This thesis investigates how Japanese doctors create and maintain patient-centred consultations through their verbal interaction with patients, and the extent to which features of Japanese interpersonal communication influence the institutional discourse. Audio recordings of 72 doctor-patient interactions were collected at the outpatient department of a Japanese teaching hospital. All consultations involved new cases. There were two kinds of consultations: a preliminary history-taking interview with an intern and a diagnostic consultation given by an experienced doctor. After transcribing the recordings sequences of the discourse were analysed qualitatively on a turn-by-turn basis and a corpus of the data was analysed quantitatively to establish frequencies of discourse features related to patientcentredness. A review of literature (Chapter 2) establishes the standard structure of medical consultations and the relationship of the doctor and patient during consultations in terms of the asymmetry of speaking initiative according to consultation phases. The second part of Chapter 2 is an examination of Japanese communication style, attested to be influenced by culturally specific norms of behaviour that are demonstrable through verbal interactions. Chapter 3 describes the research method, and this is followed by four chapters of analysis. Chapter 4 describes the nature of the two kinds of consultations; the phases they include, and how the participants shift from one phase to the next with phase transition markers. Particular attention is paid to opening and closing phases, as they are most relevant to the establishment and consolidation of a patient-centred relationship. Chapter 5 investigates patterns of questioning by doctors, identifying functional categories of questions to see how they are used to coax information from the patient. Chapter 6 examines how the doctor encourages the patient’s narrative through backchanneling; how the doctor accommodates the patient through sensitive explanations of treatments and procedures; and how the voice of the patient emerges through calls for clarification, and voicing concerns. Chapter 7 highlights discourse sequences that may indicate culturally specific influences, and examines the emergence of laughter as an indicator of Japanese interpersonal interaction. The features of these Japanese consultations are consistent with medical consultations described in English speaking settings regarding phases and the discourse strategies used to achieve patient-centredness. While there appear to be Japanese cultural influences in the interactions consistent with previous cross-cultural studies the author argues that the institutional setting (clinical framework) is more immediately relevant to the conversational dynamics of the interactions than the Japanese cultural setting. Finally, medical consultations involving new cases have more features of service encounters and therefore not controlled by the guidance-cooperation model of doctor-patient interaction.

The diploma thesis deals with witchcraft and other mystic phenomena in conception of Edward Evan Evans-Pritchard. It is focused especially on the notion of witchcraft in connection with magic, shamanism and oracles. It describes relation of all these phenomena towards religious belief and various attitudes towards them. It defines respective practices and explains differences between them. Last but not least, it introduces usual reactions to them. Via concrete situation it also shows interconnection of all described phenomena and presents them as a coherent and logical system.

This thesis is an exploratory look at the process for designing the costumes for Neil Simon’s The Good Doctor. This production was produced at the University of New Orleans as part of its 2012-2013 season. Within this thesis we explore the multifaceted journey of the costume design process. As a designer, it is one’s job to use both historical and textual analysis in order to create a design that supports the thematic structure of the play. The following journey begins with initial research on the complex relationship between Neil Simon and his subject Anton Chekhov. It continues to include individual character concepts, as well as a re-telling of the production process. Finally, it concludes with an analysis of the validity of the design as a whole. Costume Design, Neil Simon, Anton Chekhov, The Good Doctor

Doctor en Ciencias con mención en Biología

Civil disputes between doctor and patient in medical healthcare The issue of civil disputes between doctor and patient in medical healthcare is characterized by a high degree of interdependence of substantive and procedural questions. The main issue here is inequality between doctor and patient in their relationship, which is based more on factual inequality than inequality in rights. The patient as consumer and therefore the weaker party has limited access to relevant information concerning the subject of the relationship between doctor and patient. On the other hand, a doctor is a subject which has in its power almost all the relevant information. As can be seen, for a given relationship is characteristic a high degree of inequality of information. This inequality, which arises in the relationship always, is not sufficiently addressed by the substantive regulation and its effects are present in subsequent court proceedings in the form of an information deficit. Intention of this paper is to present the fundamentals of the relationship between physician and patient, the reasons for the information deficit and its consequences in legal proceedings and ways of its compensation. The aim is to assess whether the current regulation is to ensure equality between doctor and patient with emphasis on the...

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.

A proposição dessa dissertação é demonstrar as características do processo comunicativo que acontece na relação médico-paciente, dentro do ambulatório, a fim de compreender sua função como mediadora da tensão existente entre as expectativas do paciente quanto ao atendimento idealizado e o serviço público realmente prestado na área da saúde em São Paulo. Considerou-se pertinente analisar a questão da comunicação na saúde pública em São Paulo, usando como parâmetro o Hospital do Servidor Público Francisco Morato de Oliveira, pertencente ao Instituto de Assistência Médica ao Servidor Público Estadual, o IAMSPE, por ser uma instituição que poderá fornecer dados sobre uma população de usuários, de serviços e de médicos. Para isso foi preciso identificar as normas padrão de atendimento do hospital; a percepção do paciente sobre o médico e também de como acha que o médico o percebe, assim como do atendimento recebido pelo médico e pela Instituição. A percepção dos médicos sobre si mesmo, sobre o paciente e o atendimento oferecido por ele e pela Instituição. A noção de comunicação de ambos e a qualidade da comunicação nesta relação - procurando identificar os condicionantes que existem entre o atendimento esperado e o atendimento real. Foi realizada uma pesquisa de campo com médicos e pacientes dos serviços mais representativos (pela importância e população atendida) e essa amostra mostrou-se significativa, tanto pelos dados colhidos pelos questionários quanto pela observação feita pelos pesquisadores. Os resultados dos dados e das informações colhidas são um retrato temporal dos papéis percebidos e vividos por médicos e pacientes no contexto de uma instituição de saúde pública na cidade de São Paulo. / This dissertation aims to study the characteristics of the communication process between the doctor and the patient within the clinic, so as to better understand it and analyze it as the mediation between patients\' expectations - concerning idealized public health service - and the real public health service offered in São Paulo. Therefore, communication in Hospital do Servidor Público Francisco Morato de Oliveira (a public hospital), a division of Instituto de Assistência Médica do Servidor Público Estadual IAMSPE (Health Care System of the Public Sector), was analyzed. This institution provided valuable data and information about its patients, services and physicians. To carry this research out, it was necessary to identify how the hospital provides its service, how the patient perceives the physician and how he believes the physician perceives him -, how the patient perceives the services of the physician and of the Institution, and how the physicians perceive themselves, patients and the service offered both by himself/herself and by the Institution. The notion and the quality of the communication in this relationship were studied in order to identify the characteristics of both desired and real services. A field research was carried out with physicians and patients of the most representative services (ranked by importance and by the size of the population served), and this portion of the population proved itself to be significant, because of both the data collected through questionnaires and the researchers view point. The results of the data and information collected are a timely picture of the roles perceived and lived by doctors and patients in the context of a public health care institution in the city of São Paulo.

O foco deste estudo está nas possíveis transformações na relação de poder estabelecida entre médico e paciente representada em três comunidades virtuais com tema em saúde-doença. Trata-se de uma pesquisa qualiquantitativa com uso da técnica do Discurso do Sujeito Coletivo (DSC), o que possibilita a construção de discursos coletivos distintos que expressam as representações sociais de uma coletividade. Como resultado é possível verificar: (i) porque as pessoas participam de comunidades virtuais; (ii) como as pessoas participam; (iii) como se organizam essas comunidades; (iv) quais tipos de informações são mais buscados; (v) quais conteúdos informacionais existem nos fóruns de discussão (vi) como se dá a interação entre integrantes da comunidade; (vii) como as relações de poder estabelecidas entre médico e paciente são tratadas nas comunidades; (viii) identificação de possíveis transformações na relação de poder estabelecida entre médico e paciente. Conclui-se que a maior parte dos integrantes das comunidades analisadas está em um nível associativo-participativo de compartilhamento das informações e experiências. Esse nível, apesar de não se constituir em ação de cooperação e prática de produção coletiva, permite aos integrantes se tornarem pacientes mais ativos em seus processos de saúde e doença. Os resultados sugerem que o princípio ético da autonomia está, legalmente e na prática, mais fortalecido, contribuindo com a constituição de um indivíduo integrante, interativo, mais autônomo / Possible changes in the power relationship established between doctor and patient represented in three online communities which address the subject of health and illness is the focus of this study. This is a qualitative and quantitative research using the Collective Subject Discourse (DSC), which allows the construction of separate collective discourse, which expresses the social representations of a collectivity. As a result, it is possible to verify: (i) why people participate in such virtual communities , (ii) how people participate, (iii) how those communities are organized, (iv) what types of information are most searched, (v) which information exist in those discussion forums (vi) how community members interact, (vii) how the power relations established between doctor and patient are treated in these communities, (viii) identification of possible changes in the relationship established power between doctor and patient. We conclude that most members of the communities studied are in an associative-participatory level regarding information and experiences sharing. This level, though is not considered as an action of mutual cooperation and collective production practice, allows members of such communities to become more active as patients in their processes of health and disease. The results suggest that the principle of autonomy is, legally and in practice, more energized, contributing to the constitution of an individual, integral, interactive, and increasingly autonomous

There are numerous empirically described problems of communication in healthcare. The doctor/patient relationship is fundamental to many such problems. The changing nature of healthcare and the doctor/patient relationship is explored in this thesis. An increasing evidence base demonstrates that patient outcomes in healthcarea re directly relatedt o clinical communication. However, more fundamental than patient outcomes is the very nature of personhood and the effects illness has on individual autonomy. A theory of human need provides the foundation for discussion. Autonomy in healthcare is discussed in these terms and is argued as a basic human need. Moreover, human communication is argued as a basic human need using the same theoretic approach. It therefore follows logically that health professionals have the same duties and responsibilities to meet basic human communication needs on the same terms as those for autonomy. The relationship between autonomy and communication is shown to be a reflexive one. A theory of democratic communication is drawn on to describe the type of communication that will meet autonomy and communication needs. This is set in the context of healthcare. Consent in healthcare is used to show how far we have come in meeting communication and autonomy needs. Given the arguments o far it is reasonable to expect medical education to respond to the changing and recognised needs of the users of healthcare. The role of effective communication in medical education programmes is explored. Finally, a strategic approach to organising and delivering a communication curriculum is proffered which tries to meet both the philosophically and democratically argued basic needs. The resulting communication curriculum combines theoretic foundations with a pragmatic approach to the problems of clinical practice. If the approaches in this thesis are followed then communication can no longer be perceived as something doctors do after they have completed other medical tasks. Effective doctors have to be effective communicators in order to meet patients' needs.

Made available in DSpace on 2016-04-29T14:27:18Z (GMT). No. of bitstreams: 1 Antonio Alone Maia.pdf: 1544608 bytes, checksum: 1f7096be45b8738b8c3b55b9a59685c7 (MD5) Previous issue date: 2011-02-16 / ADVENIAT / During the period of colonization most African cultural practices were discouraged in the name of civilization. Nevertheless, the local knowledge is part of the culture and the culture is something alive and active that people carry inside themselves. The colonial regime changed, but its track and politics somehow remained commanding in the new local governments in the period of independence and post independence. But the people, who had suffered before because of the colonial situation, then by the civil war, never gave up living its culture the way they inherited from their ancestors in matters of knowledge, relationship and behavior. This research talks concretely about the Mozambican people. The aim of this research is to talk about Nyungwe s cultural etiologies of health, disease and cure from an anthropological and theological point of view: attendance, treatment and cure. Where do people find response for daily situations related to health? When a woman does not get pregnant, or a man does not manage to make a woman pregnant, how does biomedicine handle this issue? If the woman gets pregnant and does not manage to have the baby or if she has a spontaneous abortion during pregnancy period, how do the doctors from the hospital as well as the traditional doctor deal with this problem? The research aims as well to point out the role of the ancestors, traditional doctors within nyungwe s culture and from these categories to set a Christology reflection according to African and not Western ways / Durante o período colonial muitas práticas culturais dos povos africanos foram combatidas em nome da civilização. No entanto, os saberes locais fazem parte da cultura e a cultura é algo vivo e atuante que o povo carrega dentro de si. Mudou o regime colonial, mas seus rastos e suas políticas ficaram de alguma forma imperando nos novos governos locais nos períodos da independência e pós- independência. Mas o povo que antes sofrera com a situação colonial e depois com as guerras civis, nunca deixou de viver a sua cultura da forma como foi herdada dos seus antepassados em matéria de saberes, relacionamento e regras de conduta. É do povo moçambicano que a pesquisa está falando concretamente. A pesquisa pretende falar das etiologias de saúde, doença e cura na cultura Nyungwe, com um olhar antropológico-teológico: atendimento, tratamento e cura. Onde é que as pessoas encontram resposta para as situações quotidianas relacionadas à saúde? Quando uma mulher não consegue ficar grávida ou um homem não consegue engravidar uma mulher, como é que a biomedicina lida com essa situação? Se uma mulher fica grávida e não consegue ganhar o nenê ou quando ela tem abortos espontâneos no período da gravidez, como é que os médicos da medicina hospitalar assim como os médicos tradicionais lidam com esse problema? A pesquisa quer também trazer à tona o papel dos ancestrais, dos médicos tradicionais dentro da cultura Nyungwe e a partir destas categorias re-pensar a cristologia nos moldes africanos e não ocidentais