M.Sc. (Med. (Bioethics and Health Law)), Faculty of Health Sciences, University of the Witwatersrand, 2008. / The research aims to establish whether processes around the consideration and execution of the living will help enhance the doctor-patient relationship. Studies have shown that the living will is not used frequently, and that the doctor-patient relationship is often deficient. The research explores the two primary topics – the living will, and the doctor-patient relationship – separately. Each primary topic is approached via a consideration of the relevant literature, and each is then analyzed from a theoretical–ethical point of view. A synthesis of these separate investigations is presented. This synthesis concludes that the living will can help enhance the doctor-patient relationship.

No description available.

AIDS Saskatoon, considered as a health social movement, is the focus of this research. It uses notions of life-world, system and life-world colonization as well as the typology of politics introduced by Cohen and Arato to answer the questions:<p> Why did AIDS Saskatoon emerge?<p> Is AIDS Saskatoon a defensive or an offensive social movement?<p> The defensive movements action is directed inward to the lifeworld and civil society, while the offensive modes of movement activism directed outward to state and economic institutions. With regards to the first question, I argue AIDS Saskatoon was formed as a reaction to patterns of the colonization of the life-world of people living with HIV/AIDS. Relative to the second question AIDS Saskatoon is seen to be a creative response to the colonization process that takes an organizational form conducive to both defensive and offensive dimensions.<p> Data for this study were derived from ten qualitative interviews were conducted - five with individuals diagnosed HIV/AIDS positive, three with the AIDS Saskatoon administrative staff, and two with the founders of AIDS Saskatoon.

AIDS Saskatoon, considered as a health social movement, is the focus of this research. It uses notions of life-world, system and life-world colonization as well as the typology of politics introduced by Cohen and Arato to answer the questions:<p> Why did AIDS Saskatoon emerge?<p> Is AIDS Saskatoon a defensive or an offensive social movement?<p> The defensive movements action is directed inward to the lifeworld and civil society, while the offensive modes of movement activism directed outward to state and economic institutions. With regards to the first question, I argue AIDS Saskatoon was formed as a reaction to patterns of the colonization of the life-world of people living with HIV/AIDS. Relative to the second question AIDS Saskatoon is seen to be a creative response to the colonization process that takes an organizational form conducive to both defensive and offensive dimensions.<p> Data for this study were derived from ten qualitative interviews were conducted - five with individuals diagnosed HIV/AIDS positive, three with the AIDS Saskatoon administrative staff, and two with the founders of AIDS Saskatoon.

The purpose of the present study was to begin to develop an understanding of how primary care resident physicians work with patients with personality disorder-type characteristics and processes. Participants include fifteen primary care resident physicians from a community health clinic. Participants individually viewed two video vignettes of an actor-patient being interviewed by a physician. Participants were asked how they would respond to statements the actor-patient made during the course of watching the video and then answered general questions about reactions to the actor-patient and working with patients with personality disorders. Using a naturalistic qualitative analysis, data were analyzed for categories and themes. The results of the analyses are presented within a basic framework for understanding how primary care residents work with and approach the doctor-patient relationship, and treat patients with personality disorder characteristics and associated personality processes. Broad themes emerge from the data. Content of residents' responses suggests two response styles: attention to patient's presenting physical concern or identify and potentially address underlying psychological and emotional concerns. Residents characterize the establishment of a relationship with this patient population as either a distancing, paternalistic approach, or an engaging and collegial relationship. Levels of self-awareness of reactions to patients consist of either a willingness to address personal reactions or a tendency to not identify or discuss those reactions. Residents also demonstrate a dichotomous response to willingness to work with this patient population characterized by either hesitancy to do so, or a desire to engage and attempt to work with these patients. A framework for understanding the possible effects and motivating variables behind these styles is presented. The predominant effects of the residents' interactions styles are either a distancing/paternalistic relationship or an engaging/collegial relationship. Two themes appear to characterize residents' motivations: the resident was driven by self-needs or patient-needs. These results may be useful in developing an initial theory of this previously unexamined dynamic. Moreover, these results may be useful in helping physicians better develop relationships with patients, especially through improvement in recognizing and utilizing personal reaction to patients. Future inquiries directed towards understanding what physician variables contribute to these two basic interaction styles identified here may be useful.

The aim was to elucidate the social construction of chronic pain as a cause of work absence in the UK, focusing on negotiation of sickness certification and return to work, in the context of recent policies to tackle rising sick-listing rates, including a national educational programme about the health benefits of work, and introduction of the ‘fit note’. Following a literature review, two qualitative studies were conducted from a symbolic interactionist perspective. The first comprised semi-structured interviews with doctors and chronic pain patients, leading to a second study in which employers and employees with chronic pain were interviewed. Interviews were transcribed verbatim and analysed according to constructivist grounded theory principles. The first study revealed tensions in the doctor-patient relationship as the process of sickness certification was negotiated. The indeterminacy of chronic pain rendered the biomedical approach to diagnosis and assessment of capability for work problematic, while a shift to the psychosocial model could generate feelings of invalidation in patients. A wide range of moral and socio-cultural factors was invoked by doctors and patients to contest sick-listing decisions. The second study identified difficulties that can emerge when chronic pain patients return to work. Employees discussed how managers failed to understand their problems or make sustained adaptations; employers reported difficulty reconciling the needs of employees with organisational imperatives and argued that employees and doctors colluded in sanctioning low resilience. All stakeholder groups supported the fit note’s focus on capacity not incapacity, but were skeptical about whether it would surmount the tensions and difficulties that arise in sickness certification and return to work for chronic pain patients. Struggles for meaning and construction of identities are difficult for policy to address, but deeper understanding of the processes behind them and rich accounts of stakeholders’ views, may nudge the system towards more appropriate responses.

This thesis is a qualitative study investigating the communication about sexual health between HIV-positive gay men and their doctors and other health care providers. The study was conducted in 2007 and 2008 in Sydney, Australia. Data was collected through in-depth interviews with eleven HIV-positive gay men, and analysed according to a modified grounded theory approach. The study aims to explore the men??s needs, expectations and experiences in relation to how sexual health is addressed in clinical consultations. While previous research has documented that HIV/AIDS is a diagnosis that poses significant physical, emotional and social challenges for People Living With HIV/AIDS (PLWHA) which may impact on their sexual health and well-being, this thesis examines whether, and to what extent this is communicated between HIV-positive gay men and their doctors. In doing so the study identifies and describes the ways in which HIV-positive gay men understand sexual health, how they currently talk to their clinicians about sexual health issues, the priority that such issues have for these men, and barriers and ??incentives?? to sexual health being discussed within HIV treatment settings. The study reveals that the men??s communication about sexual health with their doctors is essentially limited to discussions about sexually transmissible infections (STIs), which represent a common understanding of what constitutes sexual health. The emotional and social aspects of sexual health and well-being are rarely discussed in doctor-patient communication. Instead, the men rely on sources outside the health system, such as friends, peers, partners, gay and HIV community organizations and the gay and HIV media for sexual health information, advice and support. This indicates that broad, holistic sexual health has a low priority in discussions between patients and their doctors, and that social networks therefore play an important role in how HIV-positive gay men take care of their sexual health.

This thesis is a qualitative study investigating the communication about sexual health between HIV-positive gay men and their doctors and other health care providers. The study was conducted in 2007 and 2008 in Sydney, Australia. Data was collected through in-depth interviews with eleven HIV-positive gay men, and analysed according to a modified grounded theory approach. The study aims to explore the men??s needs, expectations and experiences in relation to how sexual health is addressed in clinical consultations. While previous research has documented that HIV/AIDS is a diagnosis that poses significant physical, emotional and social challenges for People Living With HIV/AIDS (PLWHA) which may impact on their sexual health and well-being, this thesis examines whether, and to what extent this is communicated between HIV-positive gay men and their doctors. In doing so the study identifies and describes the ways in which HIV-positive gay men understand sexual health, how they currently talk to their clinicians about sexual health issues, the priority that such issues have for these men, and barriers and ??incentives?? to sexual health being discussed within HIV treatment settings. The study reveals that the men??s communication about sexual health with their doctors is essentially limited to discussions about sexually transmissible infections (STIs), which represent a common understanding of what constitutes sexual health. The emotional and social aspects of sexual health and well-being are rarely discussed in doctor-patient communication. Instead, the men rely on sources outside the health system, such as friends, peers, partners, gay and HIV community organizations and the gay and HIV media for sexual health information, advice and support. This indicates that broad, holistic sexual health has a low priority in discussions between patients and their doctors, and that social networks therefore play an important role in how HIV-positive gay men take care of their sexual health.

No abstract / Mini Dissertation (MPhil)--University of Pretoria, 2019. / Public Law / MPhil / Unrestricted

Thesis advisor: Sharlene N. Hesse-Biber / This dissertation seeks to understand obstetricians’ lived experience of decision-making in childbirth and investigate how the organizational context within which obstetricians work influences how they make treatment decisions. Understanding how obstetricians make decisions in childbirth is important because maternity care in the United States is in crisis. Our system is failing women on multiple accounts: between 1990 and 2013, maternal mortality more than doubled in the United States, and is higher than most other high-income countries. Furthermore, women continue to suffer from abusive practices by maternity care providers who dismiss their concerns and sometimes outright refuse to honor their self-determination in childbirth. Today multiple stakeholders acknowledge a need for maternity care reform; this creates new challenges for health care policy and opportunities for social science research. Obstetrician-gynecologists provide the majority of maternity care to American women, and this dissertation examines their lived experience of decision-making in birth and analyzes how a range of social forces affect this process. To investigate this phenomenon I performed 50 in-depth interviews with obstetricians from Massachusetts, Louisiana and Vermont about how they make patient care decisions in birth. The specific research questions and analysis for each chapter evolved through an iterative process that combined analytical grounded theory and template analysis. I present this in a three-article format. In article one I show how shift-work models of labor and delivery pose challenges to using a patient-centered approach to decision-making. Obstetricians either work shifts in labor and delivery or they work on-call for their patients’ births. The current thinking is that shifts are good because they allow work-life balance for doctors, reduce fatigue, and reduce convenience-based decisions. Shift work models assume that doctors and patients are interchangeable because doctors will follow protocols and standards of care produced by medical professional organizations. I argue shift work does not work in practice the way it does in theory. I explain how there are not standards for many decisions in birth, instead these decisions are characterized by medical uncertainty. In these cases, doctors rely on patient-centered approaches to make decisions. But shift work limits doctors’ ability to use patient-centered approaches. I found that shift-work models of hospital care do not provide doctors the opportunity to get to know their patients and understand their preferences. In practices that do not depend on shift work, the doctor patient relationship is far less fragmented and doctors tend to experience less conflict with their patients and are less likely to rely on stereotypes that reproduce social inequality. In article two I examine obstetricians’ understandings of convenience as a motivation in decision-making. Anecdotal evidence suggests that obstetricians sometimes make clinical care decisions less out of concern for their patients and more out of concern for their own time and schedule. This may be a particular problem in on-call models. In this paper I show doctors’ stories match anecdotal evidence: Some obstetricians make clinical decisions in birth based partially on their own convenience. Yet others actively resist the temptation of convenience, even in on-call care. A key dimension of this difference lies in doctors’ understandings of the nature of time in labor and the safety of interventions. Some doctors have a faster-the-better approach to birth and believe the routine use of interventions is the best way to practice in labor and delivery. These doctors frame their own convenience as legitimate because it overlaps with the idea that speeding up the labor is inherently good. Alternatively, other doctors believe time in labor is productive, and that interventions should be used judiciously because they increase risk of harm. These doctors cannot easily legitimize convenience because it conflicts with the reduction of interventions as a key dimension of this philosophy. I argue that because shift work poses serious challenges to patient-centered care, cultural change is a better avenue for reducing births of convenience. Article three addresses an ongoing question in medical sociology about whether physicians maintain control over their clinical work amidst challenges to their authority. Patient empowerment and standardization are two movements that sociologists have theorized in terms of weakening of doctors’ clinical discretion. I uncover how obstetricians draw on the conflicting nature of these approaches strategically to maintain their power in the face of a threat. Standards and patient empowerment act as countervailing powers; they drew on one to off set the challenge to their authority posed by the other. / Thesis (PhD) — Boston College, 2017. / Submitted to: Boston College. Graduate School of Arts and Sciences. / Discipline: Sociology.