Abstract Objective The research findings reported here describe the importance and various functions of physician listening according to patients. Methods Fifty-eight patients of the McGill ...University Health Centre were interviewed using a qualitative, interpretive design approach. Results Patients explained why listening was important to them and these findings were organized into three themes: (a) listening as an essential component of clinical data gathering and diagnosis; (b) listening as a healing and therapeutic agent; and (c) listening as a means of fostering and strengthening the doctor–patient relationship. The findings are presented along with a conceptual model on the functions of physician listening. Conclusion Elucidating the multiple functions of listening in the clinical encounter from patient perspectives can assist physicians in improving their listening approach. Practice implications For training purposes, we recommend that a module on listening should lead to a discussion not only about the skill required in listening attentively, but also to the values, beliefs, attitudes, and intentions of physicians who choose to listen to their patients. This teaching objective may be facilitated by future research that explores the concept of ‘authenticity’ in a physician's listening approach, which we argue is central to successful clinical outcomes.
In various studies during the last decade, women with medically unexplained disorders have reported negative experiences during medical encounters. Accounts of being met with scepticism and lack of ...comprehension, feeling rejected, ignored, and being belittled, blamed for their condition and assigned psychological explanation models are common. Women patients exerted themselves to attract the doctor's medical attention and interest, and were anxious to be considered as whiners or complainers. Here, we explore the nature of “work” done by the patients in order to be believed, understood, and taken seriously when consulting the doctor. A qualitative study was conducted with in-depth interviews including a purposeful sampling of 10 women of varying ages and backgrounds with chronic muscular pain. The main outcome measures were descriptions reflecting the patients’ activities or efforts invested in being perceived as a credible patient. We focused on the gendered dimensions of the experiences. The women patients’ accounts indicated hard work to make the symptoms socially visible, real, and physical when consulting a doctor. Their efforts reflect a subtle balance not to appear too strong or too weak, too healthy or too sick, or too smart or too disarranged. Attempting to fit in with normative, biomedical expectations of correctness, they tested strategies such as appropriate assertiveness, surrendering, and appearance. The most important activities or efforts varied. However, the informants were not only struggling for their credibility. Their stories illustrated a struggle for the maintenance of self-esteem or dignity as patients and as women. The material was interpreted within a feminist frame of reference, emphasising the relationship between dignity and shame, power and disempowerment for women patients’ with medically unexplained disorders.
Organic–inorganic halide perovskite (OIHP) solar cells with efficiency over 18% power conversion efficiency (PCE) have been widely achieved with lab scale spin‐coating method which is however not ...scalable for the fabrication of large area solar panels. The PCEs of OIHP solar cells made by scalable deposition methods, such as doctor‐blading or slot‐die coating, have been lagging far behind than spin‐coated devices. In this study the authors report composition engineering in doctor‐bladed OIHP solar cells with p–i–n planar heterojunction structure to enhance their efficiency. Phase purer OIHP thin films are obtained by incorporating a small amount of cesium (Cs+) and bromine (Br−) ions into perovskite precursor solution, which also reduces the required film formation temperature. Pinhole free OIHP thin films with micrometer‐sized grains have been obtained assisted by a secondary grain growth with added methylammonium chloride into the precursor solution. The OIHP solar cells using these bladed thin films achieved PCEs over 19.0%, with the best stabilized PCE reaching 19.3%. This represents a significant step toward scalable manufacture of OIHP solar cells.
By tuning the composition of precursor solution high phase purity, perovskite thin films are obtained at a temperature of 120 °C via doctor‐blading, and over 19% power conversion efficiencies are achieved in inverted p–i–n structured perovskite solar cells.
Doctor-patient (D-P) interaction currently faces a set of challenges owing to a dearth in medical resources and related communication reasons. Healthcare information technology and associated ...systems, such as those supporting online healthcare communities (OHCs) that provide new platforms for information exchange and online communication, are expected to alter traditional D-P relationship models. Despite significant results from extant research indicating patient benefits, empirical research on OHC returns for physicians is lacking. This exploratory study examines the strength of the D-P relationship and its impacts on physicians' individual outcomes in an OHC. Guided by the social capital and social ties theories, and using a structural equation modeling (SEM) approach to study 339,010 instances of doctor-patient communication from 1430 physicians at The Good Doctor (
www.Haodf.com
), which is one of the largest Chinese OHCs, we found that weak ties can result in economic and social returns for doctors. However, further analysis has indicated that strong ties mediate the effect of weak ties, thus encouraging doctors to convert weak ties into strong ties by mobilizing their website settings to strengthen their relationships and, subsequently, to be better rewarded. Implications for research and practice on the development of healthcare information technology and associated systems are discussed.
Galen is the most important physician of the Roman imperial era. Many of his theories and practices were the basis for medical knowledge for centuries after his death and some practices—like checking ...a patient’s pulse—are still used today. He also left a vast corpus of writings which makes up a full one-eighth of all surviving ancient Greek literature. Through her readings of hundreds of Galen’s case histories, Susan P. Mattern presents the first systematic investigation of Galen’s clinical practice.
Galen’s patient narratives illuminate fascinating interplay among the craft of healing, social class, professional competition, ethnicity, and gender. Mattern describes the public, competitive, and masculine nature of medicine among the urban elite and analyzes the relationship between clinical practice and power in the Roman household. She also finds that although Galen is usually perceived as self-absorbed and self-promoting, his writings reveal him as sensitive to the patient’s history, symptoms, perceptions, and even words.
Examining his professional interactions in the context of the world in which he lived and practiced, Galen and the Rhetoric of Healing provides a fresh perspective on a foundational figure in medicine and valuable insight into how doctors thought about their patients and their practice in the ancient world.
ObjectiveContinuity of care is a long-standing feature of healthcare, especially of general practice. It is associated with increased patient satisfaction, increased take-up of health promotion, ...greater adherence to medical advice and decreased use of hospital services. This review aims to examine whether there is a relationship between the receipt of continuity of doctor care and mortality.DesignSystematic review without meta-analysis.Data sourcesMEDLINE, Embase and the Web of Science, from 1996 to 2017.Eligibility criteria for selecting studiesPeer-reviewed primary research articles, published in English which reported measured continuity of care received by patients from any kind of doctor, in any setting, in any country, related to measured mortality of those patients.ResultsOf the 726 articles identified in searches, 22 fulfilled the eligibility criteria. The studies were all cohort or cross-sectional and most adjusted for multiple potential confounding factors. These studies came from nine countries with very different cultures and health systems. We found such heterogeneity of continuity and mortality measurement methods and time frames that it was not possible to combine the results of studies. However, 18 (81.8%) high-quality studies reported statistically significant reductions in mortality, with increased continuity of care. 16 of these were with all-cause mortality. Three others showed no association and one demonstrated mixed results. These significant protective effects occurred with both generalist and specialist doctors.ConclusionsThis first systematic review reveals that increased continuity of care by doctors is associated with lower mortality rates. Although all the evidence is observational, patients across cultural boundaries appear to benefit from continuity of care with both generalist and specialist doctors. Many of these articles called for continuity to be given a higher priority in healthcare planning. Despite substantial, successive, technical advances in medicine, interpersonal factors remain important.PROSPERO registration numberCRD42016042091.
Globally, at least one in four women experiences domestic violence at some point in her life, according to World Bank figures, which are confirmed by local surveys throughout the world. Since ...domestic violence can cause both acute physical injuries and long-term chronic illness, an abused woman is likely to appeal to a family doctor or general practitioner as one of her first resources for help. General practitioners, however, rarely report domestic violence in their practices.
Jarmila Mildorf's interdisciplinary study makes a unique contribution to the fields of domestic abuse and narrative studies with her analysis of the narrative practices of doctors who treat abused women. Mildorf, a sociolinguist and literary scholar, analyzes the narrative trajectories, space-time parameters, agency, modalities, metaphors, and stereotypes in thirty-six narratives deriving from in-depth interviews with twenty general practitioners in Aberdeen, Scotland. Mildorf shows what these narrative strategies reveal about the perceptions and attitudes of practitioners toward domestic violence and the ways in which the narratives linguistically reconstruct knowledge and realities of domestic violence.
Unique in its emphasis on the discourse of doctors,Storying Domestic Violencesuggests the possibility of narrative approaches in medical modules that might preclude further stigmatization and victimization of abused women. A cross section of scholars will recognize this study as significant for its potential to change how people think about domestic abuse, physician-patient relations, and public health policy.
How to choose a psychotherapist Symington, Neville; Symington, Joan; Symington, David
2002., 2002, 20180210, 2003, 2020-03-11
eBook
The demand for psychotherapy and counselling is greater than ever. More and more people are enrolling on psychotherapy and counselling courses; the number of different associations in this industry ...has doubled and everyone knows someone who is in therapy or at least thinking about it. So are standards of practice being sacrificed while we are trying to keep up with the demand? Are the right people training to be psychotherapists? Have you got the right psychotherapist?
Patients with symptoms that doctors cannot explain by physical disease are common in primary care. That they receive disproportionate amounts of physical intervention, which is largely ineffective ...and sometimes iatrogenic, is usually attributed to patients’ belief that they are physically diseased, their denial of psychological difficulties, and their demand for physical intervention. The evidence for this view has mainly been doctors’ subjective reports. By observing what patients and doctors say in consultation, we tested hypotheses arising from recent qualitative evidence. In particular, that physical intervention is proposed more often by general practitioners (GPs) than by patients, that most patients indicate psychosocial needs, and that GPs offer little effective explanation or empathy. Consultations of 420 consecutive patients identified by British GPs as presenting medically unexplained symptoms (MUS) were audio-recorded, transcribed and coded, utterance-by-utterance, using a specially developed coding scheme based on the previous qualitative analyses of these kinds of consultation. Physical intervention was, as predicted, proposed more often by GPs than patients. Also as predicted, almost all patients provided cues concerning psychosocial difficulties or their need for explanation. Although, contrary to prediction, most GPs did provide explanations other than physical disease, most also suggested physical disease. Few GPs empathised. The findings suggest that the explanation for the high level of physical intervention for MUS lies in GPs’ responses rather than patients’ demands, and we propose that explanations for ‘somatisation’ should be sought in doctor–patient interaction rather than in patients’ psychopathology.
This is a book that assembles and integrates Jackie Gerrard’s clinical work and thinking over the many years of her working life. Part I focuses on patients with specific types of psychopathology and ...explores particular difficulties in technique and thinking. Part II addresses the issues of love, hate, and the erotic. In Part III, specific challenges to the psychotherapeutic frame are demonstrated in chapters on enactments and on work with an absent patient. Richly illustrated throughout with clinical vignettes, above all, Gerrard stresses the importance of the enquiring mind and the struggle not to “know” but to be ever ready to “not know” and to explore. The book should be of interest to qualified practitioners, to those who are training in psychodynamic or psychoanalytic work, and to anyone who has an interest in psychoanalysis and the “impossibility of knowing”.
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