Data regarding professional communications between physicians and dietitians in hospitals were obtained from results of 84 responses to a survey of all hospital dietitians (135) listed in the 1982 Oregon Dietetic Associations' Membership and Employment Directory. The data were gathered utilizing an initial mail-out questionnaire and a follow-up log booklet of communications with physicians kept during five working days. The population studied was characterized as being all women between the ages of 24 and 63, with more than 50 percent under the age of 32 years. Seventy-two percent of the dietitians worked full time and seventy percent were in the clinical division of practice in The American Dietetic Association. All of the dietitians were active members of The American Dietetic Association. A data analysis indicated that 38% of the dietitians communicated with physicians less than every other day, and most frequently these communications were reported to be through patient charts in reference to dietary prescriptions. Seventy-six percent of the dietitians indicated that 30% or less of the physicians on the medical staff consistently made referrals for nutrition counseling. The most frequently referring specialists included those in internal medicine, general practice and surgery. There appeared to be no specific age group of physicians referring more frequently than others. Sixty-five percent of the dietitians indicated that they felt that their communications with physicians were inadequate. Sixty percent of the dietitians felt that their nutrition expertise was utilized by physicians only "fairly well". Less than half of the dietitians participated in interdisciplinary medical team efforts. Significant correlations (p < .05) were found among various factors involving communications between dietitians and physicians when tested using chi square. In general, dietitians in hospitals with more than 200 beds more often considered their communications with physicians to be adequate than dietitians in smaller hospitals. A larger percentage of physicians (> 50%) in hospitals with more than 200 beds had a positive attitude about nutrition. More dietitians in larger hospitals participated in interdisciplinary medical team efforts than those in smaller hospitals. Of the dietitians indicating that their communications with physicians were adequate 61% felt their nutrition expertise was utilized "very well" and 50% had verbal contact with physicians from one to three times daily. When the physician was the initiator of communications, none of the dietitians felt that their nutrition expertise was utilized "very well". When the physician was the initiator of communications, less than 10% of these were in reference to general nutrition information. Recommendations from the study to improve communications between physicians and dietitians include required assertiveness training courses for dietitians, nutrition courses for physicians and a study of dietitians' utilization of time and their perceived priorities. / Graduation date: 1984

Thesis (Ph. D.)--Virginia Commonwealth University, 2006. / Prepared for: Dept. of Information Systems. Bibliography: leaves 151-163 .

Thesis (Ph. D.)--University of Oklahoma, 1989. / Includes bibliographical references (leaves 150-157).

The relationship between the state and its professions has long been overlooked in the sociology of professions. Based on empirical data collected by in-depth interviews and through participant observation in Beijing, this thesis analyzed the dynamic relationship between Chinese urban medical professionals and the post-socialist state of the People’s Republic of China. The study reveals that the post-socialist state continues to wield large influence in the social, economic and technical areas of this profession and retain tight controls despite being in an era of market transition. This control is principally realized through the current healthcare system. Public hospitals have monopolized healthcare delivery, which gives medical professionals little alternative but to become state employees. Practicing in public healthcare organizations and lacking “exit” opportunities, they are left with little to negotiate their working conditions with the state and thus have little corporate autonomy. The lack of corporate autonomy immediately leads to the erosion of their clinical autonomy. Because of the pressure of self-financing imposed by the state, clinical practitioners consequently induce patients to accept unnecessary and excessive medical care. When they make decisions in practice, revenue generation is often recognized as more important than serving patients. This is a major source of clinical autonomy erosion. In prioritizing profit-making, Chinese urban medical professionals are perceived by the public as an “unethical profession.”The mutual distrust and conflict between professionals and patients have increased significantly in recent years. To protect themselves from growing medical disputes and, sometimes, even violence, Chinese doctors have developed “defensive medicine” strategies in their practices and in their interaction with patients. This is yet another source of clinical autonomy erosion as self-protection becomes an important calculation in balance with their own medical competence and patients’ interests. The case of medical professionals in urban China challenges Freidson’s endogenous view of professional autonomy and his distinction between corporate and technical autonomy. It also questions the simple construction of conflicting relationships between the state and professionals. Rather, this dissertation finds that there is an exchange-like relationship between professionals and the state. Professionals are not simply losers in their interaction with the state, they do profit as well as they retain job security in market transition, earn considerable economic benefits through their practice, and are shielded by public hospitals in medical disputes even if they are punished by those hospitals. Doctors receive all these gains at the large cost however as they rarely enjoy professional autonomy, suffer from a negative public image, and become scapegoats for the problematic healthcare system and the state. At the end of this thesis, I provide suggestions for the ongoing reform of China’s healthcare system. These suggestions include liberating doctors through the development of private practice and strengthening supervision over doctors’ behavior while increasing financial support for public hospitals. / published_or_final_version / Sociology / Doctoral / Doctor of Philosophy

No description available.

Thesis PlanB (M.S.)--University of Wisconsin--Stout, 2007. / Includes bibliographical references.

Thesis (Ph. D.)--University of Toronto, 2007. / Source: Dissertation Abstracts International, Volume: 68-06, Section: A, page: 2418. Includes bibliographical references (leaves 225-233).

Thesis (doctoral)--Friedrich-Alexander Universität zu Erlangen.

Thesis (M. Med. Sc.)--University of Hong Kong, 2002. / Includes bibliographical references (leaves 56-65).

Thesis (M.Med.Sc.)--University of Hong Kong, 2002. / Includes bibliographical references (leaves 56-65). Also available in print.