Physician-Patient Relationship

Objective. To identify factors associated with utilization of breast clinical examination (BCE) and their relationship with institutional medical practice. Material and Methods. This is a qualitative study conducted between 1996 and 1997 in medical units of Instituto Mexicano del Seguro Social (Mexican Institute of Social Security) and Secretaría de Salud (Ministry of Health). Eight focus groups were included: four groups of female users and four groups of health professionals; in total, 47 users and 29 physicians and nurses participated. Interpretations of information were based on the organizational ability to respond to the user's expectations, "ability/knowledge" within the organization and the institutional medical practice, at the light of the Grounded Theory. Results. Service demand was conditioned on the perception of poor quality of care, lack of trust in physicians, and organizational aspects. When providing care, male physicians were not interested and felt uneasy about performing the BCE. Female physicians seemed more interested and were well accepted by users. Conclusions. Psychological, cultural, social, and institutional barriers exist in the access and utilization of BCE. Identifying these barriers and their origins could support the development of actions to improve the physician-patient relationship.

Technicism and voiding of physicians' place as caregivers are caused by training centered on biomedical knowledge acquisition. Criticisms led medical schools to include humanity disciplines in the curriculum, but this has been shown to be insufficient. Cultural factors such as the educational environment and behavioral patterns are also involved. In this study, the aim was to comprehend intersubjective encounters between teachers and students, emphasizing contemporary culture-related factors that have been identified as important for constructing physicians' identities and attitudes. Through a case study, triangulating between participant observation, interviews with teachers and students, and official documents from a medical school in the state of São Paulo, pedagogical and intersubjective relationships of day-to-day life in the educational process were covered. In the analysis, configurations of 'self and other person', 'technology' and 'teacher-student intersubjective relationships' were constructed. Polarized manners of interaction were found: relationships of bonding and trust, disqualification and omnipotence, and violence.

Background: Research has found that 48 % of patients are anxious before surgery but patient education which involves preparing them about what to expect is associated with higher satisfaction after surgery. Patient satisfaction is important because previous research found that patients who had surgery in hospitals with the highest quartile of satisfaction had lower relative risk reductions of 11-13 % in 30-day postoperative mortality, minor complications, and failure to rescue. In using patient satisfaction as a metric in surgery, it is not yet known whether exceptions should be made for emergencies and coronavirus patients because of restricted opportunities for patient education. Methods: This study analysed the survey responses of 38,689 patients who had surgery or clinical procedures from UK NHS hospitals. Regression analysis found that patient education (captured in patients' interactions with surgeons, physicians, and other staff e.g., preparing them about what to expect from surgery or clinical procedures) significantly increased patient satisfaction. It explained 34.9 %-49.7 % of adjusted variance in patient satisfaction. Multivariate analysis of variance found that patient satisfaction was lower after emergencies and among patients in coronavirus wards, likely because of restricted time or opportunities for patient education. Conclusions: This study shows the benefits of patient education in surgery which prepares patients about what to expect. However, patient satisfaction should not be used as an isolated metric after emergency surgery and that involving coronavirus patients because of restricted time or opportunity for patient education.

This study reviews the role of artificial intelligence (AI) in enhancing healthcare through an analysis of physician-to-physician communication. It seeks to identify the best practices for extracting value from professional medical chats (PMCs) and assess the impact of AI on patient outcomes and healthcare systems, emphasizing the integration of ethical and responsible AI practices. We conducted an extensive systematic literature review using the Web of Science Core Collection. Searches encompassed English-language articles published between January 2019 and July 2023 using keywords related to AI, machine learning, natural language processing, and physician communication. Of the 247 articles screened, 13 met the inclusion criteria given their in-depth analysis of AI in healthcare communication, methodological soundness, and relevance to clinical outcomes. The review provides insights into interprofessional communication dynamics, the advancement of NLP and deep learning in medical dialogues, and strategies for effective human-machine collaboration. Ethical considerations and the need for transparency in AI applications are key to these central findings. This study highlights the untapped potential of physiciangenerated real-world data in creating value for healthcare ecosystems. It advocates for a multidisciplinary strategy encompassing communication, education, and collaboration to advance AI in healthcare responsibly. Moreover, it suggests that by combining existing techniques in the AI discipline, including neural networks, generative AI, and genetic algorithms, as well as keeping a "physician in the loop" when building AI systems, we can have a significant impact on healthcare delivery and medical research.

Study objective: We characterize communication in an urban, academic medical center emergency department (ED) with regard to the timing and nature of the medical history survey and physical examination and discharge instructions. Methods: Audiotaping and coding of 93 ED encounters (62 medical history surveys and physical examinations, 31 discharges) with a convenience sample of 24 emergency medicine residents, 8 nurses, and 93 nonemergency adult patients. Results: Patients were 68% women and 84% black, with a mean age of 45 years. Emergency medicine providers were 70% men and 80% white. Of 62 medical history surveys and physical examinations, time spent on the introduction and medical history survey and physical examination averaged 7 minutes 31 seconds (range 1 to 20 minutes). Emergency medicine residents introduced themselves in only two thirds of encounters, rarely (8%) indicating their training status. Despite physician tendency (63%) to start with an open-ended question, only 20% of patients completed their presenting complaint without interruption. Average time to interruption (usually a closed question) was 12 seconds. Discharge instructions averaged 76 seconds (range 7 to 202 seconds). Information on diagnosis, expected course of illness, self-care, use of medications, time-specified follow-up, and symptoms that should prompt return to the ED were each discussed less than 65% of the time. Only 16% of patients were asked whether they had questions, and there were no instances in which the provider confirmed patient understanding of the information. Conclusion: Academic EDs present unique challenges to effective communication. In our study, the physician-patient encounter was brief and lacking in important health information. Provision of patientcentered care in academic EDs will require more provider education and significant system support.

Abstract: The aim of this paper is to critically examine the bioethical implications of advanced healthcare technologies, particularly AI, on patient experience and human identity. I will argue that the increasing reliance on AI risks dehumanization, loss of autonomy, and perpetuation of biases. Through a critical analysis of relevant literature and the philosophical framework of Paul Ricoeur, I will analyze the crucial role of patient testimony in counteracting these risks. In light of these concerning findings, I will prove the necessity for ethical reflection and a human-centered approach to technological development in medicine, prioritizing narrative, transparency, and cultural sensitivity.

Keywords: medical ethics; clinical practice; artificial intelligence; patient-physician relationship; Paul Ricoeur; bioethics; autonomy; hermeneutics; narrative medicine; culture; technology

A primary purpose of research is to generate new knowledge. Scientific advances have progressively identified optimal ways to achieve this purpose. Included in this evolution are the notions of evidence-based medicine, decision aids, shared decision making, measurement and evaluation as well as implementation. The importance of including qualitative and quantitative methods in our research is now understood. We have debated the meaning of evidence and how to implement it. However, we have yet to consider how to include in our study findings other types of information such as tacit and experiential knowledge. This key consideration needs to take place before we translate new findings or 'knowledge' into clinical practice. This article critiques assumptions regarding the nature of knowledge and suggests a framework for implementing research findings into practice.

In recent decades, many jurisdictions have moved toward legalizing euthanasia and assisted suicide, alongside a near-universal increase in public acceptance of medical aid in dying. Here, we draw on a comprehensive quantitative review of current laws on assisted dying, experimental survey evidence, and four decades of time-series data to explore the relationship between these legislative transitions and change in moral attitudes. Our analyses reveal that existing laws on medical aid in dying impose a common set of eligibility restrictions, based on the patient’s age, decision-making capacity, prognosis, and the nature of their illness. Fulfillment of these eligibility criteria elevates public moral approval of physician-assisted death, equally in countries with (i.e., Spain) and without (i.e., the United Kingdom) assisted dying laws. Finally, historical records of public attitudes toward euthanasia across numerous countries uncovered anticipatory growth in moral approval leading up to legalization, but no accelerated growth thereafter. Taken together, our findings suggest that the enactment of medical aid in dying laws, and their specific provisions, crystallize patterns in moral intuition.

Objective: To design and validate an instrument to measure satisfaction with the care received in hospitalized patients. Material and method: A questionnaire on "healthcare during hospitalization" was designed and tested in a pilot study with 31 hospitalized patients. The questionnaire was validated in a second sample of 394 patients hospitalized in the University Hospital of Caracas-Venezuela between 2002 and 2004. A statistical analysis for item selection, an exploratory principal components factor analysis with varimax rotation for construct validity and Cronbach's alpha coefficient for internal consistency were performed using SPSS 10 for Windows. Results: Forty-three dichotomic items were selected to measure elements associated with patient satisfaction. The questionnaire has a final dichotomic item evaluating the patient's overall satisfaction and six items on sociodemographic data. The exploratory factorial analysis identified six factors associated with hospitalized patients' satisfaction with the care received, explaining 38.0% of the variance: evaluation of the work and attitude of nursing staff, the work and attitude of medical staff, the environmental conditions of hospitalization, perceived physical improvement, medical information, and evaluation of the unit's performance. Conclusions: The questionnaire designed appears to be a promising instrument for valid and reliable measurement of patient satisfaction during hospitalization. A set of recommendations for strengthening the instrument in future investigations are presented.

OBJECTIVES: Effective communication is a critical component of quality health care, and to improve it we must understand its dynamics. This investigation examined the extent to which physicians' and patients' preferences for control in their relationship (e.g., shared control vs doctor control) were related to their communications styles and adaptations (i.e., how they responded to the communication of the other participant).

This article explores the contradictions within the medical profession, where doctors often model unhealthy behaviors they are trained to treat, such as tattooed dermatologists, smoking cardiologists, and breast health specialists who wear tight bras. It critiques how cultural conditioning blinds both doctors and patients to lifestyle factors contributing to disease, emphasizing that doctors are not immune to the same unhealthy habits. The piece also addresses the pressures and contradictions of medical culture, questioning whether doctors can truly offer sound health advice while they themselves are compromised by the very culture that fuels the diseases they treat.

Background: The correspondence of satisfaction ratings between physicians and patients can be assessed on different dimensions. One may examine whether they differ between the two groups or focus on measures of association or agreement. The aim of our study was to evaluate methodological difficulties in calculating the correspondence between patient and physician satisfaction ratings and to show the relevance for shared decision making research. Methods: We utilised a structured tool for cardiovascular prevention (arriba™) in a pragmatic cluster-randomised controlled trial. Correspondence between patient and physician satisfaction ratings after individual primary care consultations was assessed using the Patient Participation Scale (PPS). We used the Wilcoxon signed-rank test, the marginal homogeneity test, Kendall's tau-b, weighted kappa, percentage of agreement, and the Bland-Altman method to measure differences, associations, and agreement between physicians and patients. Results: Statistical measures signal large differences between patient and physician satisfaction ratings with more favourable ratings provided by patients and a low correspondence regardless of group allocation. Closer examination of the raw data revealed a high ceiling effect of satisfaction ratings and only slight disagreement regarding the distributions of differences between physicians' and patients' ratings. Conclusions: Traditional statistical measures of association and agreement are not able to capture a clinically relevant appreciation of the physician-patient relationship by both parties in skewed satisfaction ratings. Only the Bland-Altman method for assessing agreement augmented by bar charts of differences was able to indicate this.

Objectif : L’empathie est une competence que les etudiants en medecine doivent maitriser. En les mettant au contact d’une relation medecin-malade privilegiee et empathique, le stage chez le medecin generaliste au cours du deuxieme cycle des etudes medicales ameliore-t-il l’empathie des etudiants ? Methode : Il s’agit d’une etude cas-temoins aupres d’etudiants de deuxieme cycle des etudes medicales. Les etudiants ayant choisi un stage chez un medecin generaliste (cas) et ceux ayant choisi un stage clinique hospitalier (temoins) ont ete invites a remplir un questionnaire avant et apres leur stage, qui mesurait leur empathie par la Jefferson Scale of Physician Empathy-MS (JSPE-MS). Le critere de jugement principal etait la difference de scores a la JSPE-MS entre les deux groupes d’etudiants apres le stage, ajustee sur les facteurs de confusion. Resultats : 78 etudiants (31 DCEM4 et 47 DCEM3) ont ete recrutes, 26 effectuant un stage de Medecine Generale et 52 un stage clinique hospitali...

As we have seen, there is a negotiation going on between the restrictive features of a script for a proper medical conversation on the one hand, and a more person-centered attempt to open up the conversation for the patient’s perspectives and experiences on the other hand. This means that there is created a space where the doctor can be ensured that the adequate medical approach is followed and that the patient can trust that the most pressing issues of choice is dealt with. Street-level bureaucracy can show how the ideology for an adequate consultation, is worked into practice, through realizing the ideas of evidence-based medicine and person-centered care. As Elisabeth Stokoe (2018) has demonstrated, pretending conversation where the aim is to test or teach conversational techniques, instead of being authentic institutional encounters, have different features from genuine talk. It thus has to be warned that the results in this investigation of this instructional video, may differ from authentic consultations in clinical practice.

RESUMO
Objetiva-se discutir os desafios e as dificuldades que estudantes de medicina vivenciam na comunicação de más notícias e como percebem o tratamento dado a esses desafios e dificuldades na sua formação universitária. Trata-se de uma pesquisa qualitativa com estudantes de medicina que vivenciaram atendimentos aos usuários e presenciaram a comunicação de má notícia a um paciente e/ou familiar em suas atividades prático-acadêmicas. Os principais resultados indicaram que os estudantes relacionaram a comunicação de más notícias com conceitos como morte, luto, perda e dor. Perceberam esse contexto como desconcertante e aterrorizante, ressaltando a importância do preparo educacional e emocional. Atestaram, ainda, a falta de estratégias educacionais, indicando a necessidade de mais apoio na formação médica para o desenvolvimento dessas habilidades. Conclui-se que é necessário que as escolas médicas promovam formas de implementar estratégias de habilidade de comunicação com a atualização na grade curricular para o ensino-aprendizagem de técnicas comunicacionais.
Palavras-chave: Comunicação em saúde; Relações médico-paciente; Tomada de decisão compartilhada; Estudantes de medicina; Educação médica.

Introduction: For a long time patients with cancer receiving chemotherapy were 'captive', and were considered as passive during the administration of their treatment. The development of oral treatments over the last decade has considerably changed this situation. However, very little is known about the behaviour of the patients and the physicians in this new setting. Our team carried out a social anthropological survey on patients who were autonomous in the management of their oral chemotherapy, before developing a therapeutic patient educational programme. Objectives: The objective of the survey was to identify the mental representations and behaviour of patients and prescribing oncologists. Methods: The survey included 42 patients receiving oral chemotherapy and 10 oncologists from two cancer centres in the Rhône-Alpes region in France between January and March 2007. Different qualitative study methods were used: repeated focus groups and individual face-to-face or telephone interviews. Results and discussion: The results of this survey were used to develop the objectives for a therapeutic educational programme. The way patients managed their oral chemotherapy was found to be linked to their beliefs about the treatment efficacy and toxicity. The structure and contents of the educational sessions were adapted to take into consideration the identified representation. Key words: therapeutic observance / qualitative survey / physician-patient relationship / cancer / drug treatment Résumé-Apport d'une étude exploratoire socio-anthropologique dans la construction d'un programme d'éducation des patients traités par chimiothérapie orale. Introduction : Pendant longtemps, les patients traités en oncologie et plus précisément par chimiothérapie ont été des patients " captifs ", considérés comme passifs lors de l'administration de leurs traitements. Le développement des traitements par voie orale durant la dernière décennie est un élément qui a considérablement changé cette réalité. Cependant, peu de données sont disponibles concernant les pratiques des patients et des médecins dans ce nouveau contexte. Pour élaborer un programme d'éducation thérapeutique, notre équipe a réalisé une enquête socio-anthropologique auprès de patients se trouvant en autonomie avec un traitement de chimiothérapie par voie orale. Objectifs : L'objectif de cette enquête était d'identifier les représentations mentales et les pratiques des patients et des oncologues prescripteurs. Méthodes : Elle a porté sur 42 patient(e)s sous chimiothérapie orale et 10 oncologues à partir de 2 centres spécialisés en cancérologie de la région Rhône-Alpes entre janvier et mars 2007. Diverses méthodes d'investigation qualitatives ont été employées : entretiens de groupe répétés, interviews en face en face et par téléphone. Résultats et discussion : Les résultats de cette enquête ont ensuite servis à l'élaboration des objectifs du programme éducatif. La question des pratiques autour des chimiothérapies orales s'est révélée liée à des croyances interrogeant les notions d'efficacité et de toxicité du médicament. Les méthodes et contenus des séances d'éducation ont été adaptés en fonction des représentations identifiées.

Sections of this article have been adapted from Bluebond-Langner M, DeCicco A, Belasco JB. Involving children with life-shortening illnesses in decisions about participation in clinical research: a proposal for shuttle diplomacy and negotiation. In: Kodish E, editor. Ethics and Research with Children. Oxford: Oxford University Press; 2005. p. 323-43. The authors would like to thank Johnson & Johnson Family of Companies, Stanley Thomas Johnson Foundation, Olivia Hodson Foundation, National Endowment for the Humanities, REACH Fund of Great Ormond Street Hospital, Fannie E. Rippel Foundation, and ELS counselors for their support of Bluebond-Langner's work on children's participation in decision making about care, treatment, and research participation.

Purpose: The increasing importance of flexibility in the general practitioner (GP) -patient consultation approach in primary care requires healthcare managers and physicians to find a balance among all the potentially important characteristics of consultation. This study used a discrete choice experiment (DCE) to assess patients’ preferences for different attributes of GP consultation and how the rate at which they traded between different attributes is affected by socio-demographic characteristics and past experiences with primary care services . Methods: A survey was conducted to a sample of 6970 residents in Tuscany region, Italy. Besides socio-demographic characteristics the survey collected information about participants’ past experience with GP consultation in the last 12 months. Moreover, participants were asked to select their preferred option in a series of pairwise choices, defined by the following attributes: level of involvement in decision making, amount of information ...

From the perspective of medical anthropology and comparative research, American oncology appears as a unique variant of international biomedical culture, particularly when contrasted with oncological practice in societies such as Japan and Italy. Based on interviews with 51 oncologists in Harvard teaching hospitals, this paper argues that American oncological practice draws on distinctive cultural meanings associated with "hope" and is infused with popular notions about the relationship between psyche and soma, the progressive efficacy of biotechnical interventions, truthtelling, and the nature of the physician-patient relationship.

Objectives. To describe the communicative behaviour by residents at the beginning (reception and first seconds after obtaining information) and closing of the consultation and to evaluate in what way very early interruptions in the patient monologue affect within-consultation results, such as the duration of their closing and the appearance of new concerns in this phase. Design. Descriptive observational study. Location. Primary care clinics. Participants. Thirty seven third year residents of family medicine and 307 patients with incidental problems. Material and method. All the consultations were videotaped and analysed by 2 trained observers who used previously validated established ad hoc procedures. Results. The reception and closing of the consultations by the residents were very short and very poorly communicated since they used very few relational abilities. Half of the doctors redirected the initial discourse of the patient very early on (in 16 sec) and this was significantly associated (P=.03) with new concerns by the patient at the time of closing and with longer goodbyes (P=.001). Conclusions. The conduct of the residents in the moments studied surely limits their ability to establish and maintain a clinical relationship, to obtain information and explain what they are giving to the patients. The dysfunctional closures are most probable when the doctor assumes a dominant role very early: this behaviour does not shorten the consultations.

Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine, as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In ‘III: core principles—primary care, systems, and family’, authors address the following themes: ‘Continuity of care—building therapeutic relationships over time’, ‘Comprehensiveness—combining breadth and depth of scope’, ‘Coordination of care—managing multiple realities’, ‘Access to care—intersectional, systemic, and personal’, ‘Systems theory—a core value in patient- centered care’, ‘Family-oriented practice—supporting patients’ health and well-being’, ‘Family physician as family member’ and ‘Family in the exam room’. May readers develop new understandings from these essays.

La medicina narrativa ha logrado aunar dos vertientes que parecían, desde hace un tiempo, estar desvinculadas y sin esperanza de confluencia. Por un lado, la práctica clínica potenciada por los avances científicos y tecnológicos, y por otro el trato humano y humanitario de los otros, de esos otros iguales a mí. Ambas perspectivas, tanto en los planes de estudios como en la práctica, parecían discurrir por caminos paralelos. No se visualizaba un modo de lograr una sinergia virtuosa que los incluyera a ambos.

Le corps de la médecine et le corps tel qu'il est vécu par le sujet lui-même répondent à deux modes d'appréhension différents, voire deux logiques parfois incompatibles. Le premier relève d'un processus constant d'objectivation, lié à la croissance exceptionnelle des connaissances et des techniques médicales ; le second témoigne d'une subjectivation toujours à l'oeuvre dans l'expérience vécue du malade, mettant au premier plan les notions de corps propre et d'intersubjectivité. Malgré l'amélioration indéniable du pronostic de certaines maladies graves, cette objectivation n'est pas sans effet sur la subjectivité des malades, ainsi que sur celle des médecins, et donc sur l'intersubjectivité inhérente à la relation thérapeutique. Cette mécanisation du vivant est contemporaine de l'avènement de la science, marquée par la philosophie de Descartes et par les premières dissections anatomiques de Vésale, consacrant ainsi une véritable rupture épistémologique en séparant l'homme de son corps. Cette coupure entre le corps anatomique de la médecine et le corps vécu du malade entraîne, selon nous, un remaniement profond de la relation médecin-malade, dont la désubjectivation de part et d'autre n'est pas le moindre des risques. Redonner toute sa place à cette subjectivité, voire à une certaine subjectivation au sein même de la maladie, paraît dès lors un enjeu décisif d'une psychologie clinique de la santé qui, sans méconnaître l'apport de la science médicale, n'oublie pas pour autant sa préoccupation constante pour le sujet malade.

The decision to prescribe neuroleptics for the treatment of psychosis involves a potentially tragic choice between, on the one hand, a probability of psychosis and a probability of side effects, such as tardive dyskinesia, on the other. In an experimental paradigm, we examined this decision process. We hypothesized that linguistic factors considered irrelevant under classical formulations of individual choice behavior would have a significant effect on this decision. All subjects were presented with a case vignette involving a potentially psychotic patient. Subjects were then asked what probability of tardive dyskinesia they would either "accept" or "risk" in order to prevent psychotic decompensation. In addition this factor was crossed with a contextual factor that varied the patient's age. The effect of "risk" versus "accept" language was evident in significantly different patterns of decision making across age groups. The data have impo...

BackgroundAn effective patient‐physician relationship (PPR) is essential to the care of patients with irritable bowel syndrome (IBS). We sought to develop and validate an IBS‐specific instrument to measure expectations of the PPR.MethodsWe conducted structured focus groups about PPRs with 12 patients with IBS. Qualitative analysis was used to generate a questionnaire (the Patient‐Physician Relationship Scale [PPRS]), which was modified with input from content experts and usability testing. For validation, we administered it online to US adults with IBS. Participants also completed the Functional Bowel Disorder Severity Index, the Rome III Adult Functional gastrointestinal (GI) Disorder Criteria Questionnaire, and modified versions of the Communication Assessment Tool (CAT‐15) and Patient‐Doctor Relationship Questionnaire (PDRQ‐9). We performed principal components factor analysis for the PPRS.Key ResultsThe PPRS contained 32 questions with responses on a 7‐item Likert scale. Themes ...

Cortés-Padilla MT, Rascón-Gasca ML. Factores psicosociales relacionados con la rehospitalización de pacientes con psicosis orgánica Salud Publica Mex 2001;43:529-536. El texto completo en inglés de este artículo está disponible en: http://www.insp.mx/salud/index.html Resumen Objetivo. Conocer los factores psicosociales relacionados con la frecuente rehospitalización de pacientes con psicosis orgánica. Material y métodos. Estudio de tipo observacional descriptivo, de corte transversal. La muestra estuvo formada por 33 pacientes del Hospital Psiquiátrico Guillermo Dávila, con Unidad de Medicina Familiar Número 10 del Instituto Mexicano del Seguro Social de la Ciudad de México, con psicosis orgánica y quienes durante los años de 1993-1994 presentaron más de dos rehospitalizaciones. Instrumentos: Entrevista grabada, o muestra de conversación de cinco minutos, para la emoción expresada (EE), cuestionarios mixtos para la Concepción de Enfermedad y la Relación médico-paciente. La validez y confiabilidad de los datos se establecieron con las pruebas de Kappa y Alpha de Cronbach y se efectuó análisis estadístico descriptivo e inferencial. Resultados. El 60.9% de los familiares presentan alto nivel de EE, es decir, expresan crítica, hostilidad o sobreinvolucramiento emocional; el 64.3% de los sujetos de la muestra conviven más de 35 horas a la semana con familiares que presentan Alta EE. Conclusiones. Altos niveles de EE estuvieron asociados con los frecuentes reingresos a hospitalización. Existe mayor conocimiento de las características de la enfermedad por parte del familiar que del paciente. La relación médico-paciente es satisfactoria pero no forma conciencia de enfermedad ni propicia apego al tratamiento terapeútico. El texto completo en inglés de este artículo está disponible en: http:// www.insp.mx/salud/index.html Palabras clave: trastornos organomentales psicóticos; actitud; emociones; reingresos; México Cortés-Padilla MT, Rascón-Gasca ML. Psychosocial factors associated with hospital readmissions of patients with organic psychoses Salud Publica Mex 2001;43:529-536.

Se realizó un estudio con el objetivo de caracterizar la calidad de vida de 50 pacientes con diagnóstico de retinopatía diabética, atendidos en el Centro de Atención al Diabético del municipio de Guantánamo, durante el primer semestre de 1998. Se evaluaron variables como: calidad de vida física, psicológica, social y biopsicosocial, así como la influencia en ella de la edad, el sexo, tipo de diabetes y el tipo de retinopatía. Se concluyó que la mayoría de los pacientes con retinopatía diabética tiene calidad de vida no aceptable, con deterioro significativo de la calidad de vida física y psíquica, la cual estuvo determinada, fundamentalmente, por la disminución de la agudeza visual. La calidad de vida social fue la menos afectada. La calidad de vida biopsicosocial tuvo comportamiento similar a la psíquica. Hubo predominio del sexo masculino y de las edades comprendidas entre 45 y 64 años. Fue mayoritario el número de pacientes con diabetes tipo II.

The author, editors, and reviewers of this guide would like to acknowledge all of those who have worked to focus attention on the promise of reducing the incidence and mortality of colorectal cancer, the nation's second-leading cause of cancer mortality. They include many dedicated individuals who have worked with, or been funded by, the Agency for Healthcare Research and Quality, the American Cancer Society, the Centers for Disease Control and Prevention,

This letter from Mumbai includes a short biography of Dr. Vijayprasad Gopichand, a note on the need for physically handicapped physicians and medical personnel to be treated with dignity, pleads for respect to be paid to nurses by physicians, and asks why the search through the literature by authors of medical papers is so superficial. Dr. Gopichand's papers are especially worthy of study by physicians in India.

En la medida que el yo no es substancia, no puede ser definido, pero sí relatado y relatar es dar sentido a lo heterogéneo, sin unificar... Quizás a la pregunta ¿quién eres? habría que responderle en la forma clásica y contar una historia" -H. Arendtlosophy and Literature-of the Universidad Nacional del Sur. A research project integrating the different perspectives and allowing for reflection was carried out. Different debates, issues or problems were proposed with the aim of reaching a productive dialogue among health "sciences", literature, and philosophic-existential arguments.

PALABRAS CLAVE Grupos Balint; Grupos de reflexión; Relación médico-paciente; Atención primaria; Competencia profesional; Modelo biopsicosocial Resumen Objetivo: Describir el desarrollo de un grupo de reflexión entre profesionales de atención primaria de Navarra, entre octubre de 2007 y junio de 2008, a través de la presentación de casos. Diseño: Estudio descriptivo, retrospectivo. Emplazamiento: Atención primaria. Participantes: Un psiquiatra, una enfermera y 11 médicos de familia. Método: Se llevaron a cabo 8 sesiones de 2 h y media de duración; evaluaciones informales después de cada sesión; recogida sistemática de notas por parte de 3 miembros del grupo, con posterior puesta en común, y evaluación del grupo en la última sesión. Resultados: El carácter del grupo fue participativo, autorreflexivo y práctico. Se presentaron 52 casos que se agruparon en 5 áreas: encuentros difíciles, errores profesionales, maltrato a la mujer, dilemas éticos y relaciones en el equipo. Los participantes expresaron las emociones de la consulta y obtuvieron herramientas y recursos de actuación para posteriores situaciones similares a los casos presentados, tal y como se expresó en la evaluación. Conclusiones: Se expuso un gran abanico de casos y se desarrolló una serie de emociones en los participantes; de la puesta en común y reflexión surgió una autopercepción de

This study sought to assess the psychometric properties of the 9-item Shared Decision-Making Questionnaire (SDM-Q-9) in patients with resected, non-metastatic cancer and eligible for adjuvant chemotherapy. A total of 568 patients were recruited from a multi-institutional, prospective, transversal study. Patients answered the SDM-Q-9 after visiting their medical oncologist who, in turn, completed the SDM-Q-Physician version. Reliability, factorial structures [exploratory factor analysis (EFA), confirmatory factor analysis (CFA)], and convergent validity of the SDM-Q-9 scores were explored. SDM-Q-9 showed a clear factorial structure, compatible with a strong and replicable general factor and a secondary group factor, in patients with resected, non-metastatic cancer. Total sum scores derived from the general factor showed good reliability in terms of omega coefficient: .90. The association between patient and physician perception of SDM was weak and failed to reach statistical signific...

Objective: To design and validate an instrument to measure satisfaction with the care received in hospitalized patients. Material and method: A questionnaire on "healthcare during hospitalization" was designed and tested in a pilot study with 31 hospitalized patients. The questionnaire was validated in a second sample of 394 patients hospitalized in the University Hospital of Caracas-Venezuela between 2002 and 2004. A statistical analysis for item selection, an exploratory principal components factor analysis with varimax rotation for construct validity and Cronbach's alpha coefficient for internal consistency were performed using SPSS 10 for Windows. Results: Forty-three dichotomic items were selected to measure elements associated with patient satisfaction. The questionnaire has a final dichotomic item evaluating the patient's overall satisfaction and six items on sociodemographic data. The exploratory factorial analysis identified six factors associated with hospitalized patients' satisfaction with the care received, explaining 38.0% of the variance: evaluation of the work and attitude of nursing staff, the work and attitude of medical staff, the environmental conditions of hospitalization, perceived physical improvement, medical information, and evaluation of the unit's performance. Conclusions: The questionnaire designed appears to be a promising instrument for valid and reliable measurement of patient satisfaction during hospitalization. A set of recommendations for strengthening the instrument in future investigations are presented.

La atención a la enfermedad se caracteriza por ser una respuesta social con prácticas complejas y heterogéneas, a través de la cual se articulan los diversos modelos médicos para resolver las necesidades y demandas de la enfermedad, del enfermo y su propia atención. Esto implica tanto la utilización de los recursos terapéuticos de la biomedicina como de modelos médicos alternativos, añadiéndose además, una serie de terapéuticas provenientes de la autoatención.

Rationale and Objectives. The diagnostic mammography suite is a microcosm of challenging physician-patient communication in radiology. Little has been written about communication practices in the diagnostic mammography suite, the effect of this communication on both physicians and patients, and implications for radiology training programs. We surveyed radiology residents and staff about communication training, practices, and experiences communicating directly with patients in the diagnostic mammography suite. Materials and Methods. We asked the membership of the Association of Program Directors in Radiology to disseminate surveys to radiology residents and staff radiologists in their institutions. We analyzed response frequencies and correlations. Results. We received responses from 142 residents and 120 staff radiologists. More than half of staff respondents spoke personally with every patient who had an abnormal diagnostic mammogram; 37% felt they had inadequate time to do so. Most residents and staff highly rated their own communication skills and confidence in ability to explain results and respond to patients' emotions, but experienced stress doing so. A majority of respondents reported no formal communication skills education after medical school. Twenty-nine percent of staff respondents regularly observed residents' communication with patients and 39% of residents reported receiving feedback about their communication. Residents' opportunities to observe staff communicate with a patient and to receive feedback on their own patient interactions were correlated with self-rated communication skill and confidence in ability to respond to patients' emotions (P Ͻ .05). Conclusions. Radiologists engage in challenging and stressful patient communication interactions. There is a paucity of educational curricula on interpersonal and communication skills in radiology. This has implications for both patient and physician satisfaction and patient outcomes.

This study sought to assess the psychometric properties of the 9-item Shared Decision-Making Questionnaire (SDM-Q-9) in patients with resected, non-metastatic cancer and eligible for adjuvant chemotherapy. A total of 568 patients were recruited from a multi-institutional, prospective, transversal study. Patients answered the SDM-Q-9 after visiting their medical oncologist who, in turn, completed the SDM-Q-Physician version. Reliability, factorial structures [exploratory factor analysis (EFA), confirmatory factor analysis (CFA)], and convergent validity of the SDM-Q-9 scores were explored. SDM-Q-9 showed a clear factorial structure, compatible with a strong and replicable general factor and a secondary group factor, in patients with resected, non-metastatic cancer. Total sum scores derived from the general factor showed good reliability in terms of omega coefficient: .90. The association between patient and physician perception of SDM was weak and failed to reach statistical signific...

This paper is a report of a systematic review conducted to analyse, evaluate and synthesize the rigour of measures used in nursing research to assess empathy, in order to identify a 'gold standard' for application in future studies. Background Empathy is considered essential to the provision of quality care. We identified 20 different empathy measures used in nursing research. There are inconsistencies between tools, indicating both the inherent complexity of measuring empathy and the need to evaluate the rigour of the measures themselves. Data sources An extensive search was conducted for the period 1987 and 2007 using the Medline, CINAHL and PsycINFO databases and the keywords 'empathy', 'tool', 'scale', 'measure', 'nurse' and 'nursing'. Twenty-nine studies were identified as relevant, in which 20 different empathy measurement tools were used. Twelve tools met the inclusion criteria for this review. Method

En révisant et en élargissant le concept d'impasse dans la théorie relationnelle, l'auteur montre comment, à partir du modèle des maladies auto-immunes, il est possible de postuler l'émergence d'une psychosomatique moderne où l'ensemble des acteurs du soin peuvent, dans un esprit de transdisciplinarité et en tenant compte de la nature fondamentalement plurifactorielle de la maladie, contribuer au mieux-être du patient porteur de pathologie somatique.

In the UK, medical ethics and law are often thought of and taught together, but while 'good medical ethics' is often reflected in law-the need to obtain a patient's adequately informed consent, for example-this is not necessarily the case. Sometimes medical ethics is more demanding than law; at other times, perhaps counterintuitively, the law appears to ask more of doctors than does good medical ethics.

Context: Despite a mission statement and curriculum that are unique in our country in proposing to direct physicians to primary care (PC), the proportion of doctors graduating from Ben Gurion University (BGU) who choose PC is similar to that of other Israeli medical schools. Objectives, methods and study population: To investigate factors underlying our graduates' career choices we sent a questionnaire to six consecutive classes that had graduated from this medical school. We hypothesized that medical school was not the decisive factor in uencing career choice. Results: Returns were received from 135 graduates (54%). The nature of a specialty was the most important factor in choosing a career and in rejecting PC. Differences between primary care physicians (PCPs) and non-primary care physicians (NPCPs) were identi ed. PCPs emphasized factors relating to their personal lives. NPCPs emphasized the nature of a specialty in career choice. The most important factor in choosing PC was the physician-patient relationship and human aspects of medicine. Medical school was viewed as playing a minor role in career choice. Proposed interventions: Graduates proposed methods to increase the proportion of doctors choosing PC. These included: economic incentives; changing work conditions; strengthening contact with tertiary care; continuing medical education; and changing PC clerkships in medical school. Conclusion: The inherent nature of a specialty is central to career choice. In PC, the patient-physician relationship is central to physicians' career choice.

With the creation of DNA banks, short and long-term studies can be conducted on the DNA of many individuals using stored cells and tissues. These studies allow an analysis of the pathophysiological impact of genetics and help define individual markers predictive of risk. Genome analysis is thus an important advance in medical science, providing essential information for establishing appropriate measures to slow disease development, limit severity or improve safe recovery. The use of genetic results may however have an adverse effect in certain situations if the genetic information collected were deviated from its purely medical purpose under the influence of social, occupational or economic factors. The aim of our study was to analyse the ethical challenges linked to the implementation of DNA banks in France, particularly to see how to maintain the concept of individual protection in biomedical research within the patient-physician relationship in the current context of legal and ad...

Since uncertainty is a major challenge in medicine and bears the risk of causing incorrect diagnoses and harmful treatment, there are many efforts to tackle it. For some time, AI technologies have been increasingly implemented in medicine and used to reduce medical uncertainties. What initially seems desirable, however, poses challenges. We use a multimethod approach that combines philosophical inquiry, conceptual analysis, and ethical considerations to identify key challenges that arise when AI is used for medical certainty purposes. We identify several challenges. Where AI is used to reduce medical uncertainties, it is likely to result in (a) patients being stripped down to their measurable data points, and being made disambiguous. Additionally, the widespread use of AI technologies in health care bears the risk of (b) human physicians being pushed out of the medical decision-making process, and patient participation being more and more limited. Further, the successful use of AI requires extensive and invasive monitoring of patients, which raises (c) questions about surveillance as well as privacy and security issues. We outline these several challenges and show that they are immediate consequences of AI-driven security efforts. If not addressed, they could entail unfavorable consequences. We contend that diminishing medical uncertainties through AI involves a tradeoff. The advantages, including enhanced precision, personalization, and overall improvement in medicine, are accompanied by several novel challenges. This paper addresses them and gives suggestions about how to use AI for certainty purposes without causing harm to patients.

Prior to the development of the pharmaceutical industry and the advocacy of evidence based medicine in the late 20th century, placebo treatments were commonly used by physicians. In current clinical practice, neither a physician's confidence in the efficacy of a specific treatment nor his personal ethical norms are any longer sufficient to initiate a given therapy. We will discuss whether placebo treatments can be ethically used in clinical practice as an alternative to standard therapy, and propose an innovative conceptualization of the factors involved in the exclusion of placebo treatments from the clinical setting. Patient-related ethical and interpersonal arguments and physician-related legal and ideological arguments concerning placebo usage are presented. We describe current use of placebo treatments in the healthcare system and suggest that placebo therapy thrives and that its therapeutic efficacy is widely acknowledged. There is currently "underground" use of ...

Objective: To design and validate an instrument to measure satisfaction with the care received in hospitalized patients. Material and method: A questionnaire on "healthcare during hospitalization" was designed and tested in a pilot study with 31 hospitalized patients. The questionnaire was validated in a second sample of 394 patients hospitalized in the University Hospital of Caracas-Venezuela between 2002 and 2004. A statistical analysis for item selection, an exploratory principal components factor analysis with varimax rotation for construct validity and Cronbach's alpha coefficient for internal consistency were performed using SPSS 10 for Windows. Results: Forty-three dichotomic items were selected to measure elements associated with patient satisfaction. The questionnaire has a final dichotomic item evaluating the patient's overall satisfaction and six items on sociodemographic data. The exploratory factorial analysis identified six factors associated with hospitalized patients' satisfaction with the care received, explaining 38.0% of the variance: evaluation of the work and attitude of nursing staff, the work and attitude of medical staff, the environmental conditions of hospitalization, perceived physical improvement, medical information, and evaluation of the unit's performance. Conclusions: The questionnaire designed appears to be a promising instrument for valid and reliable measurement of patient satisfaction during hospitalization. A set of recommendations for strengthening the instrument in future investigations are presented.

sychodynamic concepts can be used to help understand and manage certain difficulties that arise within the physician-patient relationship. The concepts of transference, countertransference, and action (in the form of acting out and enactment) are discussed. A case description is included to show how these concepts apply to the day-today practice of primary care medicine.