This research study explores in general the nature of a private general medical practice [PGMP] and whether analysis of the PGMP as a social system can lead the Group Dynamics Practitioner towards developing interventions that will enhance group effectiveness in the PGMP support staff group. The main assumption is that, through the application of a framework of analysis based on that of G. C. Homans and the AGIL functional prerequisites developed by T. Parsons, a structured analysis of the external and internal variables that impact on the PGMP as a social system can be undertaken. The findings of the analysis would lead to the formulation of interventions that would improve the performance effectiveness of the PGMP as a social system. Following a two-questionnaire survey of 17 practices that provided demographic information as well as soft skills training needs, a single PGMP was identified for the case study. Data pertaining to the group as a social system were collected, and by using direct observation, content analysis and a sociometric test, the practice support staff sub-system, being the main focus of this research, could be analysed. By linking the findings to the elements of the framework of analysis, areas of ineffective group functioning could be identified and interventions suggested. This research indicates that the choice of soft skills is associated with the nature and size of the practice, as well as the dynamics of the sociometric patterns characteristic of the relations within the practice support staff subsystem; that while some practice support staff have preferences for sociometric task and socio-emotional relations outside their work clusters, these seem to serve as a buffer against clique forming, thus enhancing the function of integration within the social system as a whole; and that the physical practice layout, and the interaction dynamics that it creates, tend to hinder integration between the members of the practice support staff group, as a social subsystem.

The primary objective of this study was to analyze dyadic verbal interactions and to determine whether they were associated with the roles of the participants. These "interactions occurred in the chronic paediatric health care delivery system between parents of handicapped children and physicians and between those same parents and other members of the health team. Additional objectives of this research included testing of the reliability of the Sequential Analysis of Verbal Interaction (SAVI) instrument and its utility in the health care system. Clinical data were obtained during regularly scheduled appointments in the form of audio-taped interviews using 37 parent-professional 'and 37 parent-paraprofessional dyads. A six-minute sample was selected from each interview tape, coded at three-second intervals, transcribed into the class of communication behaviour and analyzed. Subsequent to data collection, reliability and utility of the SAVI instrument were examined and determined to be appropriate for this study. The major finding of the study was that parents of handicapped children used different verbal messages and behaviours than professionals and paraprofessionals. The communication pattern for all three groups, using Agazarian's (1968) model was cross-purpose. Under a proposed model, adapted from Agazarian's, the parents' pattern of communication was considered to approximate the problem-solving pattern more closely. The conclusion drawn from this exploratory study was that very little of a personal nature was occurring in interpersonal communication, which in turn hindered the development of a problem-solving pattern of communication. An important direction for further research would be the testing of the predominance of the cross-purpose pattern of communication using a larger and more homogenous sample of professionals and paraprofessionals. / Graduate and Postdoctoral Studies / Graduate

M.A. (Business Management) / With the raise of competition in the Gabonese health industry and increased costs, most health service providers in Gabon have become under pressure to deliver good service quality. This also relates to the military hospital in Libreville in Gabon striving to provide adequate health services to its patients. The cost for hospitals to attract patients through several means such as providing good service quality has become crucial. Patient loyalty and retention can have an important financial advantage for a hospital, thus it has become essential for hospitals to create a sustaining relationship with their patients. The question of assessing service quality presents itself. This study investigated service quality at a military hospital in Libreville in Gabon. It was the objective of this study to establish if there is a difference in how patients rate doctors and nurses on the service quality dimensions. This research was quantitative and descriptive in nature. Theory relating to service quality and patient satisfaction was provided. The population for the study consisted of patients who were at least 18 years old, males and females, who have experienced medical services and stayed over at the military hospital for at least one night. A self administered questionnaire was designed based on the theoretical literature illustrated in the study. The questionnaire assessed various elements that were identified through the literature review. The questionnaire was based on a set of statements linked to the literature theory, and a 7-point Likert scale which enabled respondents to choose from seven different alternatives ranging from strongly disagree to strongly agree. A number of statistical analysis techniques were undertaken to achieve the objectives of the study, such as factor analysis. The conclusion and findings of the research assisted in explaining the objectives of the study and the results of the statistical analysis were found to reject the hypotheses that there is no significant difference in how patients rate the reliability, responsiveness, assurance and empathy of doctors and nurses and to reject the hypothesis that patients do not have a positive perception of the tangible aspects of a military hospital in Libreville, Gabon. In terms of the doctors’ services, patients felt a need for more privacy in terms of the confidentiality of their treatment, a need for more individual attention, a need to be heard, and to trust doctors. Therefore such needs could be addressed through improved compassion, communication and understanding of doctors during the diagnosis of the problem. The feeling expressed was that doctors should pay more attention to patients’ problems and share with them their experience. Doctors at the military hospital should develop more work ethic where patients’ records and cases should never be discussed with anyone without patients’ permission. The military hospital should employ highly trained and qualified doctors to address the trust issue with patients. Lastly, consultation time may need to be reviewed to add some extra time to better address patients’ needs during their consultation with doctors. In terms of the services delivered by nurses towards patients, the latter were of the opinion that there was a need for more individual attention from nurses. Such individual attention could include greater information sharing when a patient is treated, friendlier communication to install greater trust and respect. Such needs could be addressed through improved patience, compassion and understanding by nurses during their dealings with patients. Nurses should also develop more work ethic regarding patients’ records, and cases should never be discussed with anyone without their permission. Officials in the hospital should hire highly trained and qualified nurses to address the issue of trust in patients and consultation time may need to be reviewed to add some extra time to better address patients’ needs during their dealings with nurses.

This study examined patient behavior in the emergency department and trained physicians to respond to that behavior. It demonstrated that physicians can increase patient satisfaction by responding to the thoughts, feelings and actions which the patients are experiencing. The literature provided variables for patient satisfaction and physician counseling techniques. These variables provided the base for a Patient Satisfaction Inventory (PSI) and a training module for the physicians. Patient behavior was evaluated through the clinical Thinking, Feeling and Acting interview, given to patients, before and after each patient was seen by the physician. This information was then provided to the physicians. For half of the patients, physicians responded according to patients thinking. feeling and acting components of behavior. For the others, physicians received no information other than the generic summary card summarizing thoughts, feelings and actions of the patients as a group. The PSI was completed by all patients after discharge from the emergency department. Pre and post training scores were compared on the PSI to determine if there was a difference in patient satisfaction. An increase in patient satisfaction was experienced after the physicians were trained to purposefully respond to patient behavior. On the PSI, patients perceived greater compassion, understood and communicated with the physician better, and perceived more accurate diagnoses and treatments. These increases in patient satisfaction were significant (p < .01) regardless of whether the physician had the actual patient information from the clinical TF A interview or just the generic summary. The physicians seemed to become sensitized to the patients needs by organizing the data they already had about the patients. Implications for the counseling field and training physicians to better serve their patients were discussed. / Ed. D.

The purpose of this study was to examine the premise that a stimulus to the physician in the form of a written reminder would aid the physician in influencing his patient in compliance with a therapeutic diet. Compliance outcome related to the physician-patient relationship and the quality and skills displayed by the dietitian were analyzed. A short questionnaire was designed to obtain information on types of diet and whether the physician had mentioned diet during a visit to his office. Likert-type responses to attitude statements related to physician-patient relationship, compliance, skills and knowledge of the dietitian, and patient understanding of reason for dietary restrictions were included. The questionnaire was mailed to previously hospitalized patients who had been instructed on a therapeutic diet. A random sample of their physicians were mailed letters to remind them of their patients' diet. The results indicated that there was a higher rate of initiation of discussion of diet with the patient among physicians whose patients were on simple diet modification when the physician had received a stimulus. Physician inquiry concerning the patient's diet was identical whether physicians had received a stimulus or not among patients with complex diet modification. The physician-patient relationship was perceived more positively by the complex diet group whose physician had received a stimulus than by the complex diet group whose physicians had not received the stimulus. The dietitian was perceived as being more knowledgeable and skilled by the patients with complex diets than by patients with simple diet modifications. / M.S.

The research is situated in a busy intensive care unit in a tertiary referral centre university hospital in Scotland. To date no research appears to have been done with a focus on handover in intensive care, across the professions involved, examining how handover is enacted. This study makes an original contribution to the practical and pedagogical aspects of handover in intensive care both in terms of the methodology used and also in terms of its findings. In order to study handover a mixed methods approach has been adopted and fieldwork has been done in the ethnographic mode. Data has been audio recorded and transcribed and analysed to explore the clinical handovers of patients by doctors and nurses in this intensive care unit. Texts of both handover, and the artefacts involved, are reviewed. Material from journals, books, lectures and websites, including those for health care professionals, patients and relatives, and those in industry are explicated. This study explores the role of material artefacts and texts, such as the intensive care-based electronic patient record, the whiteboards in the doctors’ office, and in the ward, in the enactment of handover. Through analysis of the data I explore some of the entanglements and ontologies of handover and the multiple things of healthcare: patients, information, equipment, activities, texts, ideas, diseases, staff, diagnoses, illnesses, floating texts, responsibility, a plan, a family. The doing of handover is framed theoretically through the empirical philosophy of Mol’s identification of multiple ontologies in clinical practice (Mol, 2002). Each chapter is prefaced by a poem, each of which has relevant socio-material elements embedded in it. The significance of the findings of the research for both patient care and clinical education and learning is surfaced.

No description available.

Thesis (M.A.)--University of Stellenbosch, 2000. / ENGLISH ABSTRACT: This paper examines aspects of power within the physicianpatient relationship. The historical development of the physician-patient relationship is briefly reviewed and some of the complexities of the relationship highlighted. It is shown that, historically, there is no imperative for the physician to consider only the interests of the patient and it has always been acceptable to consider the interests of a third party, such as the State or an employer - essentially the interests of whoever is paying the physician. The classical sources of power are then considered. These sources include legitimate power, coercive power, information power, reward power, expert power, referent power, economic power, indirect power, associative power, group power, resource power and gender power. Other approaches to power are also considered such as principle-centred power as described by Covey, power relationships as explained by Foucault, the power experience as described by McClelland and an analysis of power as expounded by Morriss. The various sources of power are then considered specifically within the physician-patient relationship to determine: if this particular type of power is operative in the physicianpatient relationship, and if so if it operates primarily to the advantage of the physician or the advantage of the patient. A simple method of quantifying power is proposed. Each form of power operative in the physician-patient relationship is then considered and graphically depicted in the form of a bar chart. Each form of power is shown as a bar and bars are added to the chart to 'build up' an argument which demonstrates the extent of the power disparity between physician and patient. It is clearly demonstrated that all forms of power operate to the advantage of the physician and in those rare circumstances where the patient is able to mobilize power to his/her advantage, the physician quickly calls on other sources of power to re-establish the usual, comfortable, power distance. Forms of abuse of power are mentioned. Finally, the ethical consequences of the power disparity are briefly considered. Concern is expressed that the power disparity exists at all but this is offset by the apparent need for society to empower physicians. Conversely, consideration is given to various societal developments which are intended to disempower physicians, particularly at the level of the general practitioner. Various suggestions are made as to how the power relationships will develop in future with or without conscious effort by the profession to change the relationship. / AFRIKAANSE OPSOMMING: Hierdie voordrag ondersoek aspekte van mag in die verwantskap tussen pasiënt en geneesheer. Die historiese ontwikkeling van die verwantskap word kortliks hersien en 'n kort beskrywing van die ingewikkeldheid van die verwantskap word uitgelig. Vanuit 'n historiese oogpunt, word 'n geneesheer nie verplig om alleenlik na die belange van die pasiënt om te sien nie en was dit nog altyd aanvaarbaar om die belange van 'n derde party soos die Staat of 'n werkgewer se belange to oorweeg - hoofsaaklik die belange van wie ookal die geneesheer moet betaal. Die tradisionele bronne van mag word oorweeg. Hierdie bronne sluit in: wetlike mag of 'gesag', die mag om te kan dwing, inligtingsmag, vergoedingsmag, deskundigheidsmag, verwysingsmag, ekonomiesemag, indirektemag, vereeningingsmag, groepsmag, bronnemag en gelslagsmag. Alternatiewe benaderings word ook voorgelê, naamlik die beginsel van etiese mag soos deur Covey beskryf, krag in menslike verhoudings soos deur Foucault, die ondervinding van krag soos beskryf deur McClelland en 'n ontleding van krag soos deur Morriss verduidelik. Hierdie verskillende mag/gesagsbronne word spesifiek met betrekking tot die geneesheer-pasiënt verhouding uiteengesit om te besluit: of hierdie tipe mag aktief is tussen geneesheer en pasiënt, en indien wel, werk dit tot die voordeel van die geneesheer of die pasiënt. 'n Eenvoudige sisteem vir die meting van mag/gesag word voorgestel. Die bronne word individueeloorweeg en gemeet en die resultaat in 'n grafiese voorstelling voorgelê op so 'n wyse dat 'n argument daardeur 'opgebou' word om die verskille van van mag/gesag tussen geneesheer en pasiënt uit te wys. Dit word duidelik uiteengesit dat alle vorms van mag/gesag ten gunste van die geneesheer werk. Kommer is getoon dat hierdie magsverskil werklik bestaan, asook die snaakse teenstelling dat die gemeenskap wil eintlik die geneesheer in "n magsposiesie plaas. Die etiese gevolge van hierdie ongebalanseerde verwantskap, asook die moontlikheid van wangebruik van hierdie mag word ook genoem. Verskillende gemeenskaplike ontwikkelinge wat die mag van die geneesheer wil wegneem word geidentifiseer, meestalop die vlak van die algmene praktisyn. Verskeie voorstelle vir toekomstige ontwikkeling van die verwantskap word voorgelê, met of sonder spesifieke pogings van die professie om die verwantskap te verbeter.

The patient's failure to cooperate effectively in the patient/physician (patient and physician) interaction has been shown to be a problem of significant magnitude. In the present study, an attempt was made to identify specific, patient behaviors which might be related to physician judgment of a good patient and progress of treatment. A checklist of 37 behaviors was compiled. A series of 100 patients was observed during their interaction with physicians and occurrences of behaviors from the checklist were noted by an experimenter. Physicians also indicated whether the patient was considered to be a good patient and whether treatment was progressing as expected. For every third patient, physicians noted the occurrence of behaviors from the checklist. An association was found between some behaviors from the checklist and the physicians' judgment. There was also shown to be a difference in the ability of the experimenter and the physicians involved to detect these behaviors.

A thesis submitted for the degree of Doctor of Philosophy in the Faculty of Humanities, University of the Witwatersrand, 2017 / This study explores the role of the doctor-patient relationship in the management of diabetes in South Africa. The originality of this study lies in the unique manner in which the topic is approached from an explicit theoretical perspective as well as the context in which it is studied. It takes into account the biomedical aims of diabetes management as well as the socio-cultural context of the environment in which communication occurs. Diabetes Mellitus is a chronic disease of lifestyle (CDL) and one of the most prevalent chronic diseases, both globally and within South Africa. In South Africa, although statistics vary across provinces and within different demographic and socio-economic groups, it is estimated that about 5.5% of the population over the age of 30 years, has diabetes. The disease has a significant impact on morbidity and mortality in the country, as well as on socio-economic development. The need to improve diabetes education and awareness, in addition to the need to address patient adherence to management plans and the prevention of complications, are vital in order to effectively manage this rising epidemic. Current management of diabetes favours an individualised approach to risk reduction. This involves patient adherence to a negotiated (between doctor and patient) management plan, as well as modifications in the patient’s lifestyle behaviours. International literature on adherence to the management plans of all CDLs suggests that there are many challenges. Furthermore, most studies have shown that there are shared common barriers inherent to all chronic diseases, where the complexity and chronicity of treatment are major factors in adherence. Despite the large number of studies and the identification of many influencing factors, few direct and replicable causal links to adherence have been found. Models of adherence from other chronic diseases in South Africa have highlighted the importance of patient motivation to change behaviour as being linked to their perceptions and beliefs, formed by the attitudes of those with whom they interact. A review of the literature on health communication in various fields of medicine identifies the need for a firm perspective and justification of the methodology employed in the study. Various theoretical stances are examined but it is ultimately the interaction between doctor and patient within the sociocultural context of the consultation that is seen to be most relevant. A social constructionist perspective is justified as the basis from which a disease such as diabetes, which requires complex therapeutic manipulation and lifestyle adaptations, can be studied. A brief overview of medical education is also discussed as it pertains particularly to the teaching of communication skills and behaviours. This becomes relevant as it is medical training that ultimately informs clinical practice. In recent years, medical education has been called upon to be more socially relevant and incorporate a multitude of supporting competencies into training. These models are described and interrogated with relevance to the study aims. The research was conducted in the province of KwaZulu-Natal (KZN) in South Africa within the diabetes clinics of two district level public health care institutions; one was located in the eThekwini metropolitan area (Durban) and the second at a rural site in northern KZN. These hospitals were purposively selected because of their contrasting locations, reflecting diverse socio-economic, ethnic, racial and language groups, thus providing a rich set of data. In keeping with the social constructionist perspective of the study, natural consultations at both sites were the primary source of data aimed to focus on the communication between doctor and patient. A total of 24 routine diabetes follow-up consultations provided the data source. Consultations between patients and doctors were audio- and video-recorded and ethnographic observations were made by the researcher, who was an observer in all consultations. All consultations were transcribed, translated into English if necessary, and analysed using elements of conversational analysis transcription conventions. In order to understand the contextual environment of the study, ethnographic observations made by the researcher during the consultations and other site visits are also included in the data set. These observations are presented and contrasted with the experiences of doctors and patients as explored in interviews and focus group discussions at each site. Participants were asked to comment on their experience of their clinical care as well as the interaction with their doctor and their ability to manage their diabetes. By using multiple data sources and contrasting the findings, the study provides a robust framework from where communication in diabetes can be examined. By analysing the data from a socio-constructionist viewpoint it became evident that the relationship between doctor and patient was a strong influential factor on disease management. Furthermore, the manner in which various communication behaviours were interpreted was seen to be able to transcend the superficial socio-cultural environment should other interpersonal factors mitigate the relationship. Not only was the process by which communication content delivered important, but also the underlying attitudes, past experiences and broader context of the consultation. If patients and doctors found themselves in the position to internalise the behaviours experienced in the consultation, their feelings, ideas and beliefs towards one another and diabetes was seen to change. Over time, it was suggested that these new attitudes would feedback either positively or negatively on future interactions. This study also showed how cultural norms cannot be part of a checklist but that they are dynamic over time and are influenced by a multitude of factors, including past experiences and mutual respect, which need to be understood from an interactional and relational perspective. A new model that incorporates existing knowledge coupled with integration of clinical, scientific diabetes management and the art of communication is also described. The findings from this study should be used to guide and inform clinical practice in order to improve health outcomes for those living with diabetes. By extension, they should also be used to inform medical education models where communication is being incorporated into clinical skills training. As was found by observing and analysing clinical practice behaviours for the purpose of this study, the author believes that by internalising experiences, students may be able to forms new ideas and attitudes towards communication which will enhance their clinical practice. The methods utilised in this study have also highlighted the fact that previous methods have not been sensitive enough to the human dynamics that occur in health communication in diabetes and future research should be developed with a strong theoretical perspective that guides an appropriate methodological approach. This study depicts the pivotal role communication plays within each unique consultation and how the manner in which the interaction is perceived and interpreted will have a strong influence on behavioural decisions. However, it is not merely the words that are spoken or the language in which they are spoken but rather the internalisation and adaptation to the context that will ultimately will guide behavioural change. / XL2018