The importance of interpersonal communication between healthcare providers and patients is well established. Provider-patient interactions occur in the context of societal health care trends and institutional constraints. Several authors address how common interactional structures can facilitate or hinder the delivery of health care.
Physician-Patient Communication
Both groups were also trained to understand psychosocial problems in primary care settings (Roter et al., 1995). Psychosocial communication is extremely important in caring for the mental health and well-being of patients. False positives, false negatives and the validity of the diagnosis of major depression in primary care.
Unexamined Discourse
That is, the overarching theme of the responses to our inquiries centered on the lack of emphasis on the social aspects of healthcare and healthcare outcomes. It is clear that we are at an important moment in the history of healthcare. We purposefully selected leaders at prominent healthcare organizations on the East and West Coasts and in the Midwest.
Doctor-Patient Communication from an Organizational
Perspective
In addition, external organizations in the form of third-party payers exert influence on the doctor-patient relationship. As changes in the organization and financing of health care have unfolded over the past few years, there have been corresponding implications for doctor-patient communication. Anecdotal information indicates serious problems for patients caused by changes in the doctor-patient relationship.
One way that healthcare organizations and managed care plans can offset the otherwise negative impacts on doctor-patient communication is through. Consequently, the organizational context cannot be ignored when it comes to the use of communication technology in the doctor-patient relationship. Doctor-patient communication from an organizational perspective 81 has the potential to also improve the doctor-patient relationship.
There are implications for physician-patient communication related to the use of information and communication technology for patients, physicians, and health care organizations. The use of e-mail has the potential to transform the doctor-patient relationship from one of. From relationship to encounter: An examination of longitudinal and lateral dimensions in the doctor-patient relationship.
The effect of the doctor-patient relationship on emergency department use among the elderly.
Exploring the Institutional Context of Physicians’ Work
The case of doctors' roles in managed care therefore provides an opportunity to study specific roles and the structural context of health services. Exploring the Institutional Context of Physicians' Work 97 percent of such employees using various forms of managed care have grown (Ellis, 2001). Barbour and Lammers (2007) examined physicians' satisfaction and dissatisfaction with managed care using an institutional perspective.
Community Clinic began accepting Medicaid and other managed care plans early in the organizational shift to such payment structures. Hypothesis 1d: Specialist doctors across all three groups will have shorter experience with managed care than primary doctors. These hypotheses are checks that our expectations of doctors' experience with managed care are actually born out.
Hypothesis 4b: Specialists are more likely than primary care physicians to believe that large managed care organizations compromise physicians' integrity. As a manipulation check, we included measures of the extent to which physicians were involved in fee-for-service and managed care arrangements. Perhaps more importantly, our data are only about physicians' response to managed care given their organizational arrangements.
Contracts in managed care are only one example of formalized communication in healthcare.
Culture, Communication, and Somatization in Health Care
Psychiatric treatment was obtained; the psychiatrist concluded that her somatoform symptoms were more severe than those typically seen in non-refugees experiencing domestic violence in the United States. A fifth barrier to interaction concerns cultural differences in the emotional impact and stigma of illness. Linguistic and cultural differences in communication patterns lead to cross-cultural variations in the prevalence of somatoform symptoms, making their recognition more difficult for GPs.
However, similar psychosocial processes occur in refugees from other countries and in many non-minority patients in the United States who have experienced severe trauma. The traumatic events and the physical symptoms remain separate in the consciousness of the patient and the physician. In the latter cultural context, the terrible story can then be converted into somatic symptoms.
This argument recognizes the substantial variability that manifests itself in the connections between trauma, culture and somatization. The coherence versus incoherence of this narrative becomes a decisive feature in the transformation of traumatic events into somatoform symptoms. That is, within cultures different biological characteristics or experiences may lead to individual variation in processing the horrific narrative.
Trends in the use of alternative medicine in the United States Results of a national follow-up study.
Bilingual Health Communication
I just let the patient and the caregiver talk a little bit, and I just interpret. Sara explained: “The purpose [of medical interpreting]. In this interaction, the interpreter followed the speaker's utterances very closely in the marked rendition. While a pass-through role implies the expectation that interpreters will interpret everything, in this example the interpreter acknowledged that the caregiver could understand the patient's comment and did not require interpretation (i.e., the patient replied in English).
By not interpreting (or repeating) the patient's comment, the interpreter further minimized her presence in the meeting and strengthened the relationship between caregiver and patient. Christie's communicative strategies effectively minimized her presence (i.e., the caregiver and patient appeared to be talking directly to each other) while achieving the speaker's communicative goals (e.g., verifying that information was appropriate and obtaining details about a child's illness ). In addition, on all occasions when a healthcare provider drew the curtain to perform a physical examination, the interpreters always stood outside the curtain and interpreted the oral messages of the speaker (i.e., becoming "the voice").
By managing their physical position, interpreters emphasized the provider and the patient as the primary participants in the medical encounter. In these situations, the spoken utterances may not be directed to the primary speakers (ie, provider or patient) the interpreter serves or be relevant to the medical encounter. When an interpreter believes that the conversation that occurred is not relevant to the provider-patient interaction (ie, the interaction is still fair and impartial), he or she may simply inform the speaker that the conversation is unrelated to the medical encounter, to provide a brief summary of the context (eg, "Doctors are talking about another patient.") and allow privileged information to remain private.
The main purpose of this chapter is to propose a new model (ie the mediator model) to replace the channel model, a default role of medical interpreters.
Negotiating the Legitimacy of Medical Problems
Given this commitment, an important part of the patient's project during the visit may relate to the justification of the visit itself. Ensuring this reasonableness is effectively matched by ensuring the doctorability of the concerns they present. Up to this point in the patient's description, we have considered the issue of treatment options as a perspective that may dominate the problem presentation phase of the consultation.
The patient, who has positioned himself as skeptical about the nature of the problem prior to the physician's "no problem" evaluation, expresses agreement with that evaluation (Rule 34). Here the patient shows initial awareness of the problem about 10 weeks prior to this visit (line 11), depicts becoming aware of it as the product of a perfectly normal experience (Halkowski, 2006), and offers a routine and benign self-control. diagnosis as his initial interpretation (Jefferson, 2004) of the cause (lines 11-12). New information in history may emerge that undermines the legitimacy of care, and care may be observably or factually invalidated by diagnoses and counseling that do not match the patient's level of concern.
Although history-taking is usually concerned with the co-constructive elaboration of patient symptoms into medical signs, the preliminary validation of the patient's problem as legitimate may nevertheless remain problematic. Here, online comments that provide a "no problem" diagnostic outcome that contradicts the child's reported symptoms elicit responses from both the child and the mother that function to defend the legitimacy of the visit. This chapter has presented a series of examples in which a concern about the legitimacy of visiting the doctor's office is more or less evident on the surface of the medical conversation.
Here, presentation of symptoms is almost inevitably complicated by justification of the appropriateness of seeking medical care.
Keeping the Balance and Monitoring the Self-System
Despite the successes of psychopharmacology, documented elsewhere (Schatzberg & Nemeroff, 1998), there is considerable room to improve the quality and effectiveness of medication management in psychiatry (Gabbard & Kay, 2001; Lamberg, 2000; Medawar & Hardon , 2004; Tasman et al., 2000). In psychiatry, adherence to drug therapy regimens is extremely poor, regardless of the underlying disease. Half of patients referred by primary care providers failed to keep their psychiatric clinic appointment in another study (Grunebaum et al., 1996).
According to the trajectory model, one only enjoys a subjective sense of health and well-being when the three elements of the BBC chain - body, biographical time and self-concepts - are in balance, interactively stabilizing and reinforcing each other (Corbin & Strauss a; Lambert et al., 1997). Maintaining the balance and monitoring of the self-system 187 Conceptions of self Self-concepts refer to all the constructs typically described as self-image and identity (Ashmore & Jussim, 1997; James, 1961; McCall & Simmons, 1978). Above all, patients are motivated to maintain or restore stability between the elements of the BBC chain.
The answer is obvious from the perspective of the BBC network. In the trajectory model, in which the emphasis is on maintaining the integrity of the BBC chain, a body defect is significant if and only if it disrupts the alignment of the BBC— chain. Patients aim to preserve or restore the integrity of the BBC chain, regardless of biomedical consequences.
We want to argue that the trajectory model, through its emphasis on the stability of the BBC chain, does a better job than the biomedical model of capturing the lived experience of illness.
