Truth telling forms part of the contemporary debate in clinical bioethics and centers around the right of the patient to know honest information concerning his or her medical condition / illness and the duty of the doctor to inform the patient of such. Anecdotal evidence seems to imply that patients have concerns with the practice of truthtelling. Many often complain that they are not being informed and sometimes simply being ignored in matters that primarily concerns their health. On the other hand, there may be patients who do not to want a truthful answer to their health problems-they would in fact rather not know. The aim of this study was to explore my intuition that patients who attend the Johannesburg General Hospital are not given full information about their condition(s) and / or treatment(s) although they would like to know. The study explored the preferences of patients regarding the practice of truth telling and their attitudes toward truth telling in four out patient clinics of the Johannesburg General Hospital. Four hundred and sixty five participants completed and retuned the questionnaire from four different out patient clinics, namely oncology, surgical (general surgery and orthopedics), medical (gastro, renal and general internal medicine) and the nuclear medicine unit that represented the mixed out patient clinic. The majority of participants stated that the doctor had disclosed information about their condition (92.90%). Almost all participants were of the opinion that patients have the right to know about their condition (98.28%) and also that the doctor has the duty to inform them of their condition (98.02%). If they were suffering from a serious condition, a higher percentage of participants (86.28%) would prefer to know about their condition while a small but significant percentage (13.72%) would prefer not to know. The vast majority of participants (96.64%) also preferred to know about information relating to their treatment in detail while a high percentage (87.83%) supported disclosure to relatives. Variables such as gender, age and level of education did not seem to impact on the participants’ opinions of the truth telling process with significance with the exception of iv gender in relation with knowledge of one’s condition (p=0.0176) and education with regard to opinions on the right of patients to disclosure (p=0.0430). From the above results it can then be concluded that: 1. Participants in our study supported the right of patients to disclosure and the vast majority also felt that doctors have the duty to inform patients of their condition. 2. A significant percentage of participants felt that the level of information given to them was not satisfactory even when they have requested for more. This should be looked at and means for improvement should be sought. 3. A small but significant group did not support disclosure and must be respected as autonomous beings. 4. Gender seems to influence opinions of patients concerning their condition and education impacts on opinions relating to right of patients to disclosure of information. 5. To our appeasement, we found that patients attending the Johannesburg hospital are in fact given information about their condition. It is rather the quality and the quantity of information given that should be subject to scrutiny if we would like to move towards full disclosure in the process of truth telling in our institution. 6. Future studies should be considered to assess the attitudes of doctors towards disclosing, as well as further assess conflicting opinions in small group of patients by means of direct interviews.

Thesis (M.Sc.). / Title from title page of PDF (viewed 2008/01/30). Written for the Medical Physics Unit, Faculty of Medicine. Includes bibliographical references.

Thesis (M.S.)--Boston University

Thesis (M.A.) - Simon Fraser University, 2005. / Theses (Faculty of Arts and Social Sciences) / Simon Fraser University.

Thesis (M.A.) - Simon Fraser University, 2005. / Theses (Faculty of Arts and Social Sciences) / Simon Fraser University.

Abstract General hospital psychiatry operates between the somatic and psychiatric approaches concerning the treatment of patients, combining knowledge from both somatic and psychiatric medicine. To establish its position, the general hospital psychiatry has to specify its role and means when rendering services. This study revealed how consultation had been arranged in six Finnish polyclinics of general hospitals. The goal was to find out which types of patients were referred to the consultation of the general hospital psychiatry and the extent of collaboration of the consulting psychiatrist with colleagues from other medical disciplines. Moreover, the focus of attention was on whether there were operational differences between the polyclinics of the University Hospital of Oulu and other hospitals. The work was also addressed to probing operational differences, if any, pertaining to people under or over 65. Additionally, one aspect to be clarified was how requests for psychogeriatric consultations and the responses of the consulting psychiatrists had developed during the five years period of the study. This study was part of a broad European Consultation Liaison Working Group effort aimed at clarifying the organization of general hospital psychiatry in 56 units in 11 European countries. The Finnish material consisted of 1255 patients, of whom 202 were over 65. The research methods applied here were psychiatric interviewing of clinical patients, and filling in of data collection forms following the instructions of the ECLW Group. The current work revealed that the number of psychiatric consultations was less than expected considering the incidence of psychiatric symptoms among somatically ill patients. Of the general hospital patients, elderly people were especially underrepresented. More than 90% of the patients who had a psychiatric consultation were diagnosed with a psychiatric problem. Thus the general hospital made available psychiatric treatment via psychiatric consultation, with a recommendation for future psychiatric care for more than half of the patients. However, one third of the patients under 65 and quarter of those above that age had already had on going psychiatric treatment. In view of this type of situation the position of the general hospital appears problematic. The object of consultation was in 90% of the cases the patients themselves, but in Oulu, almost half of the consultations were due to the personnel of the somatic disciplines in charge of the of the patients. The action mode in separate general hospitals was connected to established traditions, although the history of general hospital psychiatry is short and faces constraints put forward by the somatic hospitals. Collaboration between psychiatric and somatic disciplines was facing increasing difficulties during the five years observation period, probably due to economic recession.

This study reviews the growth and development of the Health Centre for Children, Vancouver General Hospital, which has offered, for the past four years, a diagnostic and treatment service to children in low-income families. The aim of the project is to determine to what extent the need in the community for a service of this kind is being met. The main research methods used to obtain the necessary information have been interviews and studies of medical and social case records. The medical structure is described in detail with suggestions for improvement of service in this area. The role which the social worker fulfills is outlined, and is compared with the role which the social worker would ideally assume in a setting of this type. Suggestions for improvement of service are made in this area also. Particular emphasis is placed upon the need for treatment of the "whole" individual, a factor which, because of concentration upon expansion of medical services, appears to have received too little attention in the Health Centre. Although there is still room for improvement in the programme, there is reason to believe that the need in the community for a service of this kind is being met to a great extent. The main indication of this is the comparatively large number of people who use the Health Centre facilities. This is particularly evident when attendances for the four-year period are compared with the numbers who used the only public medical services formerly available. Since the Health Centre will be moving into new and more spacious quarters in the course of the next few months and since, at this time, many major and minor changes will be instituted, this study is considered an interim one. It would be valuable to have a further study completed after four or five years of continued operation. / Arts, Faculty of / Social Work, School of / Graduate

This study is concerned with analyzing the ways in which the members of an organization faced with problems of unpredictability and uncertainty, adapt to the situation and achieve some degree of control over it. Chapter 1 describes the organization within which the study was conducted, and also discusses the methodology employed. Chapter 2 reviews the literature pertinent to the problem, both on the spheres of organization theory and medical sociology. Chapter 3 describes the role and mode of adaptation of the physician to the situation. Chapter 4 examines the role of the head nurse and her relations with other ward members. Chapter 4 examines the role of the head nurse and her relations with other ward members. Chapter 5 provides an analysis of the sources of tension and conflict in the ward and the final chapter contains a summery of the previous arguments and a discussion of their pertinence to sociological theory. / Thesis / Master of Arts (MA)

Thesis (M.S.)--Boston University

Thesis (M.S.)--Boston University