Globally, trade and industry has shifted its focus from the traditional service delivery approaches to various alternative practices to be more successful, cost efficient, customer orientated, flexible and innovative. This shift in focus has lead to organisations applying a customer centric approach in their business. In order to understand customer centricity, it is necessary to be familiar with the term customer service. Customer service is the offering of services to customers before, during and after a purchase. It is a series of activities designed to enhance the level of customer satisfaction, i.e. the feeling that a product or service has met the customer’s expectations. Although it seems to be difficult to create and maintain a positive service culture, the implementation and upkeep of service excellence hold numerous advantages for organisations in both the short and the long term. Excellent customer service leads to an increase in profits as well as assist organisations in achieving a competitive advantage. Organisations with a customer centric approach can expect to experience a 30% higher return on investment on their marketing efforts compared to their peers not embracing customer centricity. Moreover, exceptional customer service will lead to customer satisfaction, which in turn, may well lead to customer loyalty which is crucial in the current volatile economic market. Recent economic instability triggered financial uncertainty in trade and industry. This causes difficulties for organisations to gain a competitive advantage and predict consumer behaviour. The organisations that will survive and outlive these uncertain circumstances will be those that maintain a customer centric focus. A customer centric focus implies that organisations place their customers first by concentrating on their needs and behaviours. These organisations will also attempt to eliminate internal factors that constrain service offerings to customers. Furthermore, customer centricity includes the alignment of resources of the organisation to successfully respond to the ever-changing needs of the customer, while building mutually profitable relationships. The main difference between customer service and customer centricity appears to relate to meaningful changes that customer centric organisations make in addressing their customers’ expectations and providing reciprocal support. Customer centricity seems to take customer service thus a step further with regards to service delivery. The healthcare environment forms an important part of trade and industry and economic instability also affects this sphere. In this study, the focus filters to the healthcare industry in South Africa and the role and importance of a customer centric approach to doctors. The South African healthcare environment consists of two sectors, namely large public (managed by government) and smaller, higher quality private healthcare. The South African healthcare system is unique to those of other countries as it is dynamic and multifaceted. The legislative framework within the healthcare system gives South African citizens the right to access healthcare services. Due to a skewed financing system in healthcare, this framework has a major impact on both the public and private sectors. The private healthcare industry in South Africa has grown dramatically with the number of beds doubling between 1988 and 1993. This was mainly due to the international trends toward privatisation and advanced by government's policies for privatisation. This resulted in the migration of doctors from public service to private practices. Specialists play an integral part in providing healthcare services. The private hospital industry provides admitting and treating facilities where doctors prescribe the care that hospitals should deliver to patients. This interplay between private hospitals and specialists emphasises that specialists are important customers of private hospitals. The importance of obtaining and retaining doctors is also highlighted in the vision and mission of the top three private hospital groups in South Africa, namely Mediclinic, Netcare and Life Healthcare. Many challenges exist to grow and maintain patient volumes for the private hospital sector. One thereof is to establish doctor (and their practices') support by building an optimum mix of loyal specialist and general practitioner (GP) networks for the hospital. The management and nurturing of relationships with doctors through these networks could lead to a competitive advantage for private hospitals. A study was therefore conducted to gain insight as to how specialists define customer centricity as well as their expectations of private hospitals when applying a customer centric approach towards doctors. The research was of qualitative nature. An experimental research design was applied and included 11 participants. Semi-structured interviews with specialists from one of the top three private hospital groups were conducted in order to gather relevant data. The interviews were transcribed and coded. Results were analysed and interpreted via thorough content analysis. Participants highlighted the following elements as important when defining customer centricity: customer focus, satisfaction, facilities and resources, accessibility, safety and cost effectiveness. In addition, participants confirmed that the following aspects marked their expectancies of a customer centric organisation: quality patient care and services, facilities and resources, effective communication, support and cooperation, provision of sufficient and well trained staff, mutual financial gains, appreciation, resolving of problems, involvement in decision making and respect. Conclusions and recommendations pertaining to future research were also provided. / MBA, North-West University, Potchefstroom Campus, 2014

Globally, trade and industry has shifted its focus from the traditional service delivery approaches to various alternative practices to be more successful, cost efficient, customer orientated, flexible and innovative. This shift in focus has lead to organisations applying a customer centric approach in their business. In order to understand customer centricity, it is necessary to be familiar with the term customer service. Customer service is the offering of services to customers before, during and after a purchase. It is a series of activities designed to enhance the level of customer satisfaction, i.e. the feeling that a product or service has met the customer’s expectations. Although it seems to be difficult to create and maintain a positive service culture, the implementation and upkeep of service excellence hold numerous advantages for organisations in both the short and the long term. Excellent customer service leads to an increase in profits as well as assist organisations in achieving a competitive advantage. Organisations with a customer centric approach can expect to experience a 30% higher return on investment on their marketing efforts compared to their peers not embracing customer centricity. Moreover, exceptional customer service will lead to customer satisfaction, which in turn, may well lead to customer loyalty which is crucial in the current volatile economic market. Recent economic instability triggered financial uncertainty in trade and industry. This causes difficulties for organisations to gain a competitive advantage and predict consumer behaviour. The organisations that will survive and outlive these uncertain circumstances will be those that maintain a customer centric focus. A customer centric focus implies that organisations place their customers first by concentrating on their needs and behaviours. These organisations will also attempt to eliminate internal factors that constrain service offerings to customers. Furthermore, customer centricity includes the alignment of resources of the organisation to successfully respond to the ever-changing needs of the customer, while building mutually profitable relationships. The main difference between customer service and customer centricity appears to relate to meaningful changes that customer centric organisations make in addressing their customers’ expectations and providing reciprocal support. Customer centricity seems to take customer service thus a step further with regards to service delivery. The healthcare environment forms an important part of trade and industry and economic instability also affects this sphere. In this study, the focus filters to the healthcare industry in South Africa and the role and importance of a customer centric approach to doctors. The South African healthcare environment consists of two sectors, namely large public (managed by government) and smaller, higher quality private healthcare. The South African healthcare system is unique to those of other countries as it is dynamic and multifaceted. The legislative framework within the healthcare system gives South African citizens the right to access healthcare services. Due to a skewed financing system in healthcare, this framework has a major impact on both the public and private sectors. The private healthcare industry in South Africa has grown dramatically with the number of beds doubling between 1988 and 1993. This was mainly due to the international trends toward privatisation and advanced by government's policies for privatisation. This resulted in the migration of doctors from public service to private practices. Specialists play an integral part in providing healthcare services. The private hospital industry provides admitting and treating facilities where doctors prescribe the care that hospitals should deliver to patients. This interplay between private hospitals and specialists emphasises that specialists are important customers of private hospitals. The importance of obtaining and retaining doctors is also highlighted in the vision and mission of the top three private hospital groups in South Africa, namely Mediclinic, Netcare and Life Healthcare. Many challenges exist to grow and maintain patient volumes for the private hospital sector. One thereof is to establish doctor (and their practices') support by building an optimum mix of loyal specialist and general practitioner (GP) networks for the hospital. The management and nurturing of relationships with doctors through these networks could lead to a competitive advantage for private hospitals. A study was therefore conducted to gain insight as to how specialists define customer centricity as well as their expectations of private hospitals when applying a customer centric approach towards doctors. The research was of qualitative nature. An experimental research design was applied and included 11 participants. Semi-structured interviews with specialists from one of the top three private hospital groups were conducted in order to gather relevant data. The interviews were transcribed and coded. Results were analysed and interpreted via thorough content analysis. Participants highlighted the following elements as important when defining customer centricity: customer focus, satisfaction, facilities and resources, accessibility, safety and cost effectiveness. In addition, participants confirmed that the following aspects marked their expectancies of a customer centric organisation: quality patient care and services, facilities and resources, effective communication, support and cooperation, provision of sufficient and well trained staff, mutual financial gains, appreciation, resolving of problems, involvement in decision making and respect. Conclusions and recommendations pertaining to future research were also provided. / MBA, North-West University, Potchefstroom Campus, 2014

Thesis (PhD)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Communication between doctors and patients in clinical settings is notorious for being difficult. This problem has inspired a wealth of empirical research from a variety of academic fields on the subject of doctor-patient communication. However, very little attention has been paid to the role of modern medicine's intellectual self-image as natural science in interactions within clinical medical settings. The aim of the current study was to philosophically investigate the influence of the medical profession's intellectual self-image on communication between doctors and patients. Jürgen Habermas' work on Universal Pragmatics was used to comment on doctor-patient communication as it is described in the existing empirical research literature. Michel Foucault's work on discourse and power was used to analyse and describe medical discourse and the nature of power in doctor-patient relationships. The outcome of this philosophical analysis leads to the conclusion that modern medicine's intellectual self-image has a pervasive and negative influence on communication between doctors and patients during clinical consultations. This is because medicine's positivist world-view results in an almost exclusive focus on the physical aspects of disease in clinical medicine. The patient's mind and his/her social world are not of great significance from the natural scientific perspective. Medical professionals may thus easily regard their clinical task solely as the physical treatment of physical disorders. They are very likely to consider many communicative activities as unrelated to their clinical task. Inadequate doctor-patient communication can easily affect the quality of medical care and patient outcomes in a negative manner, as well as diminish the quality of the doctor's occupational experience. For this reason I conclude that medicine's natural scientific intellectual self-image is not appropriate for the task of providing medical care to individual patients. Two additional reasons support this conclusion, namely the misidentification of clinical medicine as a natural science and the inappropriateness of a scientific conception of truth for the context of doctor-patient interactions. The implications of these conclusions are that the intellectual self-image and world-view of modern medicine should change to better agree with the nature of clinical practice and to make room for the psychological and social dimensions of the patient's life within health care. The medical profession should also revise its conception of science to a theory that acknowledges that interpretive reasoning and knowledge without guaranteed certainty are legitimate elements of science. I advocate for consciousness among the medical profession of the reality of medical discourse and its effects on doctors, patients and on their interaction with one another. / AFRIKAANSE OPSOMMING: Kommunikasie tussen dokters en pasiënte in kliniese omgewings is daarvoor berug om moeilik te wees. Hierdie probleem het 'n magdom empiriese navorsing vanuit 'n verskeidenheid van akademiese velde omtrent dokter-pasiënt kommunikasie geïnspireer. Baie min aandag word egter gewy aan die rol van moderne geneeskunde se intellektuele selfbeeld as 'n natuurwetenskap in interaksies in kliniese mediese omgewings. Die doel van die huidige studie was om die invloed van die mediese professie se intellektuele selfbeeld op kommunikasie tussen dokters en pasiënte filosofies te ondersoek. Jürgen Habermas se werk oor Universele Pragmatiek (Universal Pragmatics) is gebruik om kommentaar te lewer oor dokter-pasiënt kommunikasie soos wat dit beskryf word in die empiriese navorsingsliteratuur. Michel Foucault se werk oor diskoers en mag is gebruik om mediese diskoers en die aard van mag in dokter-pasiënt verhoudings te ontleed en te beskryf. Hierdie filosofiese ontleding gee aanleiding tot die gevolgtrekking dat moderne geneeskunde se intellektuele selfbeeld 'n deurdringende en negatiewe invloed op kommunikasie tussen dokters en pasiënte gedurende kliniese konsultasies het. Die rede hiervoor is dat geneeskunde se positivistiese wêreldbeskouing lei tot 'n byna uitsluitlike fokus op die fisiese aspekte van siekte in kliniese geneeskunde. Die pasiënt se verstand en gees (mind) en sy/haar sosiale wêreld is nie van groot belang vanuit die natuurwetenskaplike perspektief nie. Persone in die mediese beroep mag hul kliniese taak dus maklik as bloot die fisiese behandeling van fisiese afwykings beskou. Dit is baie waarskynlik dat hulle vele kommunikatiewe aktiwiteite as onverwant tot hul kliniese taak beoordeel. Ontoereikende dokter-pasiënt kommunikasie kan die kwaliteit van mediese sorg en pasiënte se gesondheidsuitkomste maklik negatief beïnvloed, en ook die kwaliteit van die dokter se ervaring van sy/haar beroep verlaag. Om hierdie rede maak ek die gevolgtrekking dat geneeskunde se natuurwetenskaplike intellektuele selfbeeld nie toepaslik is vir die opdrag om mediese sorg aan individuele pasiënte te lewer nie. Twee verdere redes ondersteun hierdie gevolgtrekking, naamlik die verkeerdelike identifikasie van kliniese geneeskunde as 'n natuurwetenskap en die onvanpastheid van 'n wetenskaplike konsepsie van waarheid vir die konteks van dokter-pasiënt interaksies. Die implikasies van hierdie gevolgtrekkings is dat die intellektuele selfbeeld en wêreldbeskouing van moderne geneeskunde moet verander om beter ooreen te stem met die aard van die kliniese praktyk en om ruimte te maak vir die sielkundige en sosiale dimensies van die pasiënt se lewe in gesondheidsorg. Die mediese professie moet ook haar konsepsie van die wetenskap hersien na 'n teorie wat erken dat interpreterende redenasie en kennis sonder gewaarborgde sekerheid, geregverdigde elemente van die wetenskap is. Ek pleit vir bewustheid onder die mediese professie van die realiteit van mediese diskoers en die effek daarvan op dokters, pasiënte en op hul interaksie met mekaar.

Thesis (MA (African Languages))--Stellenbosch University, 2008. / The purpose of this study is to apply relevant and up-to-date theories concerning language learning and acquisition to the specific needs of second-language learners of isiXhosa in the field of health sciences through microanalysis of doctor-patient dialogues in isiXhosa. This study explores a task-based approach to language learning and teaching that differs from traditionally applied methods. In this approach, the performance of a task is regarded as the key feature in the language-learning process. This is in accordance with the central aim of the task-based approach to language learning and teaching, which is to transform the prescribed roles of teachers and learners in the classroom context so that learners move from being passive observers to being actively involved in their own learning processes, and teachers become facilitators and not presenters of the language.In an endeavour to exploit the possibilities of tasks in the teaching and learning of isiXhosa for health sciences needs, this study investigates the various components that comprise a task as well as the possible effects that these components may have on language learning and use. The results of the study could then provide teachers of second-language courses with specific notions and strategies, which, when successfully applied, could ensure optimal language learning and acquisition for language learners. To expand the study, an analysis is conducted regarding the presence and nature of cognitive complexity and syntactic complexity in authentic doctor-patient dialogues in isiXhosa. The classification of these conversations will serve to inform the manner in which tasks could be sequenced in a task-based language teaching course for second-language learners.

Thesis (PhD)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: This is a qualitative analytical study that investigates the use of English as lingua franca (ELF) between doctors and patients with different L1 at four different HIV/AIDS clinics in the Western Cape. The study addresses a gap in medical research, especially in the field of HIV/AIDS, namely, a lack of sufficient data-driven analytical investigation into the linguistic and conversational nature of doctor-patient communication in ELF in this setting in South Africa. A literature review contextualises ELF, discourse analysis (DA), conversation analysis (CA) and genre theory providing a theoretical framework for the study. The methodology involves audio-recording and transcription of HIV/AIDS consultations conducted in ELF. From the genre perspective, the study investigates the different genres in and determines if HIV/AIDS consultations are a sub-genre of medical discourses. DA investigates what contextual, socio-cultural linguistic features characterise medical interaction in this multilingual context and what ELF linguistic strategies participants use to signal and resolve misunderstanding. CA investigates the turn organisation and turn-taking patterns in the consultations to assess participants’ contributions and identify different types of sequences that characterise them, aiming to understand how they enable the interactants play their roles as doctors and patients. The results reveal that HIV/AIDS consultations exhibit formal features of doctor-patient consultations in general and intertextually revert to other oral genres leading to the conclusion that, considering their purpose, participants and context, HIV/AIDS consultations are like all medical consultations and are a sub-genre of medical discourse. The macro analysis reveals that the interactants’ socio-cultural and multi-linguistic backgrounds do positively influence the nature of the interaction in this context as it highlights characteristic linguistic features of ELF usage like borrowing, linguistic transference from L1, the use of analogy, code-switching and local metaphors all resulting from processes of indigenisation and hybridisation. The results reveal few instances of misunderstanding, concurring with earlier studies that problems of miscommunication may be minimal when two languages and/or cultural groups interact. The micro analysis reveals that the turns in the consultation follow the pre-selection and recurrent speakership patterns and that despite the advocacy for partnership between doctors and patients in their contribution and negotiation of outcomes, the doctor unavoidably remains the dominant partner. S/he determines the course of the consultation by initiating more turns, asking most of the questions and often unilaterally deciding on topic changes. S/he has longer talking time than the patient in the sequences and the physical examination and prescription phases of the consultation while the patient is mostly portrayed almost as a docile participant yielding to the doctor’s requests and taking very little if any initiative of his/her own to communicate his/her views and desires. The study reveals instances of both patient and doctor initiated repair to resolve any misunderstanding, which improves the quality of the interaction and its outcomes such as adherence and treatment follow-up. The study further highlights the challenges faced in the field which impacted on the data, the most crucial being the complicated but necessary ethical procedures required to get participants’ consent to participate in the study. / AFRIKAANSE OPSOMMING: Hierdie kwalitatiewe analitiese studie ondersoek die gebruik van Engels as lingua franca (ELF) tussen dokters en pasiënte met verskillende eerstetaal (T1) by vier verskillende MIV/vigs-klinieke in die Wes-Kaap. Die studie werp die soeklig op ʼn leemte in mediese navorsing, veral op MIV/vigs-gebied, en bring ʼn gebrek aan datagedrewe analitiese ondersoek na die taalkundige en gespreksaard van dokter-pasiënt-kommunikasie in ELF in hierdie omgewing in Suid-Afrika aan die lig. ʼn Literatuuroorsig van navorsing kontekstualiseer ELF, genre-teorie, diskoersanalise (DA) en gespreksanalise (GA), en bied ʼn teoretiese raamwerk vir die studie. Die navorsingsmetode behels oudio-opnames en transkripsie van MIV/vigs-konsultasies in ELF. Uit die genre-oogpunt bestudeer die navorsing die verskillende genres in MIV-konsultasies, en bepaal of dié konsultasies as ʼn subgenre van mediese diskoers beskou kan word. Met behulp van DA stel die studie vas watter kontekstuele, sosiokulturele taaleienskappe mediese interaksie in hierdie veeltalige konteks kenmerk, en watter ELF-taalstrategieë deelnemers gebruik om misverstande aan te dui en op te los. Daarna ondersoek GA die beurtorganisasie en beurtmaakpatrone in die konsultasies, om deelnemers se bydraes te beoordeel en verskillende soorte kenmerkende sekwensies uit te wys, en uiteindelik te begryp hoe dít die onderskeie partye in staat stel om hul rolle as dokters en pasiënte te vervul. Die bevindinge dui daarop dat MIV-konsultasies formele kenmerke van dokter-pasiënt-konsultasies in die algemeen toon en intertekstueel by ander mondelinge genres aansluit. Dít lei tot die gevolgtrekking dat, gedagtig aan die doel, deelnemers en konteks, MIV-konsultasies soos enige ander mediese konsultasie is en as ʼn subgenre van mediese diskoers beskou kan word. Die makro-analise (DA) toon dat die onderskeie gespreksdeelnemers se sosiokulturele en veeltalige agtergronde ʼn positiewe uitwerking het op die aard van die wisselwerking in hierdie konteks, aangesien dit kenmerkende taalkundige eienskappe van ELF-gebruik, soos leenwoorde, taaloordrag vanaf die L1, die gebruik van analogie, koderuiling en plaaslike metafore, beklemtoon. Al hierdie eienskappe spruit uit prosesse van verinheemsing en hibridisering. Die studie toon min gevalle van misverstand, wat met die resultate van vorige navorsing ooreenstem, naamlik dat probleme van wankommunikasie minimaal is wanneer twee tale en/of kultuurgroepe met mekaar omgaan. Die mikro-ontleding (GA) dui daarop dat die beurte in die konsultasie die preseleksie- en herhalende sprekerspatrone volg en dat, ondanks die voorspraak vir ʼn vennootskap tussen dokters en pasiënte in hul bydraes en bedinging van uitkomste, die dokter onvermydelik die dominante vennoot bly. Hy/sy bepaal die verloop van die konsultasie deur meer beurte aan te voer, die meeste vrae te stel en dikwels eensydig te besluit om die onderwerp te verander. Hy/sy het ook ʼn langer spreekbeurt as die pasiënt in die gespreksekwensies sowel as in die fisiese-ondersoek- en voorskriffases van die konsultasie. Daarenteen word die pasiënt merendeels as ʼn bykans gedweë deelnemer uitgebeeld wat aan die dokter se versoeke toegee en weinig of geen eie inisiatief aan die dag lê om sy/haar sienings en behoeftes oor te dra. Die studie toon ook gevalle van sowel pasiënt- as dokteraangevoerde herstel om enige misverstand uit die weg te ruim, wat die gehalte van die wisselwerking én die uitkomste daarvan, soos behandelingsgetrouheid en nasorg, verbeter. Die navorsing beklemtoon voorts die gebiedspesifieke uitdagings wat die data beïnvloed. Die belangrikste hiervan is die ingewikkelde dog nodige etiese prosedures wat vereis word om persone se toestemming tot studiedeelname te verkry.

The Doctor Interactive Group Medical Appointment (DIGMA) is a group health intervention that combines the services of behavioral health and primary care. The DIGMA was first invented by Edward Noffsinger in 1996, in response to his own difficulties with the overtaxed primary care system at Kaiser Permanente in California (Noffsinger, 1999). Integrating healthcare services in this way has practical implications such as efficient use of resources, treating multiple complaints at once, and beginning to view the mind and body as one (Noffsinger, 1999; Engel, 1977). The DIGMA at the Austin Veterans Outpatient Clinic was designed to address the specific needs of veterans with hypertension. It consists of 4 sessions of 1.5 hours each and addresses such varied topics as exercise, stress-management, nutrition, and medication adherence. These topics are discussed in a group format with the tenets of group psychotherapy (Yalom & Leszcz, 2005) as a backdrop. An exploratory study was warranted to determine whether programs of this sort would be effective on a broad scale. A pretest/posttest design was utilized to determine if the DIGMA was effective at reducing symptoms of hypertension; improving health promoting behavior; increasing self-efficacy to manage hypertension; and increasing internal health locus of control while decreasing chance and powerful others health locus of control. Groups were conducted over a period of seven months with a total of 73 male veterans enrolled in the study. The final n was 58. Findings indicated that both systolic and diastolic blood pressure readings were reduced significantly from pretest to posttest. Health promoting behavior increased significantly; hypertension self efficacy increased significantly; and locus of control did not change significantly from pretest to posttest. The exploratory study concluded that the DIGMA may be efficacious for a variety of aspects of the management of hypertension. It is suggested that further research be conducted but that integrating services in this way can lead to improved patient outcomes and can also be cost-effective. / text

Résumé. En partant d’une description des nombreux changements de la pratique médicale depuis quelques décennies, la thèse étudie divers aspects constitutifs du malaise du médecin. L’accroissement de la puissance médicale qu’a permis la technoscience est analysée et remise dans un contexte plus large où les technologies de l’information ont une grande place. L’augmentation considérable des connaissances pose un problème de maîtrise de la science médicale. La multiplicité des observations fait qu’il y a discordance de certaines d’entre elles avec les théories médicales largement acceptées. De cette manière, le gain d’efficacité est associé à une perte de la cohérence du discours médical. Le rôle du médecin disparaît derrière la technique, qui semble pouvoir, seule, rendre tous les progrès accessibles. Le médecin devient alors un simple distributeur de services et, à ce titre, développe parfois des offres de pratiques sans fondement, voire dangereuses. Le pouvoir du médecin est évoqué, et se ramène in fine à la fourniture d’un diagnostic et d’une explication de sa maladie au patient. Le rôle des explications particulières que donne le médecin au malade est exploré à la lumière d’une conception narrative et évolutive de la vie humaine. Le rôle du médecin apparaît alors comme d’aider le patient à réécrire a posteriori le fil d’une histoire qui apparaît initialement comme interrompue par la maladie. Le rôle social de maintien de l’ordre de la pratique médicale est alors évoqué. Ensuite, par une approche descriptive du phénomène religieux, on montre que la médecine du XXIe siècle a les caractéristiques d’un tel phénomène. Entités extrahumaines, mythes, rites, tabous, prétention à bâtir une morale, accompagnement de la vie et de la mort, miracles, promesse de salut, temples, officiants sont identifiés dans la médecine « classique » contemporaine. Seule la fonction de divination de l’avenir d’un homme précis est devenue brumeuse, la technoscience permettant régulièrement du « tout ou rien » là où auparavant un pronostic précis (et souvent défavorable) pouvait être affirmé. L’hypothèse que la médecine est devenue une religion du XXIe siècle est confrontée à des textes de S. Freud, M. Gauchet et P. Boyer. Non seulement ces textes n’invalident pas l’hypothèse, mais la renforcent même. Il apparaît que le fonctionnement de l’esprit humain favorise l’éclosion de religions et donc la prise de voile de la médecine. La dynamique générale de la démocratisation de la société montre que la médecine est une forme de religion non seulement compatible avec une société démocratique, mais est peut-être une des formes accomplies de celle-ci, où chaque individu écrit lui-même sa propre histoire. Le danger qu’il y a, pour le patient comme pour le médecin, si ce dernier accepte de jouer un rôle de prêtre, est ensuite développé. Enfin, la remise dans le cadre plus général de l’existence humaine, l’évocation de la dimension de révolte de la médecine, de son essentielle incomplétude, l’acceptation d’une cohérence imparfaite permettent au médecin de retrouver des sources de joie afin de, peut-être, ne tomber ni dans un désinvestissement blasé, ni dans un cynisme blessant. Summary From a description of the many changes medical practice has undergone for a few decades, the work goes on to study many sides of the modern doctor’s malaise. The gain of power made possible by technoscience is put on a larger stage where information technologies play a major role. The abundance of knowledge makes health literacy more difficult. the great number of observations makes discrepancies with general theories more frequent. The gain in power is associated with a loss of coherence of the medical speech. The doctor’s role vanishes behind technology that seems to be the only access to all medical progresses. Doctors becomes mere service providers and go on to offer unvalidated or even harmful services on the market. Modern medical power resumes into the explanations and diagnosis given to the patient. The role of medical explanations is explored through an evolutive and narrative vision of human life. The duty of the doctors then appears to allow a new narration of the self that bridges the gap disease introduced into the patient’s life. The role of medicine in maintaining social order is mentioned. Through a sociological approach of the religious phenomenon, one can see that XXIst century medicine is such a phenomenon. Medicine knows of extrahuman entities, myths, rites, taboos, miracles, temples; priests are present in modern mainstream medicine. Some want to derive objective moral values from medicine, and it brings companionship to man from birth to death. The only departure from old religions was the weakened ability to predict the future of an individual patient: for some diseases for which survival was known to be very poor, the possibilities are now long-term survival with cure, or early death from the treatment. The hypothesis that medicine is a religion is confronted to texts from Freud S., Gauchet M. and Boyer P. Not only do they not invalidate the hypothesis, but they bring enrichment to it. Brain/mind dynamics is such that the appearance of religions is frequent, and makes the transformation of medicine into a religion easier. Society’s democratisation confronted to religion’s history shows that medicine is the most compatible form of religion within a truly democratic society, where each individual writes his own story. To become a priest brings some dangers for the patient, but also for the doctor. These dangers are discussed. This discussion is put into the larger context of human life. The revolt dimension of medicine is discussed, as is its never-ending task. Their acceptance, as that of a lack of total logical coherence can open the possibility for the doctor to enjoy his work, without being neither unfeeling nor cynical.

Since the shortage of humanities Ph.D.s turned to surplus in the early 1970s, a full generation of students has passed through graduate school and into the job market. This study explores the strategic changes undertaken by humanities departments in response to the continued surplus and the resulting unemployment of graduates. To gather data for the study, telephone interviews were conducted with representatives from 86 departments of English, history, and philosophy. The respondents were first asked what they thought should be done to alleviate doctoral unemployment. Then they were asked 19 questions representing individual strategic change alternatives being carried out in their departments, as well as one question concerning future changes they had planned. Finally, they were asked four questions concerning their past and present enrollments and doctoral placement rates. Analysis of the survey results showed that departments did indeed respond consciously to the poor employment prospects facing their graduates: they took measures to reduce the numbers of doctorates granted each year; they changed faculty personnel policies; they changed academic programs to better prepare their graduates for employment; they provided direct placement services, and they planned future changes. The findings also indicated that several intervening factors were related to the responses of departments. For example, public institutions were more responsive than independent institutions, and growing departments were more likely to implement changes than departments with shrinking or static enrollments. Research institutions and large institutions tended to cut back the number of graduates they produced, whereas other doctoral-granting or smaller institutions were likely to make certain academic program changes. Finally, history departments tended to prepare students for nonacademic employment; English departments prepared students for employment in high schools and community colleges, and philosophy departments were the most active in promoting their students to potential employers, although they did not target a particular job sector. In all, the departmental changes most positively related to graduate employment were changes in academic programs, and these program changes seemed to be more successful in placing doctorates in nonacademic careers than in academe.

Bakgrunn: Røyking blir fortsatt betraktet som den viktigste forebyggbare årsak til død i ge land. Praktiserende leger er nøkkelpersoner innen tobakksforebygging. Enkel rådgiving, som minimal intervensjon, gitt av allmennleger øker andelen røykfrie pasienter signifikant. Kan en oppsøkende intervensjon gjennomført av en likemann være en egnet metode for å få leger til å ta opp tobakksbruk oftere og på en bedre måte, og kan denne undersøkelsen påvise dette? Hensikt: Hensikten med denne studien er: 1) Vurdere om primærlegene i Agder har endret praksis i perioden 2001-2004 med hensyn til hvor ofte og hvordan de tar opp tobakksbruk med sine pasienter og eventuelle hindringer for dette. 2) Undersøke om oppsøkende intervensjon er en egnet metode for å få leger til å endre praksis ved at de bidrar mer og bedre med individuell røykeintervensjon. Metode: Randomisert kontrollert studie for å undersøke om oppsøkende intervensjon er en egnet metode for å få leger til å endre praksis. Denne studien er sett i lys av en sammenliknende analyse av legenes røykeintervensjon og hindringer for dette i perioden 2001-2004. Resultat: Allmennlegene i Agder har endret praksis i perioden 2001 til 2004. Legene tar oftere opp tobakksbruk uten av pasientene har røykerelaterte symptomer, og det er færre hindringer både for å spørre om røykevaner og for å tilby hjelp til røykeslutt. Studien kan ikke bekrefte at oppsøkende intervensjonen er en egnet metode for å få leger til endre praksis ved at de bidrar mer og bedre med individuell røykeintervensjon. Konklusjon: I perioden 2001-2004 har det vært en signifikant endring i legenes røykeintervensjon og hindringer for dette. Studien kan ikke påvise at legene som fikk opplæringen ”Røykeslutt i praksis” bidrar mer med individuell røykeintervensjon enn kontrollgruppen, og det er heller ikke signifikante forkjeller på hindringer for en slik intervensjon / Background: Cigarette smoking is still considered the leading preventable cause of death in the western world. Physicians constitutes a key personnel in tobacco prevention. Brief advising, such as minimal intervention, performed by general practitioners, GPs, increases the number of smoke free patients significantly. The potential effect of outreach visits performed by a peer educator is a question to be studied. Objective: The objective of this study is: 1) Assesswhether the primary physicians in Agder, during the period 2001 to 2004, have changed their professional practice as tohow often and in which way they discuss smoking habits with their patients and possible barriers to stop them. 2) The study also seeks to determine whether outreach visits constitute an effective method to make GPs change their professional practice by contributing more and better to individual smoking cessation. Method: Randomised controlled study to determine whether outreach visits constitute an effective method to make GPs change their practice. This study is also viewed in the light of a comparative analysis of doctors’ attitude to tobacco prevention over the period 2001-2004. Result: During the period 2001-2004 the GPs in Agder have changed their professional practice. They discuss more frequently tobacco use with patients without smoke-related symptoms, and there are fewer barriers that keep them from asking about smoking habits and from offering assistance with smoking cessation. The effect of outreach visits in improving professional practice cannot be ascertained through this study. Conclusion: During the period 2001-2004 there has been a significant change in the GPs intervention work and fewer barriers to stop them. The GPs who received training through the program “Røykeslutt i praksis” do not contribute to individual smoke intervention any more than the control group. We were unable to detect any significant differences regarding barriers to such intervention / <p>ISBN 91-7997-153-9</p>

The study is an examination of the quest motif as it occurs in the Tarot and two dramatic works, King Lear and Marlowe's Dr. Faustus. The development of the quester is traced from his naivete, through a series of trials, to the consummation of his quest.The hero's quest is essentially to achieve an integration of polar opposites: light and dark, good and evil, the conscious and unconscious. Both the Fool of the Tarot and Lear seem to achieve that harmony, and, thus, I treat the Tarot and King Lear in separate sections of the first chapter. I begin with the Tarot also because of its enormous suggestiveness for elucidating the quests of Lear and Faustus. The archetypal nature of the quest is ultimately what unites the three works, and the Tarot provides a repository for the symbols and primordial images that inform quest literature.The second chapter deals with Dr. Faustus. Unlike the Fool and Lear, Faustus never seems to attain the hero's vision of light and harmony (however, the conclusion is ambiguous); indeed, he inverts the quest to its diabolical opposite and becomes the trickster in league with the demonic forces that form the negative corollary to the hero. Faustus' quest is the coexisting opposite of Lear's and the Fool's, and, as such, is the other pole that must be seen to experience the whole.