Bien que ce livre contienne, pour le médecin du xxie siècle, de précieuses leçons qui portent à la réflexion, il présente aussi un intérêt majeur pour le patient lui-même. Dans cette perspective, ...donner comme recevoir des soins de santé de qualité dépend d’une relation médecin-patient fondée sur l’humanisme.Si le récit de l’expérience professionnelle du Dr Hadler se passe en territoire américain, l’humanisme de celui-ci veut transcender les frontières en ajoutant aux valeurs morales de toute société humaine.Il faut saluer le courage de l’auteur qui aborde des questions dérangeantes. Avec une ferme conviction et une grande éloquence, il multiplie ses efforts afin de mieux nous inciter à saisir l’importance de la relation médecin-patient dans le processus de guérison.Nortin M. Hadler, M.D., M.A.C.P., M.C.R., F.A.C.O.E.M., est diplômé du collège de Yale et de l’École de médecine de Harvard. Professeur émérite de médecine et de microbiologie à l’École de médecine de l’Université de Caroline du Nord, il est l’auteur de 200 articles et de 12 ouvrages. Sur le plan international, il se distingue par ses positions très critiques contre le surdiagnostic et le surtraitement en prônant une approche thérapeutique plus humaniste.
The troubling increase in treatment resistance in psychiatry has many culprits: the rise of biomedical psychiatry and corresponding sidelining of psychodynamic and psychosocial factors; the increased ...emphasis on treating the symptoms rather than the person; and a greater focus on the electronic medical record rather than the patient, all of which point to a breakdown in the person-centered prescriber-patient relationship. Psychodynamic Psychopharmacology illuminates a new path forward. It examines the psychological and interpersonal mechanisms of pharmacological treatment resistance, integrating research on evidence-based prescribing processes with psychodynamic insights and skills to enhance treatment outcomes for patients who are difficult to treat. The first part of the book explores the evidence base that guides how, rather than simply what, to prescribe. It describes precisely what psychodynamic psychopharmacology is and why its emphasis on combining the often-neglected psychosocial aspects of medication with biomedical considerations provides a more optimized approach to addressing treatment resistance. Part II delves into the psychodynamics that contribute to pharmacological treatment resistance, both when patients' ambivalence about their illness, the medication itself, or their prescriber manifests in nonadherence and when medications support a negative identity or are used as replacements for healthy capacities. Readers will gain basic skills for addressing the psychological and interpersonal dynamics that underpin both scenarios and will be better positioned to ameliorate interferences with the healthy use of medications. The final section of the book offers detailed technical recommendations for addressing pharmacological treatment resistance. It tackles issues that include countertransference-driven irrational prescribing; primitive dynamics, such as splitting and projective identification; and the overlap between psychopharmacological treatment resistance and the dynamics of treatment nonadherence and nonresponse in integrated and collaborative medical care settings. By putting the individual patient back at the center of the therapeutic equation, psychodynamic psychopharmacology, as outlined in this book, offers a model that moves beyond compliance and emphasizes instead the alliance between patient and prescriber. In doing so, it empowers patients to become more active contributors in their own recovery.
This book presents a comprehensive analysis of the use of patient-/person- centred communication in providing healthcare for ageing populations through an ethnographic approach to physician in-home ...medical consultations in Tokyo, Japan, alongside interviews with physicians. It focuses on illustrating how linguistic dimensions of person-centred communication work by citing examples of case studies, as well as the sociocultural differences between the US, the UK, Japan and other societies in which person-centred communication models are employed. The author uses her own framework, which takes into account face and politeness theory, and makes recommendations for future training.
The goal of patient-centered communication (PCC) is to help practitioners provide care that is concordant with the patient's values, needs and preferences, and that allows patients to provide input ...and participate actively in decisions regarding their health and health care. PCC is widely endorsed as a central component of high-quality health care, but it is unclear what it is and how to measure it. PCC includes four communication domains: the patient's perspective, the psychosocial context, shared understanding, and sharing power and responsibility. Problems in measuring PCC include lack of theoretical and conceptual clarity, unexamined assumptions, lack of adequate control for patient characteristics and social contexts, modest correlations between survey and observational measures, and overlap of PCC with other constructs. We outline problems in operationalizing PCC, choosing tools for assessing PCC, choosing data sources, identifying mediators of PCC, and clarifying outcomes of PCC. We propose nine areas for improvement: (1) developing theory-based operational definitions of PCC; (2) clarifying what is being measured; (3) accounting for the communication behaviors of each individual in the encounter as well as interactions among them; (4) accounting for context; (5) validating of instruments; (6) interpreting patient ratings of their physicians; (7) doing longitudinal studies; (8) examining pathways and mediators of links between PCC and outcomes; and (9) dealing with the complexity of the construct of PCC. We discuss the use of observational and survey measures, multi-method and mixed-method research, and standardized patients. The increasing influence of the PCC literature to guide medical education, licensure of clinicians, and assessments of quality provides a strong rationale for further clarification of these measurement issues.
Doctor–patient communication is an interpersonal process and essential to relationship-centered care. However, in many studies, doctors and patients are studied as if living in separate worlds. This ...study assessed whether: 1) doctors' perception of their communication skills is congruent with their patients' perception; and 2) patients of a specific doctor agree with each other about their doctor's communication skills. A cross-sectional study was conducted in three provinces in Canada with 91 doctors and their 1749 patients. Doctors and patients independently completed questions on the doctor's communication skills (content and process) after a consultation. Multilevel modeling provided an estimate of the patient and doctor variance components at both the dyad-level and the doctor-level. We computed correlations between patients' and doctors' perceptions at both levels to assess how congruent they were. Consensus among patients of a specific doctor was assessed using intraclass correlation coefficient (ICC). The mean score of the rating of doctor's skills according to patients was 4.58, and according to doctors was 4.37. The dyad-level variance for the patient was .38 and for the doctor was .06. The doctor-level variance for the patient ratings was .01 and for the doctor ratings, .18. The correlation between both the patients' and the doctors' skills' ratings scores at the dyad-level was weak. At the doctor-level, the correlation was not statistically significant. The ICC for patients' ratings was .03 and for the doctors' ratings .76. Overall, this study suggests that doctors and their patients have a very different perspective of the doctors' communication skills occurring during routine clinical encounters.
Doctor/patient interaction has been the object of various reform efforts in Western countries since the 1960s. It has consistently been depicted as enacting relationships of dominance or oppression. ...Most younger medical practitioners have received interaction skills training during their professional education, intended to encourage more equal forms of consultation behaviour. However, the evidence that ‘patient-centredness’ has a positive impact on health outcomes is at best mixed. At the same time, empirical studies of consultations point to the remarkable persistence of asymmetry. These two factors together suggest that asymmetry may have roots that are inaccessible to training programmes in talking practices. Illustrating our argument with findings from conversation analytic studies of doctor/patient interaction, we suggest that asymmetry lies at the heart of the medical enterprise: it is founded in what doctors are there for. As such, we argue that both critical and consumerist analysts and reformers have crucially misunderstood the role and nature of medicine.
► The medical profession has long been criticised for exerting professional dominance over patients. ► A variety of reforms have attempted to address this, notably the emphasis on patient-centred medicine. ► Analysis of empirical studies of consultations shows continued asymmetry. ► We argue that this is because this asymmetry has roots that are inaccessible to talk reform. ► We advocate for a different reform project.
In the second half of the eighteenth century, celebrated Swiss physician Samuel Auguste Tissot (1728-1797) received over 1,200 medical consultation letters from across Europe and beyond. Written by ...individuals seeking respite from a range of ailments, these letters offer valuable insight into the nature of physical suffering. Plaintive, desperate, querulous, fearful, frustrated, and sometimes arrogant and self-interested in tone, the letters to Tissot not only express the struggle of individuals to understand the body and its workings, but also reveal the close connections between embodiment and politics. Through the process of writing letters to describe their ailments, the correspondents created textual versions of themselves, articulating identities shaped by their physical experiences. Using these identities and experiences as examples, Sonja Boon argues that the complaints voiced in the letters were intimately linked to broader social and political discourses of citizenship in the late eighteenth century, a period beset with concerns about depopulation, moral depravity, and corporeal excess, and organized around intricate rules of propriety. Contributing to the fields of literary criticism, history, gender and sexuality studies, and history of medicine, Telling the Flesh establishes a compelling argument about the connections between health, politics, and identity.
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