While insulin omission has been found to be a common behavior in those with type I diabetes, it has been primarily studied within the context of disordered eating behavior. Previous research supports medical providers and patients lack of comfort in discussing insulin omission. This study was designed to answer two questions. Why do young adult college students with type I diabetes omit insulin? and what factors facilitate and act as barriers to open communication regarding insulin omission in the patient-provider interaction. A total 13 (10 females, 3 males) college students completed a qualitative interview focused on insulin omission and communication of this behavior to medical providers, and 11 of the 13 completed a modified EAT-26. Using consensual qualitative research methods CQR (Hill, Thompson, & Williams, 1997), domains that emerged were reasons for insulin, predominant reason for insulin omission, motivators to give insulin as prescribed (i.e., adhere), overall communication of insulin omission to medical providers, and factors facilitating and barriers inhibiting communication regarding insulin omission to medical providers. Typical reasons for insulin omission included forgetting or delaying and forgetting, worrying about hypoglycemia and its social implications, being in situations where limited access to food/medical supplies, planning to be physically active, or being unsure of carbohydrate count in food. Insulin omission as a weight loss behavior was not reported by any of the participants during the interviews and all denied using insulin as a way to control their weight or shape on the EAT-26. Clinical implications and future research directions are discussed. / Department of Counseling Psychology and Guidance Services

The General Medical Council has emphasised the importance of teaching communication skills to medical undergraduates. A two year follow-up study was undertaken, therefore, to assess the possible short-term and long-term benefits of the participation of cancer patients in communication skills training. Two hundred and forty nine third year students in the academic years 1992-1993 and 1993-94 received communication skills training (9 hours) in small groups: half the students were taught with patients who had cancer and the other half with patients who had another diagnosis. Each student was required to make a videotaped interview. These recorded interviews were evaluated by a trained rater. In addition, students completed a pre-course and post-course Attitude Questionnaire to assess their knowledge of and attitudes toward cancer and its management. Of the 1992-93 cohort of third year students, a sample of 54 students participated in the follow-up evaluation in fifth year. Fifty four Attitude Questionnaires were satisfactorily completed. All of the 54 students made a videotaped interview with a gynaecological cancer patient in a standardised setting. Each interview was rated independently by two raters. Analyses of the third year video recordings revealed differences in interview performance between the two groups. Following the course, between-group analyses and with-in group analyses identified various attitudinal differences. Analyses of the fifth year video recordings revealed that the interview performance of both groups had improved since their third year. However, those students originally taught with cancer patients were more likely to assess the impact of the symptoms on the patient's life. In addition, between-group and within-group analyses of the attitudinal data showed that both groups had retained positive attitudes with regard to the psychosocial aspects of cancer. These findings have implications for training medical undergraduates in communication skills.

This thesis critically reviews medical journal literature on the physician-patient interview. The review focuses on literature which is written by and for physicians, in Canadian and American, English language medical journals. Articles, essays and letters to the editor are examined as a cultural exchange amongst physicians that both shapes and is shaped by the values of the medical profession. Chapter One presents literature concerning physician-patient communication in general. The following Chapters Two, Three and Four ("The Physician as Medical Interpreter," "Physician and Patient: in Conflict and in Silence," and "The Patient as Narrator,") focus on themes in the medical journal literature written by physicians on the clinical interview. These Chapters examine the values, explicit and implicit, of this literature. The values are examined for possible epistemological origins in traditional medical ethics, philosophical bioethics, contemporary social movements for the dignity and rights of the individual, and other sources. Thematic shifts in these values over the past twenty years, and the sources of these shifts, are also examined. Finally, the Conclusion evaluates the significance of this literature for the development of a medical morality.

Typescript. / Thesis (Ph. D.)--University of Hawaii at Manoa, 1985. / Bibliography: leaves 236-245. / Photocopy. / Microfilm. / v, 245 leaves, bound

People with hepatitis C (HCV) face stigma and discrimination because of the association of this disease with injecting drug use (IDU). Research has found that many instances of HCV-related discrimination occur in the health care sector. Health care workers' beliefs about their HCV positive clients are likely to influence how they relate to clients and their treatment delivery. This research assessed the implicit and explicit attitudes of both health care workers and their HCV positive injecting drug using (HCV+) clients toward each other and then established whether these affect the treatment experiences of health care workers and clients. The sample consisted of 60 health care workers (doctors and nurses), 120 HCV+ and 120 HCV- clients, recruited from the same treatment facility. Participants were given a series of attitude and treatment experiences measures to complete. Data illustrate that while health care workers' and HCV+ clients' explicit attitudes towards each other were positive, clients with HCV still rated their health care workers less highly and reported less satisfaction with their treatment than HCV- clients. Analyses also indicated that more conservative health care workers displayed greater prejudice toward their HCV+ clients because they believe that injecting drug use is controllable. This prejudice toward IDUs on the part of health care workers was associated with worry about the behaviour of IDU clients and this worry in turn predicted differences in treatment experiences reported by HCV+ and HCV- clients. These data support the contention that health care worker concerns, particularly those related to injecting drug use, underlie discriminatory treatment of people with HCV. Finally the research also addressed the impact of health care worker contact with HCV+ clients on their attitudes towards this group. Analysis revealed that while health care workers who have had more contact with people with HCV show more positive explicit attitudes, they also show less favourable implicit attitudes toward IDUs. This may reflect the difficulties and stresses associated in caring for IDUs and may provide insight into the hidden costs involved for health care workers working with a population that may be challenging and at times difficult to manage.

Thesis (M.D.)--University of Adelaide, Dept. of Surgery, 1999. / Includes bibliographical references (leaves 249-291).

Thesis (Ph. D.)--University of Sydney, 2002. / Includes tables and questionnaires. Title from title screen (viewed Apr. 28, 2008). Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy to the Dept. of Public Health and Community Medicine, Faculty of Medicine. Includes bibliography. Also available in print form.

Thesis (Ph. D.)--UCLA, 2008. / Vita. Includes bibliographical references (leaves 257-269).

Thesis (doctoral)--Uppsala universitet, 1995. / Summary in English. Includes bibliographical references (p. [231]-241).

Thesis (M.S.)--University of Michigan, 1992.