Research shows that health disparities exist among patients of varying races, ethnicities, and cultures in the United States. Numerous studies have suggested that these disparities may be partly associated with physician-patient communication. The larger project that this thesis is a part of is a mixed-methods analysis of physician-patient communication across patient race, ethnicity, and culture. This thesis specifically excluded qualitative studies and focused on how such communication can affect health outcomes. Sixty-nine studies were identified and appraised for quality. Of these, only four associated physician-patient communication with the health outcomes of patients. These studies had inconsistent results, highlighting the gap in research exploring the association between communication, patient ethnicity, and health outcomes.

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.

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.

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]

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