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This investigation explored the role of informational and psychological privacy in the health context by examining the relationship between type of relationship (physician versus acquaintance), type of observation (self-report versus observation), and communication strategies used to restore or preserve privacy (interaction control, dyadic strategies, expressions of negative arousal, blocking and avoidance, distancing, and confrontation). It was hypothesized and confirmed that individuals report exhibiting more behaviors to restore or preserve informational privacy in response to an informationally privacy-invasive question posed by an acquaintance than by a physician. The hypothesis that presentation of an informationally privacy invasive question by the physician causes patients to exhibit more communication strategies after the privacy invasive question than before, was unsupported. Finally, the hypothesis that individuals actually exhibit more privacy restoration behaviors than they report using in a similar situation with their physician was also unsupported. Patients reported using more communication strategies than they actually exhibited. One confound to the self reports was that videotaped participants reported the use of fewer direct privacy restoring communication strategies than non-videotaped.

ABSTRACT HOSPITALS WITH PHYSICIAN CEOS: AN INSTITUTIONAL THEORY PERSPECTIVE By: Jeremy S. Zoch, Ph.D. A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Health Related Sciences at Virginia Commonwealth University. Virginia Commonwealth University, 2011 Major Director: Kenneth R. White, Ph.D. Professor Department of Health Administration The complexities of the healthcare industry at the beginning of the 21st century continue to challenge hospitals to optimize their operations. A key leadership position in the overall success of a hospital is the role of the Chief Executive Officer. The purpose of this study was to determine the kind of leader that hospitals have in place and to analyze more closely those specific organizations that have physician CEOs. This study had three distinct objectives. The first was to describe the organizational variables for American Hospital Association (AHA) hospitals with CEOs who are physicians. The second objective was to analyze the organizational and market characteristics of hospitals with physician CEOs. The final objective was to examine the similarities and differences between hospitals that have a CEO who is a physician and those headed by a CEO who is not a physician. Institutional theory was utilized to form a theoretical model and to develop the relevant hypotheses. The study was a retrospective, cross-sectional study of over 5600 American Hospital Association (AHA) short-term, acute care hospitals located in the United States. Data sources utilized were the AHA’s Annual Survey of Hospitals, the Area Resource File, Centers for Medicaid and Medicare Services, HealthLeaders-Interstudy, and SK&A from 2007-2008. There were 118 hospitals out of 5,671 with a physician CEO in 2008. The descriptive statistics and multivariate logistic regression analyses revealed that although hospitals with physician CEOs are located in many different locations and types of hospitals, they are some attributes that indicate a greater likelihood. Hospitals with physician CEOs are most prevalent in the northeast. The multivariate logistic regression analyses revealed there is a greater likelihood that hospitals with physician CEOs are more likely to be larger, specialty, not-for-profit and non-church operated, teaching, and be in a market with higher physicians per capita. The study also found that there wasn’t more likelihood for a hospital to have a physician CEO when comparing with US News top hospitals, based on affluence of a market, based on the competition in the market, or the managed care penetration. The study identified several of the components and how they positively relate to the institutional theory model that was developed. The study also identified several limitations that could further be improved using additional research approaches and obtaining more data. Overall, the study has furthered the information available about hospitals with CEOs who are also physicians and their corresponding organizational and market characteristics.

In the recent past, physicians found answers to questions by consulting colleagues, textbooks, and professional journals. Now, the availability of medical information through electronic resources has changed physician information-seeking behaviors. Evidence-based medicine is now the accepted decision-making paradigm, and a physician's ability to locate best practice guidelines through electronic information resources has become an essential skill. As physicians struggle to stay current in the wake of an ever-growing volume of medical information, several electronic resources claim to provide one-stop access to the most current information with correct and complete answers to problems encountered in the practice of health care. The complexity of medical information, however, prevents one resource from meeting all of a physician's information needs. The research described here sought to identify which resources physicians used to find answers for a particular area of inquiry, identify the appropriateness of their resource selection, and compare the choices with their satisfaction with their results. A questionnaire was e-mailed to a randomized group of family practice physicians asking them to indicate which resources they use to answer questions that arise within their professional practice. Physicians were also asked to rate the attributes of these resources. Their responses revealed that physicians do not always select the correct resource and are not necessarily confident even when they do select the correct resource. Physicians did not demonstrate a global overview of the strengths and weaknesses of information resources, but rather, consistently chose the same resources in approximately the same order regardless of the information they were seeking. The results of this study indicate that physicians do not understand the scope and capabilities of the resources they are using. This research has produced recommended guidelines to provide health information professionals with a course of action to restructure physician training. These guidelines cover such concepts as vetting a resource, selecting the correct resource for a topic of interest, when to partner with an information professional, an overview of the resources their patients may be using, and a synopsis of other features to support information literacy.

Extensive research has been conducted on the attitudes of physicians and nurses toward euthanasia. However, little is known on the attitudes of suicide prevention workers (SPWs). The objectives of this study were to: (1) examine the attitudes of SPWs toward euthanasia for a non-descript person versus for a loved one; (2) verify the association between personal factors (experiences, sociodemographics) and attitudes, and (3) explore personal experiences of SPWs in relation to grievous illness. A survey was sent out to all suicide prevention centres across Quebec (n=32). A majority of SPWs (55.7%) held positive attitudes toward euthanasia for a non-descript person and for a loved one (49.5%). Statistically significant differences were found in attitudes among SPWs who had personal and professional experiences. There were no other statistically significant differences in the attitudes of SPWs toward euthanasia for a non-descript person or for a loved one, and any of the sociodemographic factors. Three themes emerged from the qualitative analysis of open-ended question on personal experiences of SPWs: respect of choice, suffering/low quality of life and palliative care. While some findings may be concluded from this study, it is essential that this topic be explored further as research on SPWs’ attitudes on euthanasia is limited. Research outcomes of this study can have important short-term and long-term implications on suicide prevention and training of SPWs to improve services offered to clients.

My thesis develops an understanding of patient role and identity performances in psychiatric consultations. Recent increased attention to shared-decision making and patient-centred care in psychiatry is in large part influenced by changing ideas about the doctor-patient relationship, challenging power discrepancies and reconsidering notions of ‘expert' and ‘lay' contributions. Previous work surrounding this field has mostly focused on psychiatrists' talk, asking ‘how can psychiatrists improve shared-decision making skills?' While important, I argue that this focus is at odds with the principles behind shared-decision making by failing to consider patients' own performances in their talk with psychiatrists. I re-analyse recorded interactions in 92 psychiatric consultations with patients prescribed anti-psychotic medication. Drawing on the work of Goffman, I identify frames which are negotiated throughout the consultations and explore how these shape the roles and ‘footing' adopted by patients. I demonstrate techniques used by patients to maintain a balance between making credible and influential claims and maintaining an acceptable patient role. Finally I consider the impact of family members attending these consultations. I explore how they collaborate and compete with patients in making claims, and the impact of their presence on patients' own performances. The thesis makes the case for considering patients as active participants in constructing the interaction in psychiatric consultations and the need to understand the work being undertaken by patients to construct their place in the immediate discourse and in their wider social connections. It moves towards developing this understanding by providing a detailed review of various techniques seen in this data set. In using a frame analysis it also provides a relatively new perspective on considering discourse and demonstrates how this kind of approach can be useful when analysing institutional talk.

Maintaining the proper physician-patient relationship in health care is vital to the well-being of patients, especially when considering end of life decisions such as euthanasia. Because this topic has been in the forefront of media in recent years, there appears to be a need to understand how the relationship between physician and patient works in these practical situations, as well as understand what the most appropriate model of patient care is in regards to maintaining patient autonomy. However, before this can be done this paper will begin with a brief look at the overall permissibility of euthanasia, using the arguments of Dan Brock and Leon Kass. Once the issue of permissibility is discussed, I continue by investigating three main models of patient care presented by Linda and Ezekiel Emanuel: informative, interpretive, and deliberative. Each of these models presents a different view of patient autonomy that changes how the physician and patient interact. By discussing the philosophical requirements of autonomy presented by philosophers such as Harry Frankfurt, Susan Wolf, and Andrea Westlund, I argue that the deliberative model of patient care provides the most sufficient view of autonomy while also protecting the physician-patient relationship and patient well-being.

Since the beginning of the 21st century, the doctor-patient relationship in China has become increasingly confusing to observers. On the one hand, insiders of the medical discipline believed that the doctor-patient relationship could not even be worse. On the other hand, Chinese health care professionals appeared to be much more popular than they used to be. On the leading social media site, Weibo, many health care professionals managed to transform themselves into celebrities by producing content and interacting with ordinary social media users. These grassroots celebrity physicians have obtained tens of thousands, and even millions, of social media fans on Weibo, and they initiated online conversations about public controversies surrounding health and medicine, such as the doctor-patient relationship, health care reform, the use of Traditional Chinese Medicine, and so on. The seemingly conflicting phenomena reflected the crises Chinese health care professionals were facing and their struggles to free themselves from these crises. Distrusted by the public, health care professionals attempted to repair their reputations and to rebuild a relationship of trust through their efforts in cyberspace. In other words, health care professionals' social media activities were largely a response to the frustrations they had experienced in their professional careers. In turn, being liked by numerous social media users reflected the publics' need to have direct conversations with health care professionals. This study used textual analysis, in-depth interviews, and surveys 1) to explore Chinese celebrity physicians' motivations for and gratifications obtained from establishing a professional presence via social media; 2) to examine the online conversations between celebrity physicians and their social media fans; and 3) to discuss the potential medical, political, and cultural outcomes of their online activities. Results of the study suggested that celebrity physicians in China mainly used social media to achieve three goals: to increase public health literacy, to rebuild their professional identities, and to push the government to make changes to the current health care system. Accordingly, celebrity physicians were found to play multiple roles on Weibo: medical experts, opinion leaders, and celebrities. Each of these roles were performed and recognized by their social media fans in different ways, indicating the complexity of virtual social networks. By analyzing Chinese celebrity physicians' online narratives and examining the factors that shaped their online activities, the project further explored the sociological factors contributing to digital media use, revealed the multiple connections contributing to the formation of virtual social networks comprised of celebrity physicians and their social media followers, and studied the presentation of cultural tension in cyberspace. From the practical perspective, future scholars and advocates could use the findings of this study to better design health and science campaigns. From the theoretical perspective, this study expanded the scope of the uses and gratifications approach, proposed new angles for examining the doctor-patient and the celebrity-fan relationships, and discussed the online presentation of, and inherent nuances contributing to, cultural conflicts.

Currently in the United States, five states have enacted physician-assisted suicide as a legal end of life option for terminal patients. Research indicates that most patients who have died under this mean have been enrolled in hospice services. With the recent enactment of California’s End of Life Option Act, hospice social workers will find themselves educating and assisting patients and/or their families with this and other end of life decisions. Research has thoroughly examined physician and nurses’ involvement and attitude in the matter, but little has been researched regarding social workers. This study aimed to identify the factors that affect hospice social workers’ attitude towards physician-assisted suicide and how California’s End of Life Option Act affects their practice. In-depth face-to- face interviews with 8 hospice social workers were conducted. The study found that all 8 participants held positive attitudes towards physician-assisted suicide, support the End of Life Option Act, and feel prepared to assist patients and handle requests for the End of Life Option. Factors such as social work values and professional experience have a positive effect and validate their attitude, and factors such as religion does not affect their attitude. Due to low participation, the overall results were limited; therefore, additionally research should be extensively conducted to gain a better understanding. Regardless, a structured physician-assisted suicide protocol for social workers would benefit micro practice and macro developments.

This thesis examines the relationship between physician communication style and patient satisfaction in the diagnostic medical interview. Patient satisfaction is a critical issue for health care organizations today. Health care organizations are coping with the recruitment and maintenance of patient consumers in a competitive and costly market. The literature indicates that effective communication between the physician and the patient is important to patient satisfaction. The physician needs to structure the medical visit in order to acquire medical information and, at the same time, invite communication with patients to determine their concerns and needs. Patient satisfaction may ensue if the patient perceives the physician as possessing a positive communication style.