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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.

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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.

Abstract Traditionally, doctors and patients are based on different cognitions and ways of thinking to communicate with each other. Doctors are often holding dominated role in the process. The knowledge of doctors is coming from the curricula that they have learned at medical school and their clinical experience, whereas the knowledge of patients is coming from their health experience and the information which was reported in the common medical magazines and journals. Because of the different cognitive modes of medicine between doctors and patients, the efficiency of doctor-patient communication is usually unsatisfied. With the popularity of medical information, the rise of consumers¡¦ consciousness, and the change of health insurance system, patients are asking better quality of medical treatment now. Thus, the quality of doctor-patient communication seems to be more important. This research was employed by case study. The doctors and outpatients of the pediatrics department were selected as the research sample. Totally, the sample included six senior doctors with three different levels of hospital and 30 outpatients. The dialogs of interrogation enquiry between these doctors and patients were collected. The analytic framework was derived from Brown and Levinson¡¦s politeness theory, Grice¡¦s conversational maxims, and Roter¡¦s analytical system of doctor-patient communication behavior. This study analyzed the politeness strategies used during doctor-patient communication, and also found the communication modes that were frequently emerging in the diagnostic processes. The research results show that the maximum politeness strategies used in pediatrics clinics is the bald on record. This reveals a kind of consensus on the importance of communication efficiency for doctors and patients. Most of patients adopt more polite strategies to communicate with doctors for medical knowledge. The results also suggest several commonly-seen dialog modes providing the further self-awareness and self-observation for doctors and patients. Indirect communication, the off-record politeness strategies are also appeared in the dialogues of doctors and patients. This study contributed toward gaining the efficiency of doctor-patient communication, thus may be helpful in the saving of medical resources. Keywords: doctor-patient communication, politeness theory, therapeutic behavior, pediatrics clinics

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