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.
The definition of narcissism can be a moving target. Is it an excess of self-love? Profound insecurity? Low self-esteem? Too much self-esteem? Because of the multifaceted nature of narcissistic ...personality disorder (NPD), treating this disorder presents clinicians with a range of wholly unique challenges. Narcissism and Its Discontents recognizes the variable nature of NPD and provides a template for adjusting treatment to the patient rather than shoehorning the patient into a manualized treatment that may prove to be less effectual. This guide offers clinicians strategies, including transference and countertransference, to deal with the complex situations that often arise when treating narcissistic patients, among them, patient entitlement, disengagement, and envy. The authors provide a skillful integration of research and psychoanalytic theory while also addressing psychotherapeutic strategies that are less intensive but also useful-being cognizant of the fact that a majority of patients do not have access to psychoanalysis proper. A chapter on the cultural aspects of narcissism addresses the recent societal fascination with NPD in the discourse on politics and celebrity, particularly in the age of social media. Regardless of the treatment setting-psychoanalysis, psychotherapy, pharmacotherapy, partial hospital, or inpatient-clinicians will find a wealth of approaches to treating a diverse and challenging patient population in Narcissism and Its Discontents.
With the development of e-health, the number of doctors providing consultation services in online healthcare communities (OHCs) is growing. Their aim is to help patients obtain healthcare information ...and treatment. Since the doctors' contributions are essential to a sustainable development of OHCs, understanding why doctors contribute to OHCs is crucial. However, the related literature that investigate motivators of doctors' contribution behaviours in OHCs is scant. OHCs are a type of novel online community through which doctors not only obtain personal compensation but also interact with patients to build their relationship network. Hence, both personal and social motivators may affect doctors' contributions to OHCs. Based on the theories of self-determination and Maslow's hierarchy of needs, we established an empirical model to explore the effects of reputation, monetary rewards, doctor-patient interaction and professional status. The empirical results show that both personal and social motivators have positive effects on doctors' contributions to OHCs, and that doctors' professional status has a moderating effect. These findings help us understand the motivational mechanisms of doctors' contributions to OHCs.
We all have a good idea of how we want things to go when we visit a physician. We expect to be able to explain why we are there, and we hope the physician will listen and possibly ask questions that ...help us clarify our thoughts. Most of us hope that the physician will provide some expression of empathy, offer a clear, nontechnical assessment of our problem, and describe "next steps" in a way that is easy to understand. Ideally, we would like to be asked about our ability to follow treatment recommendations. Some experts say that these expectations are not only reasonable but even necessary if patients are to get the care they need. Yet there is a growing body of research that suggests the reality of physician communication with patients often falls short of this ideal in many respects.
A careful analysis of the findings of this research can provide guidance to physician educators, health care administrators, and health policy makers interested in understanding the role that improved physician communication can play in improving quality of care and patient outcomes.Physician Communication with Patientssummarizes findings from the academic literature pertaining to various aspects of this question, discussing those findings in the context of current pressures for change in the organization and delivery of medical services.
For many doctors, their role as powerful healer precludes thoughts of ever getting sick themselves. When they do, it initiates a profound shift of awareness – not only in their sense of their selves, ...which is invariably bound up with the ‘invincible doctor’ role, but in the way that they view their patients and the doctor-patient relationship. While some books have been written from first-person perspectives on doctors who get sick, never has there been a systematic, integrated look at what the experience is like for doctors who get sick, and what it can teach us about our current health care system and more broadly, the experience of becoming ill. The psychiatrist Robert Klitzman here weaves together gripping first-person accounts of the experience of doctors who fall ill and see the other side of the coin, as a patient. The accounts reveal how dramatic this transformation can be – a spiritual journey for some, a radical change of identity for others, and for some a new way of looking at the risks and benefits of treatment options. For most however it forever changes the way they treat their own patients. These questions are important not just on a human interest level, but for what they teach us about medicine today. While medical technology advances, the health care system itself has become more complex and frustrating, and physician-patient trust is at an all-time low. The experiences offered here are unique resource that point the way to a more humane future.
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