socially disadvantaged patients have higher rates of chronic illness and require more complex medical care. They also endorse higher levels of psychological distress and tend to engage in behavioral risk factors such as poor diet, physical inactivity, and smoking. These issues are particularly concerning given that this population tends to adhere less to medical recommendations, has limited access to health resources, and receives poorer treatment from providers. In an effort to address this disparity, The Affordable Care Act will expand health care access to an additional 23 million uninsured and 17 million underinsured Americans. However, simply expanding access to health care without examining and improving upon factors related to the physician-patient relationship would not fully address the health care needs of this population. This study sought to improve the quality of care received by socially disadvantaged patients by better understanding the role of race and gender on the physician-patient communication process and patient outcomes in a safety net primary care clinic. The study sample consisted of 330 low-income, uninsured/underinsured African American and White patients and 41 resident physicians. Overall, African American patients and their doctors and White doctors and their patients were viewed as engaging in the highest levels of communication. South Asian physicians, and male South Asian physicians in particular, had the lowest levels of communication and the patients of these providers experienced less improvement in their physical health. Patient education level influenced physicians’ perceptions of their patients to the extent that patients with higher educational levels were viewed as engaging in lower levels of communication. Last, indicators of a good physician-patient relationship were associated with higher levels of patient reported adherence. Practice implications and areas for future research are discussed.

The purpose of this study is to explore patients’ experiences and preferences concerning communication with primary care, as well as their attitude towards a future digital system to manage communication. The Swedish county councils and municipalities (SKL) is developing a new digital tool as a complement in the communication between patients and physicians, thus this research is a preliminary investigation of a larger approach. The research has been based on 20 semi-structured interviews with patients in ages between 21 and 86 from 13 different health care centers in Sweden. The interviews indicate that the communication between patients and physicians needs development in numerous ways and that the system used by the primary care contributes to negative outcomes in the communication. Patients’ attitudes towards a new digital system to manage communication were investigated and a majority was positive. The study’s results pointed out the importance of the physicians’ attitudes in the physician-patient communication, and brought some possible improvements to be done in the actual primary care system; as for example implementing new communication channels to allow an easier contact of patients with their health care center. The new communication tool was overall well received and even appeared to be a suitable solution for some of the problems discovered along the patients’ journey. The overall results obtained are positive and promising towards its implementation in Sweden.

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

This exploratory mixed-methods study examines the experiences of Spanish-speaking patients seeking non-urgent care in an emergency department setting. Emphasis is placed on understanding variables that influence patient satisfaction among this particular special patient population. This study draws from the explanatory models of illness and perspectives of clinically applied anthropology in contributing to the limited body of scholarly work that utilizes ethnographic approaches in clinical spaces to investigate how patients experience seeking emergency care services. Health-related deservingness, social determinants of health, and health literacy are used as complementary frameworks in understanding the unique experiences of these patients. The combination of methodological approaches employed in this study included: participant observation (120+ hours), patient shadowing (40 hours, N=10), administration of a modified patient satisfaction survey (N=100), semi-structured interviews (N=25), and retrospective analysis of existing patient satisfaction data from the research site. Quantitative findings generally indicate high degrees of satisfaction among this particular patient population, with statistically significant differences when compared to English-speaking patients. Quantitative data also indicate how modality of communication with this patient population is important to consider in terms of patient comprehension and perceived levels of care/attention demonstrated by hospital staff. The qualitative findings from this project highlight the similarities in explanatory models of illness between this patient population and emergency medical providers. Qualitative data additionally elucidates many of the barriers Spanish-speaking patients face when seeking out non-urgent care such as: limitations in exercising individual autonomy when communicating with medical staff, self-blame for not being able to effectively articulate their symptoms and concerns, as well as lack of clarity in understanding follow-up care plans. The results from this study call for addressing issues pertaining to health literacy, specifically at the end of the clinical encounter when follow-up care and treatment plans are explained to patients.

Backround. Based of my personal observations when employed as a pharmacist in a Saudi hospital it was clear that there were problems with medicine supply to outpatients. This thesis was designed to scientifically investigate the types of shortages, the reason(s) for such problems and potential solutions to the problem. Methods . This study was undertaken using a variety of experimental techniques to determine the views and perceptions of patients, pharmacists, physicians and administrative staff of the hospital under examination. To establish the scale of the problem: focus groups (n=25), structured questionnaires, structured interviews/meetings for health care professionals and a national survey (n=650) were the research tools used to objectively determine the relevant data. The data were analyzed by appropriate statistical methods. Results and Discussion That there was a real problem was quickly established in the data obtained from patients. A similar finding was made for each of the 'professional groups'. The central problem was one of shortages of medicines for prescriptions presented by outpatients. It was not a case the medicines were simply not available because they were never stocked but rather a simple shortage in the dispensary stock. It was established the lack of medicines was not due to central budget arrangements but involved prescribing quantities outside of the hospital guidelines which no degree of planning could accommodate. There was also the very unexpected finding that a prescription could be filled in a variety of hospital dispensaries as individuals could access more than one hospital or they could consult more than one physician for the same condition and obtain effectively double the supplies. Communications between the hospital and patients and the health care professionals could all be improved by perhaps increasing the knowledge of the patient about the correct use of medicines. Recommendations. A series of recommendations for future work is provided

Patient-centred care has become an important model for health-care delivery, especially in cancer care. The implementation of this model includes patient-centred communication between the clinician and his or her patient. However, most research on patient-centred communication focuses on the clinicians’ initiative: what clinicians should do and what information they should seek to elicit from patients. It is equally important to recognize what each individual patient can contribute about his or her unique perspective on the disease, its treatment, and the effects on what is important to this patient. This thesis reports the development of a system for analyzing over 1500 utterances made by patients in eight video-recorded oncology consultations at the British Columbia Cancer Agency, Vancouver Island Centre. The analysis distinguishes between biomedical information that the patient can provide and patient-centred information, which contributes the individual patient’s unique perspective on any aspect of his or her illness or treatment. The resulting analysis system includes detailed operational definitions with examples, a decision tree, and .eaf files in ELAN software for viewing and for recording decisions. Two psychometric tests demonstrated that the system is replicable: high inter-analyst reliability (90% agreement between independent analysts) on a random sample of the data set and cross-validation to the remainder of the data set. A supplemental idiographic analysis of each consultation illustrates the important role that patient-centred information played in these consultations. This system could be an important tool for teaching clinicians to recognize the individual information that patients can provide and its relevance to their care. / Graduate / 0992 / 0451 / 0350 / shealing@uvic.ca

Darbo tikslas. Atskleisti LSMU Kauno klinikų šeimos medicinos klinikoje dirbančių šeimos gydytojų ir besilankančių pacientų požiūrį į gydytojo medicininės konsultacijos tikslus ir pacientui skirto laiko panaudojimą apsilankymo metu.
Uždaviniai: 1.Atskleisti gydytojų ir pacientų požiūrį į medicininės konsultacijos tikslus; 2.Atskleisti gydytojų ir pacientų lūkesčius, susijusius su gydytojų/pacientų elgesiu konsultacijose; 3.Išryškinti pagrindinius veiksmingo gydytojo konsultacijos laiko panaudojimo kliuvinius; 4.Atskleisti ir aptarti šeimos gydytojo konsultacijai skirto laiko panaudojimo optimizavimo galimybes.
Tyrimo metodika. Tyrimo objektas – LSMU Kauno klinikų šeimos medicinos klinikos šeimos gydytojai ir klinikos pacientai. Tyrimas atliktas pagal kokybinio tyrimo metodologiją. Duomenys rinkti naudojant pusiau struktūruoto interviu metodą. Tyrimo analizė atlikta naudojant teminės analizės metodą.
Rezultatai. Tyrimo metu atsiskleidė, kad kreipdamiesi į šeimos gydytoją pacientai tikisi gauti gydymą ir pagalbą įveikiant ligą. Gydytojams pagrindinis tikslas yra suteikti pagalbą. Paaiškėjo, kad gydytojai tikisi iš pacientų bendradarbiavimo ir pasitikėjimo, o pacientai – dėmeso pacientui kaip asmeniui bei jo problemai ir galimybę gauti reikiamą informaciją. Atskleidėme, kad veiksmingo gydytojo konsultacijos laiko panaudojimo kliuvinių yra tarpasmeninėje gydytojo ir paciento sąveikoje bei netobuloje sveikatos priežiūros... [toliau žr. visą tekstą] / The aim of the study. Reveal general practitioners' and outpatients' attitude to aims of medical consultation and to outpatients' given time use effectiveness during visitation at Clinic of Family Medicine, LUHS Kaunas Clinics. Objectives: 1. Reveal general practitioners’ and outpatients’ attitude to aims of medical consultation; 2. Reveal general practitioners’ and outpatients’ expectations which are related to their behaviour during consultation. 3. Emphasize main obstacles of effective physician’s consultation. 4. Reveal and discuss the given time use optimization opportunities for general practitioners’ consultation. Methodology of the study. Object of the study – general practitioners and outpatients at Clinic of Family Medicine, LUHS Kaunas Clinics. The study was conducted by qualitative research methodology. The data was collected using a semi-structured interview method. The study was examined using thematic analysis. Results. The study revealed that patients who see a general practitioner expect to receive treatment and assistance to overcome a disease. The main aim of general practitioners is to give assistance to patients. It was identified that physicians expect cooperation and trust from patients while patients - attention to their complaints and to be treated as individual persons as well as to receive the necessary information. We have estimated that obstacles of the effective use of medical appointments are interpersonal physician-patient interaction and... [to full text]