As a therapist within the multi-disciplinary setting, one is confronted with a wide array of pathology and diagnoses. Care is taken to optimize treatment outcomes and overall return of function to every patient admitted to the various rehabilitation facilities. Treatment is often standardized to ensure quality care benchmarked against outcome parameters. The aforementioned is also true for medical practitioners, pharmacists and other auxiliary service providers. Research is aimed at improving quality of care, finding and establishing the best practises through all hospitals and care facilities. Medical care has undergone a transformation over the past few decades with a strong emphasis being placed on protocols and procedures. Through applying standardized care, protocols and procedures, the researcher have come to realize that certain denominators within patient care have no prediction or outcome control. After more than a decade of treating patients in various rehabilitation settings the researcher have come to realize that one complaint exists with each and every patient under my care – pain. This was even more evident within the group of joint replacement patients. No two patients presented with the exact same pain profile or pain reports despite various commonalities such as anthropometric data (age, gender, length, mass), surgical procedure, attending physician, care facility, pathway exposure, diagnosis, radiographic findings and pharmaceutical intervention. If all the obvious factors were identical – what accounted for the different pain reports? This question is at the heart of the study – why do pain reports differ in the presence of so many similarities between patients? It soon became apparent that pain is recognized in the organic form. Organic pain can be measured and is expected with injury, illness or surgical intervention. The entire multi-disciplinary team is aware of organic pain and ready to intervene with medication, surgery and a pathway of care. All vigorously record organic pain and adapt treatment according to the pain levels as organic pain is real pain: real pain existing through exposure to real surgical intervention. Still the question remained: if all the factors prior to surgery, during surgery and after surgery were the same, why are patients experiencing and reporting very different pain levels? This question was the catalyst for the research and lead to keen focus during patient interviews. Every patient receiving an educational session prior to surgery had very vivid ideas about the pain they will experience post-operatively. The majority of patients formed pre-conceived notions about pain prior to undergoing surgery. They presented with a clear pain rating of what they expected to feel post-operatively. The pre-conceived pain rating was constructed in almost all the cases after some form of information obtained during consultation with their surgeon or a member of the multidisciplinary team. This pain notion existed as a tangible and measurable rating in the client’s mind prior to undergoing the knee replacement surgery. In select cases perceived pain was constructed as a result of information obtained from family or friends that underwent the same procedure while other clients constructed perceived pain due to a lack of information on the proposed surgery. It became evident that education or lack thereof on surgical interventions played a primary role in the construct of perceived pain. Patients were entering theatres for procedures and already experienced a form of perceived pain. If pain could be constructed prior to experiencing surgical intervention – can perceived pain then translate into actual organic pain and account for the variable pain reports post surgery? Against this backdrop, research was directed at understanding perceived pain and the factors that aid the construction of perceived pain. As education was found to be at the heart of every pain construct, the doctor-patient consultation was evaluated as a core component to ascertain the impact this relationship has on perceived pain. Measurement of perceived pain was also performed to conclude on the impact of this pain form on organic pain. The study is aimed at addressing the variant pain reports that no pathway or procedure can predict and provide for. It is an attempt to validate pain as constructed by the patient that impacts on their post-surgical pain ratings and behaviour. This research might contribute towards existing knowledge and understanding of the influence of doctor-patient interaction as well as the significance of this interaction on pain. As only scant research on perception of pain has been undertaken this research can prove insightful for further studies or as supplement to existing views and opinions. It can also serve as a foundation in developing practices that will manage pain by enhancing doctor-patient interaction in the health setting. / MA, Medical Sociology, North-West University, Vaal Triangle Campus, 2012

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 study investigates doctors’ and patients’ usage of three speech functions; namely statements, questions and commands in the American medical drama series House M.D. Furthermore, the study investigates interruptions between doctors and patients. The aim of the study was to ascertain whether the claim that doctors practice power over patients can be verified. The data comprises transcripts of 16 video recorded sessions of doctors and patient interacting where the material was personally collected and analyzed. In their interactions, doctors were found to dominate in making statements, asking questions and uttering commands. In addition, it was detected that the doctors’ and patients’ way to communicate differed given the fact that doctors are trained in their roles as doctors while patients are not. However, both interactants were found to perform the different speech functions similarly. The study also revealed that doctors interrupted more as compared to patients. Furthermore, gendered interruptions were found in the data, all of which came from male participants and it was concluded that the findings could be linked to the social and cultural roles of the participants. Overall, it was concluded that there exists a power relationship between doctors and patients.

As a therapist within the multi-disciplinary setting, one is confronted with a wide array of pathology and diagnoses. Care is taken to optimize treatment outcomes and overall return of function to every patient admitted to the various rehabilitation facilities. Treatment is often standardized to ensure quality care benchmarked against outcome parameters. The aforementioned is also true for medical practitioners, pharmacists and other auxiliary service providers. Research is aimed at improving quality of care, finding and establishing the best practises through all hospitals and care facilities. Medical care has undergone a transformation over the past few decades with a strong emphasis being placed on protocols and procedures. Through applying standardized care, protocols and procedures, the researcher have come to realize that certain denominators within patient care have no prediction or outcome control. After more than a decade of treating patients in various rehabilitation settings the researcher have come to realize that one complaint exists with each and every patient under my care – pain. This was even more evident within the group of joint replacement patients. No two patients presented with the exact same pain profile or pain reports despite various commonalities such as anthropometric data (age, gender, length, mass), surgical procedure, attending physician, care facility, pathway exposure, diagnosis, radiographic findings and pharmaceutical intervention. If all the obvious factors were identical – what accounted for the different pain reports? This question is at the heart of the study – why do pain reports differ in the presence of so many similarities between patients? It soon became apparent that pain is recognized in the organic form. Organic pain can be measured and is expected with injury, illness or surgical intervention. The entire multi-disciplinary team is aware of organic pain and ready to intervene with medication, surgery and a pathway of care. All vigorously record organic pain and adapt treatment according to the pain levels as organic pain is real pain: real pain existing through exposure to real surgical intervention. Still the question remained: if all the factors prior to surgery, during surgery and after surgery were the same, why are patients experiencing and reporting very different pain levels? This question was the catalyst for the research and lead to keen focus during patient interviews. Every patient receiving an educational session prior to surgery had very vivid ideas about the pain they will experience post-operatively. The majority of patients formed pre-conceived notions about pain prior to undergoing surgery. They presented with a clear pain rating of what they expected to feel post-operatively. The pre-conceived pain rating was constructed in almost all the cases after some form of information obtained during consultation with their surgeon or a member of the multidisciplinary team. This pain notion existed as a tangible and measurable rating in the client’s mind prior to undergoing the knee replacement surgery. In select cases perceived pain was constructed as a result of information obtained from family or friends that underwent the same procedure while other clients constructed perceived pain due to a lack of information on the proposed surgery. It became evident that education or lack thereof on surgical interventions played a primary role in the construct of perceived pain. Patients were entering theatres for procedures and already experienced a form of perceived pain. If pain could be constructed prior to experiencing surgical intervention – can perceived pain then translate into actual organic pain and account for the variable pain reports post surgery? Against this backdrop, research was directed at understanding perceived pain and the factors that aid the construction of perceived pain. As education was found to be at the heart of every pain construct, the doctor-patient consultation was evaluated as a core component to ascertain the impact this relationship has on perceived pain. Measurement of perceived pain was also performed to conclude on the impact of this pain form on organic pain. The study is aimed at addressing the variant pain reports that no pathway or procedure can predict and provide for. It is an attempt to validate pain as constructed by the patient that impacts on their post-surgical pain ratings and behaviour. This research might contribute towards existing knowledge and understanding of the influence of doctor-patient interaction as well as the significance of this interaction on pain. As only scant research on perception of pain has been undertaken this research can prove insightful for further studies or as supplement to existing views and opinions. It can also serve as a foundation in developing practices that will manage pain by enhancing doctor-patient interaction in the health setting. / MA, Medical Sociology, North-West University, Vaal Triangle Campus, 2012

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

No description available.

No description available.

No description available.