Adult literature has shown that quality of patient-physician relationships is associated with better patient adherence to treatment recommendations across chronic illnesses. However, few studies have examined this in youth with type 1 diabetes, particularly those of Hispanic origin. Evidence indicates that minority youth with type 1 diabetes are at higher risk for poorer metabolic control and experience less satisfaction in patient-provider relationships compared to their white, non-Hispanic counterparts. This study examined the association between satisfaction with the physician-patient relationship and regimen adherence and glycemic control in 120 Hispanic youth with type 1 diabetes. Most caregivers who participated were mothers (82.5%) and youths were primarily female (51.7%). Children ranged in age from 10 to 17 (M age = 13.63 ± 2.18 years). Mean duration of diabetes was 6.26 ± 3.72 years. Most caregivers were married (64.7%). Mothers? highest level of education included 35.3% who had a high school education or less, 34.5% who had some college, and 30.2% who completed college. Mean HbA1c level on recruitment date was 7.68 ± 3.56. Adolescents and their parents independently completed an adapted version of the Medical Interview Satisfaction Scale (MISS-21) (Meakin & Weinman, 2002), which assessed their personal satisfaction with their endocrinologist?s consultation, and the Diabetes Self Management Profile (DSMP) (Harris et al., 2000), which measures adherence over the past 3 months across multiple self-care domains. Spanish translations of both forms were used when appropriate in obtaining caregiver report. Also, physicians rated their patients? regimen adherence using an average of eight items concerning patient adherence. Youth and parents shared similar perceptions concerning youth regimen adherence, as measured by the DSMP (r=.68, p<.001). Youth and parent report of their relationship with their endocrinologist was modestly correlated (r=.27, p<.01). Due to high concordance between parent and child adherence scores, further analyses used a combined DSMP score, while separate scores were used for parent and child reports of satisfaction. Age, mother?s education, and single parent status were used as control variables and were correlated with parent and child satisfaction and a combined DSMP score. Including control variables, parent and child satisfaction did not significantly predict glycemic control (R2∆=.02, p<.10). Parent and child satisfaction also did not significantly predict adherence (R2∆=.02, p=.06). Due to these unexpected findings, further exploratory analyses were conducted. Parent and child satisfaction did not predict physician report of adherence. Interestingly, parent and child report of satisfaction with communication comfort with the physician predicted physician report of adherence (R2∆=.05, p<.01). More specifically, child report of communication comfort predicted physician report of adherence (ß=.26, p<.01), while parent report did not. No subscales of the satisfaction measure (MISS) or the adherence measure (DSMP) predicted glycemic control. Findings suggested that more positive patient-physician relationships are associated with better physician-reported regimen adherence, but not with family report of adherence. However, it is unclear whether better patient-physician relationships enhance adherence or whether more adherent patients are likely to be satisfied with their provider. Further studies are needed to prospectively examine the directionality of these relationships, as well as examine methods to improve the quality of physician-patient relationships in order to increase positive health outcomes.

Thesis (M.A.)--Kent State University, 2008. / Title from PDF t.p. (viewed Nov. 10, 2009). Advisor: Timothy Gallagher. Keywords: sociology, gender, doctor-patient interactions, doing gender. Includes bibliographical references (p. 78-88).

Thesis (Ph.D.)--University of Nebraska-Lincoln, 2009. / Title from title screen (site viewed October 15, 2009). PDF text: iv, 261 p. ; 1 Mb. UMI publication number: AAT 3360084. Includes bibliographical references. Also available in microfilm and microfiche formats.

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Professionals whose job it is to counsel patients must be cognizant of the role played by communication in the establishment of a trusting working relationship. This is no less true for those within the medical community who must obtain informed consent for surgical interventions than it is for those working within the area of mental health. In order to determine what role communication plays in the obtaining of informed consent within a pediatrics setting, a qualitative study was conducted of 20 surrogates (those individuals giving consent on behalf of legally incompetent children) and of 5 surgeons performing surgical interventions on those children. Two sets of questionnaires were administered in order to elicit information pertaining to how surgeons communicate information to surrogates and to investigate how that information is received and processed by the surrogate. Results showed that while the obtaining of signed informed consent itself may not be a major problem, there are some difficulties in the communication between surgeons and surrogates in this domain. Based on the findings, recommendations for improved communication between surgeons and surrogates are proposed.

The purpose of this study was to validate a set of predictor variables which identify perspective orthognathic surgical patients who may be poor surgical risks. The predictive qualities of four MMPI scales, two Bloom Sentence Completion scales, and seven Dental Inventory scales were used to identify presurgical, orthognathic patients who were likely to express postsurgical dissatisfaction.All variables were considered jointly to assess their significance in predicting surgical satisfaction versus dissatisfaction. Subsequently, a minimal set of predictors, which accounted for a significant proportion of the criterion variance, were derived by using factor analysis.A nonrandomized, pretest-posttest design with a one-way, multivariate analysis of variance yielding a Hotelling T square statistic was used. A discriminate analysis of variance was used as a follow-up to the Hotelling T square to note those variables which caused the differences between the means.This study was conducted at a large military teaching and research hospital in Southwest Texas. Patients used in this study were identified during routine dental examinations or were referred by their dentists. Eighty-nine subjects participated in the research project. All subjects were between the ages of 15 and 50 with a mean age of 23.7. They were all volunteers and received their surgery in the same hospital by the current staff of oral surgeons. All subjects were informed that the psychological evaluation was an integral part of the oral surgery evaluation.Upon admission to the hospital the patient received the scheduled surgery and underwent 8 weeks of routine postoperative care. Prior to being discharged from the hospital the patient was readministered the MMPI, Bloom Sentence Completion, and the Dental Inventory. The 8-week period was chosen for postoperative testing because patients were medically cleared to resume normal functioning at that time.A statistically significant difference between the four MMPI scores on the results of the orthognathic surgery variable was evident when comparing satisfied versus dissatisfied patients (F = 3.020, P 0.028). Additionally, there was a multilinear relationship among the presurgical test and the level of postsurgical satisfaction.Factor analysis rendered a minimal set of predictor variables which proved practical in identifying satisfied from dissatisfied patients.Considering the limitations of the study and the above-mentioned results, it can be concluded that a minimal set of predictor variables could be effective in helping surgeons screen out those patients who have the potential of being poor surgery risks.

<p>Since the anecdotal assumption is that GPs do not effectively diagnose and manage problem drinking amongst their patients, this study investigated the role of GPs in addressing problem drinking in Cape Town as well as the prevalence of problem drinking amongst their patients.</p>

Communication skills are essential to the practice of medicine, and are now included in most medical curricula. Training in communication skills requires an experiential approach to teaching and assessment that focuses on mastery of performance. Simulated patients were introduced to the Communication Skills course for third year medical students at The University of Melbourne in 1995. This thesis describes the evaluation from the first two years of their use, and is set within the body of literature regarding this innovative educational method. The fundamental research question was: Did the introduction of simulated patients represent an improvement and enrichment in the teaching of communication skills to third year medical students? A qualitative evaluation was undertaken by focus groups with students, tutors and simulated patients, and by student questionnaire. (For complete abstract open document)

Good medical care depends on effective communication between patient and health professional. Misunderstandings can occur in any medical setting but can be further compounded by language and cultural factors in those interactions which occur in a cross-cultural context. The medical consultation is an institutional interaction and as such can involve additional, taken-for-granted evaluative and interpretive criteria which are applied by interactants automatically, without conscious reflection. Non-native speakers who may have a good functional control of the language and have few problems at the level of propositional content may experience significant difficulties at the necessary interpretative level. / Questions act to allow the questioner a degree of interactional control and when patients ask questions they not only increase their access to information but also indicate to the doctor that they wish to play a more active role in the consultation. This thesis examines the discourse of doctor-patient interactions and in particular the ways in which questions are framed and presented by patients and, because the patients in this case are children, their parents. Fifty three medical consultations were observed from both public and private pediatric clinics with patients and their parents comprising 33 native and 20 non-native speakers of English. Data for the study comprise 28 of those consultations. The data include post-consultation interviews with patients and their parents, and interviews with the treating doctors. / The analysis indicates that there are considerable differences in the patterns of questioning behaviour of native speakers and non-native speakers, and that the questioning behaviour of patients and parents seems to be influenced by the communication style of the doctor. / These findings indicate that the questioning behaviour of non-native speaking parents in medical consultations has the potential to lead to less access to information, fewer explanations about their child's condition and a less active role overall in the medical consultation. This in turn can lead to different outcomes for those parents such as lower levels of satisfaction and, potentially, lower levels of compliance with medical advice and directives. These findings also indicate that the needs of non-native speakers in such circumstances are more successfully addressed by a doctor-centred approach. / Finally, this study argues that the observed differences in the patterns of questioning behaviour between native speakers and non-native speakers is more than simple lack of linguistic resources but rather is a result of the clash between the often subtle differences in communicative competence of non-native speakers and the specialised inferential frameworks inherent in institutional discourse.